DI 42521.020: Screening and Review

changes
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~~Effective Dates: 02/11/2014 - Present~~
Effective Dates: 05/30/2018 - Present
TN 42 (08-95)
DI 42521.020 Screening and Review
A. Policy
~~ODIO and/or NEPSC will retrieve all potential claims, except those claims pending in ODAR or the DDS, covered by the Dixon timeframe (6 /1/76 - 7/19/83) as well as all subsequent claims.~~
ODIO and/or NEPSC will retrieve all potential claims, except those claims pending in OHO or the DDS, covered by the Dixon timeframe (6 /1/76 - 7/19/83) as well as all subsequent claims.
ODIO and/or NEPSC will then screen and complete a screening sheet (see DI 42521.095, Exhibit 5) for all claims covered by the Dixon timeframe.
ODIO and/or NEPSC will attempt to screen all lost/destroyed claims on the basis of the FACT and SSIRD queries (see DI 42521.020B.4.). Where the screening of the FACT and SSIRD queries yields a determination of Dixon class membership, ODIO and/or NEPSC will attempt to readjudicate the Dixon class claim(s) based on the court-ordered presumptions (see DI 42521.025) before initiating any kind of reconstruction effort (see DI 42521.020B.4.).
NOTE: All medical denials/terminations adjudicated during the period covered by Dixon (6/1/76 - 7/19/83) must be considered for screening.
B. Procedure
1. Alert/Query package
* ODIO will review the Dixon alert, related queries (FACT, SSIRD, etc.) and/or claim file(s) to determine the existence and location of Dixon claim(s).
NOTE: The absence of FACT or SSIRD information does not necessarily mean the claimant did not file an application.
* When both the FACT and SSIRD queries show “NO RECORD”, obtain a NUMIDENT query to determine if the claimant has a cross-reference SSN. If the NUMIDENT does not disclose a possible Title II or XVI claim number, follow DI 42521.020B.2.a.
2. No record of filing
* If there is “NO RECORD” of any claim on the FACT, SSR/STALE, or AR-25 under the SSN provided by the individual requesting relief under Dixon, and the Numident does not disclose a possible Title II or XVI claim number:
* Complete a screening sheet in duplicate (see DI 42521.095, Exhibit 5).
* Answer Question 7 on the screening sheet “NO” and enter screenout code 07 in Item 13 per screening sheet instructions (see DI 42521.095, Exhibit 6).
* Send the individual, any current representative(s) and class counsel the “Non-Class Membership” Notice (see DI 42521.095, Exhibit 7). Use the ODIO or NEPSC address as the return address on the envelope.
* Send a copy of the completed screening sheet to ODIO, CAS, at the address shown in DI 42521.010B. for entry into CATS and file a copy in the claims folder.
* If a response to the “Non-Class Membership” Notice comes into ODIO/ NEPSC, forward to OPPEC Litigation Staff, Attn: Dixon Coordinator at the address shown in DI 42521.020B.6.
3. Screening folders
* Review the application and Forms SSA-831/832/833-U3 (as appropriate) in the folders, as well as the FACT and SSR/STALE record to insure that all possible Dixon claims have been retrieved.
NOTE: It is not necessary to retrieve the Title XVI claim in concurrently filed Title II/XVI cases unless the medical evidence is not with the Title II claim.
* Examine the folder to determine if there is indication of a current representive.
NOTE: An individual will be considered currently represented if the reply form was completed by the representative and there is a Form SSA-1696-U4 (Appointment of Representative) or an equivalent statement of appointment in file. An individual will not be considered represented simply because he/she was represented during the course of a prior claim.
* Screen claim(s) for class membership and complete screening sheet in d uplicate (see DI 42521.095, Exhibit 5) per the screening sheet instructions (see DI 42521.095, Exhibit 6).
* Prepare the “Non-Class Membership” Notice (see DI 42521.095, Exhibit 7) if the claim is screened-out.
NOTE: If there are multiple Dixon claims and at least one claim is screened-in, do not send a “Non-Class Membership Notice” for the other claim(s) that are screened-out.
* Annotate the alert “ Dixon Period(s) to be adjudicated: Starts: (enter date period starts) Ends: (enter date period ends); Resumes: (enter date period resumes (if applicable)) Ends: (enter date period ends (if applicable)).”
* File a copy of the screening sheet in the folder and forward a copy to ODIO, CAS, at the address shown in DI 42521.010B., for entry into CATS.
* Route folder(s) and/or alert/query packages per DI 42521.030.
4. Lost/Destroyed folders
* When one or more Dixon claim(s) has been destroyed or declared lost, determine if the case may be screened-out solely on the basis of information shown on the queries.
EXAMPLE: SSIRD shows Title XVI claim(s) denied for excess income and resources.
EXAMPLE: FACT shows Title II claim(s) denied because insured status not met at any point, or alleged onset date occurred more than one year after the date that insured status was last met (disallowance code 090).
The Dixon screener will:
* Screen the available claim(s); and
* Attempt to screen the missing claim(s) on the basis of the alert/ query package.
* If all missing Dixon claims and available Dixon claims can be screened-out on the basis of the alert/query package, the screener must:
* Complete a screening sheet in duplicate (see DI 42521.095, Exhibit 5) and place a copy in the manila holder or claims folder, if available.
* Send the individual, any current representative(s) and class counsel the “Non-Class Membership” Notice (see DI 42521.095, Exhibit 7) and place a copy in the manila holder or claims folder, if available.
* Forward a copy of the completed screening sheet to ODIO, CAS at the address shown in DI 42521.010B. for entry into CATS.
* If the missing claim(s) is screened-out and the available claim(s) is screened-in, send the available claim(s) to the FO for folder update. Because the missing claim is not relevant for the purposes of the Dixon review, annotate the screening sheet that the missing claim is not relevant to the Dixon reopening. Do not prepare a notice.
* If the missing claim(s) is screened-in, apply the court-ordered presumptions. (See DI 42521.025).
* If the claim(s) of a Dixon class member cannot be located, but the application of the court-ordered presumptions to the alert/query package establishes that the class member is not entitled to any further relief, follow DI 42521.025B.2.
* If ODIO and/or NEPSC cannot adjudicate the class claim(s) based on the presumptions, ODIO and/or NEPSC will initiate folder reconstruction as follows:
* Prepare a duplicate claims folder, if necessary, to hold the alert/ query package and any documentation of attempts to locate the prior folder(s) and efforts to attempt to apply the court-ordered presumptions.
* Annotate alert “UTL Prior Claim Folder(s) - FO (enter FO code) Requested to Reconstruct. Dixon Period to Be Reconstructed: Starts: (enter date period starts) Ends: (enter date period ends); Resumes: (enter date period resumes (if applicable)) Ends: (enter date period ends (if applicable)). ”
* Photocopy the annotated alert and send a copy of the alert to the Dixon Coordinator in the SSA, OPPEC, Litigation Staff at the address in DI 42521.020B.6. for entry into CATS, and
* Send the duplicate folder via Form SSA-559 (Transmittal Slip for Claims Folder) to the servicing FO for reconstruction of the disability material. Annotate the Form SSA-559 “Dixon Lost Folder Case-Please Reconstruct. Forward Reconstructed Folder to the New York ODD for Review.” Also add the following remark if a current claim is pending in the DDS, “Associate with Current Claim Pending in the DDS.”
5. Late responders
Examine the alerts.
* Alerts for late responders are identified by the remark “LATE RESPONDER - GOOD CAUSE DETERMINATION NEEDED.”
* Alerts for timely responders do not contain any identifying remark.
* If there is any indication from any of the returned correspondence that the individual has mental impairments, deem the individual to have “good cause” for late filing and screen for class membership per DI 42521.020B.3.
If “good cause” is not deemed for late filing (i.e. a mental impairment is not present/alleged), request FO to make a “good cause” determination per GN 03101.020.
NOTE: If “good cause” is established, the FO will make a “good cause” determination and will forward the folder/alert/query package and the “good cause” determination to ODIO and/or NEPSC for class membership screening. ODIO and/or NEPSC will then screen the case per DI 42521.020B.3.
If “good cause” is not established, the FO will send the Good Cause Denial Notice (See DI 42521.095, Exhibit 4) to the claimant, class counsel, and the Litigation Staff.
6. Subsequent fully favorable determination or decision
If a subsequent fully favorable decision covers the entire Dixon period, take the following actions for:
a. PC screener action
* If a title II claim is screened-out because a later fully favorable medical allowance was made, review the folder(s) to determine if full retroactive benefits were paid (i.e., all benefits payable on the earliest Dixon application).
* If full retroactive benefits were not paid, send the folder to a Claims Authorizer (CA) for processing and annotate the route slip “Fully Favorable Medical Decision - Retroactive Payments Due On Basis Of Application Filed (show DOF).”
* Instruct the CA to use the following language on the notice:
“This determination is based on a review of your claim under the Dixon v. Shalala court case.”
b. CA action
* Prepare a new Form SSA-101-U3 (Determination of Award). Cite “ Dixon Court Case” as the reason for amending the award in Item 11 of the Form SSA-101-U3.
* Send a copy of the new Form SSA-101-U3 to:
Office of General Counsel
Correspondence Control Staff
Altmeyer Room 617
Baltimore, MD 21235
Attn: Court Case Coordinator
7. Determination regarding class membership reversed
If class counsel requests a review of the class membership determination and a review of the class membership denial indicates that the individual is a class member, (by consent of both parties or by the court), ODIO and/ or NEPSC will:
* Send the “Notice of Revised Decision Regarding Individual's Class Membership” (See DI 42521.095, Exhibit 9) to the individual, class counsel, and the individual's current representative(s), if applicable.
* Send the folder(s) and alert/query package to the component that has jurisdiction for readjudicating the class claim per DI 42502.001.

POMS Reference

DI 42521.020: Screening and Review