Citations:

Hyatt, et al. v. Shalala, United States (U. S.) District Court for the Western District of North Carolina

TN 1 (11-00)

A. Background

1. Issuance of court order

On March 21, 1994, the U. S. District Court for the Western District of North Carolina issued an order in Hyatt, et al. v. Shalala, which provided relief to certain individuals who alleged pain and had their title II and/or title XVI disability benefits denied or terminated by the North Carolina Disability Determination Section (NCDDS), or an Administrative Law Judge (ALJ), or the Administration Appeals Judge (AAJ) on or after July 7, 1981, and before November 14, 1991.

NOTE: To be eligible for relief under the court order based on an ALJ hearing or AC decision:

• the individual must have lived in North Carolina at the time of the ALJ or AC decision, or

• the individual must have received a decision by an ALJ based upon a hearing that occurred at a time when the individual resided in North Carolina, or

• the AC decision must have been initially mailed to a North Carolina address.

2. Subsequent order

On October 21, 1999, the U. S. District Court for the Western District of North Carolina issued an order in Hyatt v. Apfel, which provided relief to certain individuals who had been denied class membership and a new determination/decision under the March 21, 1994 (Hyatt III) order. This

October 21, 1999 order says SSA may not deny class membership when:

1. A subsequent claim was adjudicated by an ALJ/AAJ on or after August 6, 1990 or by the DDS on or after November 14, 1991, unless

   • it is clear that the DDS/ALJ/AAJ reopened and readjudicated the entire period covered by the earliest Hyatt III claim (see GN 04001.001 and SI 04070.001 for additional information about reopening), and

   • the notice of determination/decision identified the claim that had been reopened and readjudicated; or

2. The claimant was a Hyatt (HY) responder and before receiving a final determination/decision under HY, the claimant withdrew or failed to pursue HY relief.

3. A subsequent claim also adjudicated a Hyatt III claim based upon an amended alleged onset date of disability, unless the Hyatt III claim was reopened and was in the process of being adjudicated at the time the claimant amended his/her onset date.

3. Class counsel

The class counsels are:

Charles McB. Sasser
Cox, Gage, & Sasser
227 W. Trade Street
Suite 2160
Charlotte, North Carolina 28202
Telephone: (704) 342-4200

(and)

John R. Wester
Robinson, Bradshaw, & Hinson
1900 Independence Center
101 N. Tryon Street
Charlotte, North Carolina 28246
Telephone: (704) 377-2536

(and)

Douglas S. Sea
Cox, Gage & Sasser
227 W. Trade St.
Suite 2160
Charlotte, North Carolina 28202
Telephone: (704) 342-4200

(and)

Carlene McNulty

North Carolina Justice and Community Development Center

P. O. Box 28068

224 South Dawson St.

Raleigh, North Carolina 27611-8068

Telephone: 1(800) 299-8619

B. Policy

All claims including those previously denied class membership under the March 21, 1994 Court Order are class members as a result of the October 21, 1999 Court Order except for the exclusions identified at DI 32548.001B.3. Class members who properly respond to the Hyatt III notice and who meet the following criteria will have the opportunity to have their claims reviewed. The type of review that a class member is entitled to depends on whether he/she is a member of the Primary Subclass or the Settlement Subclass.

1. Primary subclass

Subject to the exclusions DI 32548.001B.3., the Hyatt III Primary Subclass consists of all individuals:

• whose claims which included allegations of pain were finally denied or terminated on or after July 7, 1981, and before August 6, 1990;

• provided however, that an ALJ decision issued prior to August 6, 1990, shall be deemed final for the subclass membership purposes if the AC denied a request for review of the ALJ decision on or after August 6, 1990.

NOTE: Members of the Primary Subclass will have their claims reopened and receive full appeal rights. Also, claimant is a Primary Subclass member even if his/her Hyatt III claim was reopened or readjudicated in a decision on a subsequent application after August 6, 1990.

2. Settlement subclass description

Subject to the exclusions DI 32548.001B.3., the Hyatt III Settlement Subclass consists of all individuals whose claims, which included allegations of pain were finally denied or terminated by the NCDDS on or after August 6, 1990, and before November 14, 1991.

NOTE: Not all members of the Settlement Subclass are entitled to a review. Only Settlement Subclass members whose claims were finally denied or terminated at the initial or reconsideration level of review are entitled to a review of their class claims. The type of review is a disability redetermination. Settlement Subclass members have limited appeal rights.

3. Exclusions

a. The claimant is not eligible for class membership review based on the March 21, 1994 order if:

The individual received any Class Membership Notice pursuant to either the prior Hyatt order dated June 25, 1985, or December 10, 1987, but failed to timely respond to that Class Membership Notice. (Individuals who failed to file a response to these notices may have their Hyatt III claims reviewed if they establish good cause for not responding sooner. Failure to receive a notice may constitute good cause.)

NOTE: A claim will not be excluded as a Class Claim for failure to respond to a notice pursuant to the Order dated June 25, 1985, if an individual establishes that he/she responded to a notice issued pursuant to the Hyatt order dated March 27, 1984. Good cause notices to the “postcard” responders were processed through CO.

Also, an AAJ denial of request for review, while not the “final” decision of the Commissioner, must be considered as a decision if it would permit class membership, e.g., if the ALJ's decision was before 07/07/1981 and the AAJ denied review during the Hyatt III period, claimant is entitled to Hyatt III relief. An AAJ denial of request for review must not be considered a decision if it would preclude class membership, e.g., if the ALJ's decision was before 8/6/1990 and the AAJ denied review on or after that date, claimant is also entitled to Hyatt III relief.

b. Screening for class membership eliminated

As a result of the October 1999 court order, SSA has decided to no longer screen claims for Hyatt III class membership. Consequently, class membership screening has been eliminated. Thus, all future claims will receive a Hyatt III merits determination/decision, unless in the processing of a claim, it is found that Hyatt III relief is clearly inappropriate. That is if:

• No application for disability benefits under title II and/or title XVI was filed; or

• No final medical determination was issued by a NC adjudicator (DDS, ALJ, AAJ) between 07/07/1981 and 11/13/1991. (A non-medical determination/decision is one based on fraud, insufficient quarters of coverage, excess income or resources, substantial gainful activity (SGA) or any other reason not related to proof of disability, unless the claim was a concurrent claim filed in connection with a class claim. Also, in the preceding sentence, the term “final” does not include Hyatt III claims reopened and readjudicated prior to September 30, 1999. Such claims are entitled to Hyatt III relief.)

4. Review standard

In adjudicating class claims, the disabling effects of hypertension and diabetes will be fully considered without requiring the presence of end-organ damage for a finding of disability. In addition, current instructions on evaluating symptoms (see DI 24501.021) will be applied in a manner consistent with the following:

Once an underlying physical or mental impairment that could reasonably be expected to cause pain is shown by medically acceptable objective evidence, such as clinical or laboratory diagnostic techniques, the adjudicator must evaluate the disabling effects of a disability claimant"s pain, even though its intensity or severity is shown only by subjective evidence. If an underlying impairment capable of causing pain is shown, subjective evidence of the pain, its intensity or degree can, by itself, support a finding of disability. Objective medical evidence of pain, its intensity or degree (i.e., manifestations of the functional effects of pain such as deteriorating nerve or muscle tissue, muscle spasm, or sensory or motor disruption), if available, should be obtained and considered. Because pain is not readily susceptible of objective proof, however, the absence of objective medical evidence of the intensity, severity, degree or functional effect of pain is not determinative.