TN 37 (11-94)

DI 42594.005 Providing Relief to Class Members

A. Process

Relief is provided to class members as shown here:

1. Identification

Central Office (CO) will identify by computer all potential class members.

2. Notification

  1. CO notifies potential class members by first class mail, enclosing a bar-coded responder form. FOs will display posters that provide information about the State of New York class action.

  2. Potential class members will have 120 days (from the date that they received their notice or the date that the poster was displayed, whichever is later) to request that their case be reviewed.

  3. Undeliverable notices will be returned to ODIO where the return will be annotated to a class action tracking system.

  4. CO will mail undeliverables by first-class mail.

  5. If the remailed notice is again returned as undeliverable, the tracking system will be updated and CO will attempt to obtain a new address during a matching operation with the New York State Department of Social Services.

  6. CO will again remail a notice to potential class members for whom the matching operation yields a new address. Undeliverables from this operation will again be returned to CO.

  7. For all those who remain undeliverable, or for whom no updated address was found during the matching operation, the FO will be asked to try (including a check with the post office) to obtain an updated address.

3. Responses

  1. Responses will be sent to ODIO, where they will be annotated to a class action tracking system.

  2. Written acknowledgement will be sent to all responders.

    • CO will mail acknowledgement in most cases.

    • Field Office will provide acknowledgement to walk-ins.

4. Late responders

The PC will refer to the FO cases in which the individual responded to the notice later than 125 days from the date the notice was mailed. The FO will decide whether these individuals have good cause for their late response. If good cause exists, the reply will be deemed to have been received timely. If good cause does not exist, the FO will notify the individual of this decision. The court order also provides that potential class members may demonstrate that they are responding within 120 days of their actual receipt of the notice.

5. Case call-up

  1. The tracking system will call up all cases of those who requested relief.

  2. At reasonable intervals, cases will be released for class membership screening and readjudication. (See Case Flag/Alert in DI 42594.095, Exhibit 1.)

  3. Alerts for cases of those who responded later than 125 days will be annotated “LATE RESPONDER - GOOD CAUSE DECISION NEEDED.” Alerts for timely responders do not contain an identifying remark.

  4. Folders for late responders will be sent to the FO for development of possible good cause. Other folders will be routed directly for screening.

6. Screening and readjudication

ODIO will screen most cases for class membership with assistance from NEPSC (as needed). In claim reconstruction situations and when a current claim is pending in a DDS, the NYDDS will do the screening. OHA will screen cases for which they have readjudication jurisdiction.

Readjudication will be done by NYDDS or OHA.

7. Award and payment - denials reversed to allowances

For the award and payment of denials reversed to allowances, cases will be District Office Final Authorization (DOFA). Title II cases will be processed as Award Processing Operation (APO) exclusions, with payment being made via Manual Adjustment Credit and Award Processing (MADCAP).

8. Appeals of readjudication determinations

Class members retain all rights to further administrative and judicial review of all readjudication determinations.

B. Policy

1. Jurisdiction - screening for class membership

  1. Cases will be screened by ODIO, NEPSC, or the same component that has jurisdiction for the readjudication of the class members' cases.

  2. The class membership decision is appealable. Individuals (including those who were denied on the grounds that their requests were untimely and not excused for “good cause”), may appeal to either State of New York class counsel or the Office of the General Counsel (OGC). Whenever possible, class membership disputes will be resolved between class counsel and OGC.

2. Jurisdiction - no current claim pending

Class members will have their determinations readjudicated as follows:

  1. Determinations originally made by the DDS will be readjudicated by the New York DDS, regardless of the class member's current residence.

  2. Determinations originally made by the ALJ or Appeals Council will be readjudicated by an ALJ.

NOTE: If a class member hasmore than one determination that meets all of the requirements of DI 42594.001, jurisdiction is determined by the level at which the most recent determination was adjudicated.

3. Jurisdiction - current claim pending

  1. If a claim is currently pending at the initial or reconsideration level and if a common issue exists, the current claim and the State of New York case will be consolidated at the level at which the current claim is pending, regardless of the level of adjudication of the State of New York case.

  2. If a claim is currently pending at the ALJ level, the ALJ will afford the class member the option of having the cases consolidated or proceeding with them separately. The current claim and the State of New York case will be consolidated at the ALJ level, regardless of the level of adjudication of the State of New York case, if

    • the class member agrees to the consolidation and

    • the ALJ finds that a common issue exists.

    If either of these criteria is not met, the cases will be processed separately.

  3. If a claim is currently pending at the Appeals Council level, there will be no consolidation.

  4. If a claim is currently pending in court, the class member will be notified of the option to have the cases combined or pursue them separately.

    • If the class member chooses to have the cases consolidated, they will both be adjudicated by an ALJ.

    • If the class member chooses to pursue the pending claim at the court level, the State of New York claim will be readjudicated separately.

4. Method of readjudication

  1. Original determination was a denial - The adjudicator, using the court-ordered review standard, will readjudicate the same period covered by the original determination.

  2. Original determination was a cessation - The adjudicator, using the court-ordered review standard, will readjudicate the period covered by the original determination and will also readjudicate the remaining period up to the present.

    NOTE: Class members currently receiving disability benefits will not be reviewed for continuing entitlement unless compelling evidence of medical improvement is received.

C. Procedure - appeal of non-membership decision

Appeal of a non-membership decision is as shown here.

1. General

If an appeal request is misdirected to a PC, ascertain whether the individual chooses to appeal directly to OGC or through the State of New York class counsel. Prepare SSA-5002 to summarize contact if it is oral. There are no time limits on the right to appeal a non-member decision.

2. Appeal is not in writing

Forward SSA-5002 and other documentation of appeal request to:

Cardiac Case Membership Unit
Legal Services for the Elderly
130 West 42nd Street, 17th Floor
New York, NY 10036

3. Appeal is in writing

  1. If an individual chooses to appeal directly to OGC, forward SSA-5002 and other documentation of appeal request to:

    Office of the General Counsel
    Social Security Division
    Altmeyer Building
    6401 Security Boulevard
    Baltimore, MD. 21235-6401.

  2. If an individual chooses to appeal through the State of New York attorneys, forward SSA-5002 and other documentation of appeal request to address in 2. above.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0442594005
DI 42594.005 - Providing Relief to Class Members - 04/09/2013
Batch run: 04/09/2013
Rev:04/09/2013