SI DAL04050.040 Effectuating Title XVI Court Reversal Decisions (TN 5 -- 04/2013)
SSI decisions which are reversed in Federal court should receive priority attention. To avoid any delays, field offices (FOs) should use the following procedures to control and effectuate all SSI court reversals.
1. Regional Office (RO)
The SSI Team in the RO controls the effectuation of SSI court reversal cases with an assigned team member who serves as the SSI Regional Litigation Coordinator (RLC). Contact the RLC for assistance with an SSI court case by submitting a request through vHelp.
The Office of the General Counsel (OGC) in the Regional Office sends a copy of the court reversal decision to the RLC.
The RLC emails a copy of the decision with an electronic copy of the SSI Court Case Flag (Exhibit A) to the servicing FO for effectuation. In situations where a Magistrate’s recommended decision to reverse SSA’s decision is received by the RLC, it too will be forwarded to the FO for informational purposes only. Because a Magistrate’s recommended decision is not a final judgment, the FO should not effectuate it.
2. Field Office
a. Effectuation actions
Take the following actions as soon as the final court decision is received in the FO:
Enter the case on the MDW. The “ISSUE” should be recorded as “Court Reversal” and the “CATEGORY” should be recorded as “T16APL”;
Obtain full history SSID records;
Review the court decision carefully to determine the period of entitlement. This can be difficult to ascertain if more than one application is involved or if the case is concurrent. Other queries such as an MBR or OHAQ may help determine the period of eligibility;
Conduct a pre-effectuation eligibility review (PERC); and
When the development is complete, effectuate payment and send the appropriate notice via DPS and store it in the Online Retrieval System. The notice should indicate the decision is a result of a favorable decision rendered by the U.S. District Court.
b. Locating the file
In SSI only cases, SSA litigation staff returns the paper folder to the FO. In concurrent cases, the PSC retains the title II folder and sends the title XVI material to the effectuating FO on receipt of the court order. If you are unable to obtain the paper file, search your local files and review the CCTL segment of the SSR. In addition, some FOs obtained a copy of the claims file from the plaintiff’s attorney.
In electronic folder cases, you should utilize CFRMS, eVIEW and EDCS systems to obtain a copy of the file.
If all attempts to locate the folder (or a certified copy of the folder) are unsuccessful, the FO must reconstruct the folder per GN 03105.010. An FO Folder Retrieval Checklist is available at GN 03105.070.
Return the completed electronic Court Case Flag to the RLC via fax or email.
d. Misrouted court decision
If the claimant no longer lives in the FO’s service area or if the court decision was misrouted, transfer the decision and the Court Case Flag to the servicing FO. For control purposes, notify the RLC of the transfer and annotate the MDW.
e. Claimant or representative presents court decision
The claimant or representative may contact the FO with the court decision before the RLC receives it. If this occurs, contact the RLC and begin development of the title XVI non-disability eligibility; but do not effectuate payments until notified by the RLC.
Exhibit A: SSI Court Case -- Priority Effectuation Needed
Location SSA, Office of Regional Commissioner
MOS, Center for Programs and Systems
SSI Regional Litigation Coordinator
Telephone: Telephone: (214) 767- 4224
FAX: FAX: (214) 767-1348
Number of pages: _________+ cover Date: _______________
Date of Final Court Decision: _________________
Take prompt action to effectuate this favorable SSI court decision;
Enter the case on MDW. The “ISSUE should be recorded as “Court Reversal” and the “Category” should be recorded as “T16APL”;
Obtain full history SSIDs and review the MSSICS records. If the folder cannot be located, reconstruct the claim using all available electronic records;
Review the court decision to determine the period of entitlement being awarded.
Conduct a PERC, effectuate payment and send the award notice with the proper references to the U.S. District Court;
See SI 04050.040, SI DAL04050.040, and Dallas Region SSI Court Case Processing Guide for detailed processing instructions and links;
After all actions are taken to effectuate the claim, sign and date this flag and either fax or mail it to the RLC. The FO may complete the electronic Court Case Flag contained in the courtesy email message sent simultaneously with the faxed order in lieu of a faxed or mailed reply to the RLC;
Clear the case from MDW.
Date: _______ FO Contact__________________ Title _________
SSA, ORC, MOS, SSI Team
Attn: SSI Regional Litigation Coordinator
1301 Young St., Suite 670
Dallas, TX 75202