DI 52522.005 Disability Determination Services Clark Case Processing Instructions
There is no special coding, tracking, or notice required by the disability determination services (DDS) for processing Clark cases. The DDS follows existing case development and adjudicative procedures and disability policy.
NOTE: The DDS may have to adjudicate periods different from typical title XVI claims in which the DDS generally evaluates the period from the application date forward. Before transmitting the case to the DDS, the field office (FO) should identify the case characteristics on the Clark Court Case flag.
B. No subsequent claim after an N25 technical denial
Adjudicate the Clark case from the application date of the technically denied claim to the present. If the DDS determination is an allowance, use the application date of the technically denied claim, for determining the onset date of disability, see The Established Onset Date For Title XVI Claims DI 25501.370.
C. Subsequent claim with a disability determination or decision after an N25 technical denial
Adjudicate the Clark case from the application date of the technically denied claim, through the month before the application date of the subsequent disability claim.
If the adjudication of the Clark case results in a denial, do not disturb the subsequent determination (allowance or denial). Inform the claimant in the denial notice that we reviewed the earlier period under the Clark court order provisions and found him or her not disabled for that period.
If adjudication of the Clark case results in an allowance, and the subsequent claim was a disability denial, adjudicate the claim as though no denial determination was made, and vacate the subsequent determination as follows:
For paper cases, follow normal reopening process.
For electronic cases, receipt in the subsequent claim as a reactivation.
Document the claim with a SSA-5002 (Report of Contact) that states: “Clark court order requires the DDS to vacate the subsequent claim determination made on ___________. Accordingly, the DDS vacates this disability determination.”
Annotate all documents with the remark “Determination was vacated.” in the Notes column in eView.
Close the case with No Determination (ND) decision code, selecting the ND reason “FODR – FO Determination Requested.”
Transfer the claim to the FO.
D. Subsequent title XVI non-Clark case technically denied claim
Adjudicate the Clark claim from the application date of the N25 technically denied claim, through the month before the application date of the subsequent non-Clark technically denied claim. Make a closed period disability determination for the Clark period.
E. Title XVI claim with a title II disability denial determination or decision for the same period or later
We cannot adopt the prior title II denial determination or decision under the Clark settlement. Evaluate all available evidence, including the evidence used in making the prior determination or decision, and any additional evidence received to make an independent determination on the title XVI claim. A favorable Clark determination is possible only if there is a reason to reopen the title II determination or decision.
F. Title XVI claim with a title II allowance determination or decision with an established onset date later than the title XVI application date of the N25 technically denied claim
Adjudicate the Clark case from the application date of the N25 technical denial through the title II established EOD and apply collateral estoppel to provide title XVI Clark relief from the title II EOD through the present.
If the disability determination on the Clark case is a denial, do not disturb the title II allowance. Inform the claimant in the denial notice that we reviewed the earlier period under the Clark court order provisions and found the person not disabled for that period.
If the Clark determination is favorable, the FO should determine nonmedical eligibility for the earlier period and effectuate payment accordingly.
G. FO requests DDS to vacate subsequent medical denial determination
If the recipient received title XVI disability benefits and the case terminated because of N25 parole or probation violation suspension, and then we denied a subsequent disability claim, the FO should request the DDS to vacate the subsequent denial determination. A new disability determination is not re