TN 2 (04-99)

DI 52510.020 Goodnight DDS Actions

A. Procedure - systems operating procedures

1. Case receipt

Enter Goodnight cases as receipts on the National DDS System (NDDSS) DRES screen with the following information. See SM 06001.100 for a discussion of the DDS receipt (DREC) process.

a. No current claim pending

IF THE FIELD IS...THEN...
LUN, LEXEnter the usual information.
AN, BIC, AH, XAH, DB, XAN, XBCObtain information from the original SSA-831-U3 in file.
TYPEnter the level code “RC” followed by the claim type (DIB, DI, etc.) from the original SSA-831-U3.
RCDEnter the current date (MMDDYY).
SRDEnter the current date (MMDDYY).
SOEnter “N”.
DOEnter the office code for the office that sent the folder to the DDS. This information can be found on the court case flag/alert.
LITEnter “783”.

b. Current claim pending

If a claim is pending and has been receipted into the NDDSS, associate the claim with the Goodnight claim(s), update the pending claim using the update screen and identify it for Goodnight as follows:

IF THE FIELD IS...THEN...
T2, T16, AN, BIC, AHEnter identifying information.
SOEnter “N”.
MBCEnter “AR”.

2. Case clearance

To clear cases:

  1. Follow SM 06001.350 to enter on the NDDSS.

  2. Input a systems override (SO) code of “C” to indicate case control clearance only. Clear non-class member claims as “No Decisions.”

  3. Input “783” in the LA field, if it is not displayed.

  4. Route the case to the servicing FO or, if selected for quality assurance or pre-effectuation review, to the Disability Quality Branch.

3. Folder location or status request

Obtain folder location or status request (and request folders) via the DDS query (DDSQ) facility. See SM 06002.001.

4. Identification of pending claims

When entering a receipt on the NDDSS and the edit message “OPEN CLAIM EXISTS IN (NAME OF STATE)” is received, obtain:

  1. a DDSQ;

  2. the pending claim and associate it with the Goodnight claim.

B. Procedure - screening

Take the following action to screen potential Goodnight class claims:

  • Complete a screening sheet (see DI 52510.095, Exhibit 8).

    If the DDS receives the wrong folder(s) or the folder is missing medical evidence, request FO assistance to obtain the correct folder(s).

  • Review the claim file(s) to determine if it contains a PRTF and MRFC form each completed in its entirety by a Utah DDS psychiatrist or psychologist employed by the Utah DDS on or after 01/01/91, through 02/20/94.

    NOTE: This review should be done by Utah DDS employees who are familiar with the handwriting of Utah DDS psychiatrists and psychologists.

    Set aside these claim files (“set asides”). In each set aside case, the Utah DDS psychologists or psychiatrists will review the file to determine that they completed the forms in their entirety.

    NOTE: The results of this “double screening” will be presented to an individual designated by class counsel. Plaintiffs' representative's participation in the screening process shall be limited to spending a reasonable amount of time reviewing the results of the Utah DDS's screening process. Plaintiffs' representative will not challenge the disability determination itself.

    If the Utah DDS psychiatrist or psychologist is unsure about his/her personal completion of the PRTF or MRFC forms, or if the Utah DDS psychiatrist or psychologist is no longer available to confirm his/her personal completion of the PRTF or MRFC forms, or if plaintiffs' representative has a good faith belief that the forms were not personally completed by Utah DDS psychiatrists or psychologists, then the case shall be redetermined following DI 52510.020C.

  • Make a copy of the screening sheet and put the original in the file. On a weekly basis, forward copies of the screening sheet to LS at the address shown in DI 52510.010B.2.a.

  • If the claim(s) is screened-in, follow DI 52510.020C. If there is a current claim pending in the DDS, associate the pending claim with the Goodnight claim.

  • If the claim(s) is screened-out:

    • Prepare and send a notice of non-entitlement to relief (see DI 52510.095, Exhibit 5) to the claimant, any representative, and a copy to class counsel.

      NOTE: If there are multiple Goodnight claims and at least one claim is screened-in, do not send a “non-entitlement to relief notice” for the other claim(s) that is screened-out.

      Hold the folder(s) for 60 days. After 60 days, if the screen-out determination is not disputed by class counsel, return the screened-out folder(s) to the FO and advise the FO that the claimant is not a Goodnight class member entitled to relief and to return the folder(s) to the appropriate component for filing.

C. Procedure - redetermination process

Take the following action in reviewing Goodnight class member claims:

  • Review the evidence in the claim file(s), including any new evidence that may have been received pertaining to the Goodnight claim(s) and determine whether the determination(s) under review is correct.

    Assess disability through the date of the determination on the latest Goodnight claim. Apply the statutes, regulations, and instructions in effect at the time of the redetermination.

    If the evidence in file is insufficient to assess the individual's impairment(s) during the time period covered by the class claim, secure and/or develop additional evidence relevant to the time period being redetermined, in accordance with normal claims development procedures.

    NOTE: If the Goodnight class member has a representative, conduct all development and communications through the representative unless the claimant indicates otherwise (see DI 31001.001). If the claimant requests a representative, see DI 22505.001.

  • If the redetermination results in a finding that the individual was disabled during the period covered by the class claim, reopen the Goodnight claim(s) and assess disability from the date of the original Goodnight claim(s) through the date of the new determination or the onset date of a more recent allowance. Follow the instructions in DI 52510.020D.

  • If the redetermination results in a finding that the claimant was not disabled during the period covered by the class claim, do not reopen the Goodnight claim(s). Prepare a reconsideration level determination affirming the prior denial(s) based on the information in file. Follow the instructions in DI 52510.020E.

D. Procedure - favorable redetermination

Take the following action when the redetermination results in a finding that the claimant was disabled during the redetermination period:

  • Reopen the Goodnight claim(s). Update the medical sources and develop medical and vocational factors for the period from the date of the original Goodnight determination through the present or the onset date of the most recent allowance. Do not readjudicate periods for which disability has already been established.

    NOTE: Do not secure medical evidence for periods beyond full retirement age or the date last insured.

  • Complete readjudication of the original Goodnight claim(s) for the period from the alleged onset date (or date of application in title XVI cases) through the present or the onset date of the most recent allowance.

  • Prepare Form SSA-831-U3. Follow DI 27015.001 in completing Form SSA-831-U3. Annotate the remarks section with“Goodnight Review - Favorable (or Partially Favorable). This Determination Revises the Determination(s) of (Date of Prior Denial).” If undeveloped work activity is involved, enter “File Contains Work Activity to be Developed by the FO.”

    Annotate the remarks section on the prior Form SSA-831-U3(s) with “Superseded by Goodnight Review Determination of (Date of Goodnight Determination).”

    NOTE: If multiple determinations are being reviewed, a single determination replaces the prior determinations. The earliest filing date that results in entitlement to Goodnight relief will be used.

  • See DI 52510.020H and DI 52510.020I for notice instructions in fully and partially favorable cases.

  • Route folders to the FO for updating of non-medical issues.

E. Procedure - unfavorable redetermination

Take the following action when the redetermination results in a finding that the claimant was not disabled during the redetermination period:

  • Complete Form SSA-831-U3. Annotate the remarks section with “Goodnight Review - Unfavorable. This Determination Affirms the Determination(s) of (Date of Prior Denial).”

    Annotate the prior determination(s) in the remarks section with “Superceded by Goodnight Review Determination of (Date of Goodnight Determination).”

  • Prepare and send the notice in DI 52510.020G to the claimant and any representative.

  • Return the folder(s) to the FO and advise the FO to hold the folder(s) for the appeals period.

F. Procedure - miscellaneous DDS actions

1. Whereabouts unknown

If the claimant's whereabouts become unknown during the redetermination process and the claimant cannot be located:

  1. Prepare a determination based on the evidence in file (see DI 23005.001).

  2. If the redetermination is unfavorable:

    • Prepare Form SSA-831-U3.

    • Prepare and send a personalized notice to the claimant's last known address.

    • Make systems input per DI 52510.020A.2.

    • Send the folder to the servicing FO.

  3. If a favorable reopening is possible, complete any development not requiring claimant participation and prepare a determination based on the evidence in file.

2. Claimant dies

If a class member dies prior to adjudication, request the FO to determine if an underpayment is payable per GN 02301.055A or SI 02101.003, as appropriate. If the FO advises no underpayment is payable, clear the case as a “no decision” and return the folder to the FO.

3. Reconstructed folders

After the FO completes folder reconstruction, the FO forwards the reconstructed file to the DDS. The DDS will:

  1. Presume entitlement to relief if the queries indicate a medical denial on or after 01/01/91, through 02/20/94, and reconstruct the evidence for the period covered by the missing claim. See DI 20502.030.

  2. Document the file with all efforts to secure medical evidence of record.

  3. Process the redetermination based on the reconstructed file.

4. Failure to cooperate

In failure to cooperate situations:

  1. Follow DI 23010.005 - DI 23010.025.

  2. Adjudicate the claim based on the evidence available.

G. Procedure - notices - affirmation of prior denial

1. Title II

  1. Prepare an SSA-L951-C2/U2 for title II affirmation of denial. Add the third line heading “IMPORTANT INFORMATION,” and include:

  2. An introductory statement that reads:

    • “The Goodnight court order requires the Social Security Administration to look at your earlier claim again. We have completed this review and we still find that the earlier determination in your case is proper and in accordance with the law. Therefore, the denial of your earlier application remains unchanged.”

    • An optional paragraph to be used if the claimant is in current pay status that reads:

      “This determination does not affect the checks that you are getting now based on your later application.”

    • Paragraph 4041 (delete if merged text format is used).

    • A discussion of the evidence containing the elements specified in DI 26530.020.

    • Paragraph 4107. In the second sentence, substitute, “If you still believe” for “if you believe.”

    • Paragraph REF003 on LSF.

    • Enclosures: Explanation of Determination (delete if merged text is used) and SSA Pub. No. 70-10281.

2. Title XVI

Prepare an SSA-L8052-C2/U2 for title XVI affirmation of a prior denial. Add the third line heading “IMPORTANT INFORMATION”, and include the elements from DI 52510.020G.1.

3. Concurrent cases

a. Title II

Follow DI 52510.020G.1., but add disclaimer paragraph 842 for a title II concurrent case.

b. Title XVI

Follow DI 52510.020G.2., but add disclaimer paragraph 841 for a title XVI concurrent case.

H. Procedure - notices - revision of denial to partially favorable allowance

1. Title II

a. Onset established later than alleged

For title II, onset established later than alleged, include:

  • An introductory statement that reads:

    • “The Goodnight court order requires the Social Security Administration to look at your earlier claim again.

      We have completed this review and we find that you meet the medical requirements for disability benefits on (established onset date) but you do not meet these requirements prior to that date. You must meet certain medical and non-medical requirements to be entitled to disability benefits. Attached to this notice is an explanation of the decision that we made on your claim and how we arrived at it.” (Delete last sentence if merged text format is used.)

  • An optional paragraph to be used if the claimant is in current pay status that reads:

    • “This determination does not affect the checks that you are getting now based on your later application.”

  • A discussion of the evidence containing the elements specified in DI 26530.015.

  • The last three paragraphs from the SSA-L1157-U2 DI. Add “as of the date that we have now found that you meet the medical requirements for disability benefits” after “rules” in the first sentence of the third paragraph from the SSA-L1157-U2 DI.

b. Closed period established

For title II, closed period established:

  • Include an introductory statement that reads:

    • “The Goodnight court order requires the Social Security Administration to look at your earlier claim again.

      We have completed this review and we find that you meet the medical requirements from (established onset date) to (cessation date). You must meet certain medical and non-medical requirements to be entitled to disability benefits. Attached to this notice is an explanation of the decision that we made on your claim and how we arrived at it.” (Delete last sentence if merged text format is used.)

  • Follow DI 52510.020H.1.a., second and third bullets.

  • Include the last three paragraphs from the SSA-L1157-U2 DI. (If the onset is established later than alleged, add “as of the date that we have now found that you meet the medical requirements for disability benefits” after “rules” in the first sentence of the third paragraph from the SSA-L1157-U2 DI.

2. Title XVI

Prepare an SSA-L8052-C2/U2. Add the third line heading “IMPORTANT INFORMATION.”

a. Onset established later than alleged

For title XVI, onset established later than alleged:

  • Follow DI 52510.020H.1., first three bullets.

  • Include the last three paragraphs from the SSA-L1157-U2 SI. Add “as of the date that we have now found that you meet the medical requirements for disability benefits” after “rules” in the first sentence of the third paragraph from the SSA-L1157-U2 SI.

b. Closed period established

For title XVI closed period established, follow DI 52510.020H.1.b., first two bullets, and DI 52510.020H.2.a., second bullet.

3. Concurrent cases

a. Title II

For title II concurrent cases, follow DI 52510.020H.1., but add disclaimer paragraph 842.

b. Title XVI

For title XVI concurrent cases, follow DI 52510.010H.2, but add disclaimer paragraph 841.

I. Procedure - notices - revision of denial to fully favorable allowance

1. Title II

For title II cases:

  1. Enter “ODO-DL-S” in item 29 on Form SSA-831-U3.

  2. Indicate SSA-L2000-C2 as the notice on the attachment (SSA-865) and include the following paragraph:

    • “This determination is based on a review of your claim as agreed to by the parties in the case of Goodnight v. Apfel. We have determined that your condition is disabling.”

2. Title XVI

For title XVI cases:

  1. Indicate “DO-DL-S” as the notice on Form SSA-831-U3.

  2. On the attachment (SSA-865), show SSA-L8025-U2 and include:

    • a lead-in paragraph that reads:

      “This determination is based on a review of your claim as agreed to by the parties in the case of Goodnight v. Apfel. We have determined that your