DI 42594.015: Obtaining, Screening, and Routing Folders

changes
←	*	→

~~Effective Dates: 04/09/2013 - Present~~
Effective Dates: 05/30/2018 - Present
TN 37 (11-94)
DI 42594.015 Obtaining, Screening, and Routing Folders
A. Procedure - obtaining folders
1. Determining folder location
Notice that the alert package consists of an alert, the response form, an FACT, an SSIRD (SSR and STALE), an ODIO case control record, and an AR-25.
* Examine alert package queries to determine location of all folders.
* If no record exists under that SSN, send individual copy of SSN verification notice shown in DI 42594.095, Exhibit 2. Include a return envelope (postage paid) addressed to: SSA State of New York Coordinator P.O. Box 17769 Baltimore, MD 21235.
Send another copy of notice to Office of General Counsel Correspondence Control Staff Altmeyer Room 617 6401 Security Blvd. Baltimore, MD 21235 Attn: Class Action Coordinator.
* Process as lost folder per 6. below if folder is not at location shown on case control system and if thorough folder search is unsuccessful.
2. Retrieve folder
* Locate and retrieve all folders (see DI 42594.020) covered by State of New York timeframes as well as all subsequent claims folders except claims that are currently pending.
EXCEPTION: In concurrent title II/title XVI cases, do not retrieve title XVI folder(s) located separately from title II folder.
* Associate multiple claims folders. See DI 42594.020 below.
* Attach alert to front cover of folder.
3. Folder retired to FRC or FSO during FY '81 or before
If folder was retired to FRC or FSO during FY '81 or before, proceed as follows:
* Examine ODAR data as well as MBR and SSIRD to verify that no claim was adjudicated on or after June 1, 1980.
* Examine OHO data as well as MBR and SSIRD to verify that no claim was adjudicated on or after June 1, 1980.
* If output does not clearly indicate that no claim was adjudicated on or after June 1, 1980, follow 2. above.
* If output clearly indicates that no claim was adjudicated on or after June 1, 1980,
* prepare in duplicate and release notice in DI 42594.095, Exhibit 3. Check appropriate item, depending on State of residence shown on MBR or SSIRD, and
* staple alert, responder form, and all other output to copy of notice. Cover with route slip annotated “ State of New York class membership denial - determination prior to June 1, 1980” and send to: Office of General Counsel Correpondence Control Staff Altmeyer Room 617 6401 Security Blvd. Baltimore, MD 21235 ATTN Class Action Coordinator
4. Current claim pending - State of New York folder not located
If a current claim is pending and the State of New York folder is not located:
* Contact FO, DDS, or ODAR to ascertain whether prior folder is associated with pending claim.
* Contact FO, DDS, or OHO to ascertain whether prior folder is associated with pending claim.
* If prior folder is associated with pending claim, forward alert package for association with folder. Annotate alert “Associate with claim pending in your office - State of New York class membership decision necessary per DI 32594.001.”
* Advise FO to forward folder to DDS or ODAR if FO has folder.
* If folder is located in ODAR component, send alert to: Office of Hearings and Appeals Office of Civil Actions, Division I Attn: State of New York Screening Unit 5107 Leesburg Pike Falls Church, VA 22041-3200.
* Advise FO to forward folder to DDS or OHO if FO has folder.
* If folder is located in OHO component, send alert to: Office of Hearings and Appeals Office of Civil Actions, Division I Attn: State of New York Screening Unit 5107 Leesburg Pike Falls Church, VA 22041-3200.
* If prior folder not associated with pending claim, follow 6. below.
* If current claim is pending in court, ODIO will return the alert to ODCP-LS.
5. Folder not in ODIO files
If the folder is not in ODIO files:
* Request from FRC, Wilkes-Barre, or other location as needed.
* Diary and follow up on request as needed.
6. Lost folders
If unable to locate folder within 120 days from date of alert, take following actions:
* Prepare duplicate folder to house alert package and documentation of attempts to locate prior folder(s).
* Annotate alert “UTL prior folder(s) - FO (enter FO code) requested to reconstruct.”
* Photocopy annotated alert and send copy to: Litigation Staff, OGC, SSA State of New York Court Case Coordinator 1400 Dunleavy Bldg 1508 Woodlawn Drive Baltimore, MD 21207.
* Send duplicate folder via SSA-559 to servicing FO for reconstruction of disability material.
NOTE: If MBR (etc.) shows that the claim is not a State of New York claim (i.e., based on the timeframes, etc.), screen it out rather than send it to the FO.
* Multiple folder situations - see DI 42594.023.B. below.
B. Procedure - screening and routing folders
1. Examine alert
* Identify alerts for late responders by remark “LATE RESPONDER - GOOD CAUSE DETERMINATION NEEDED.”
* Be aware the alerts for timely responders do not contain identifying remark.
2. Screening - general
* Screen folders for class membership (see Exhibit 4, DI 42594.095). Complete screening sheet in duplicate.
* Notify individual (and any representative) of screening results immediately, using most recent address available.
* Use DI 42594.095, Exhibit 5 if individual is found to be a class member.
* Use DI 42594.095, Exhibit 3 if individual is found not to be a class member. Fill in the reason for non-membership.
3. Late responders
In handling replies from late responders:
* If screened in - send folder and both copies of the screening sheet to servicing FO via SSA-559 for development of good cause for late reply per DI 12594.005 B.3.
* If screened out -release class member denial notice and send screening sheet to Litigation Staff. (The NYDDS will release the notices and send the screening sheets on claims it screens out, and will forward the folders to the NEPSC to be held for possible appeal of the decision of non-class membership.) Although there is no time limit for the filing of an appeal, only hold the folders (including those received from the NYDDS) 90 days for a possible appeal (see DI 42594.005C.). Return the folders to original filing locations if there is no appeal after 90 days.
NOTE: If a screen out is reversed after appeal (see DI 42594.005 C.), the case should be processed as in 3.a., above.
4. Timely responders - no current claim pending
In the case of timely responders with no current claim pending:
* If ALJ, Appeals Council, or Federal court made decision on which class membership is based, send folder to following location (case control location: 5012): State of New York Coordinator Office of Hearings and Appeals Office of Appellate Operations 5107 Leesburg Pike Falls Church, VA 22041-3255.
* If screened in - send folder to NYDDS.
If screened out -follow 3.b. above. Return folder to original filing location if there is no appeal after 90 days.
5. Timely responders - current claim pending
In the case of timely responders with a current claim pending:
* Current claim pending in FO or DDS even if other than NYDDS:
* Send State of New York folder to NYDDS for expedited screening.
* Notify FO or DDS by phone or teletype that State of New York review will be necessary if case is screened in and that, therefore, they may be asked to stop processing current claim and send it for consolidated processing by the NYDDS. The exception is that if the FO or DDS intends to issue a fully favorable decision, they should be told to complete their processing of the claim first. (See DI 32502.001.)
* Current claim pending at ALJ or Federal court level - Send State of New York folder to address in 4.a. above for screening. Annotate route slip, “Attached is a possible State of New York case. Please screen for class membership. There is also a pending claim in ODAR jurisdiction.”
* Current claim pending at Appeals Council level - forward State of New York folder to DDS or ODAR following B.4. above.
* Current claim pending at ALJ or Federal court level - Send State of New York folder to address in 4.a. above for screening. Annotate route slip, “Attached is a possible State of New York case. Please screen for class membership. There is also a pending claim in OHO jurisdiction.”
* Current claim pending at Appeals Council level - forward State of New York folder to DDS or OHO following B.4. above.
6. Non-Membership decision appealed
For processing see DI 42594.005C.
7. Subsequent fully favorable decisions
If there are subsequent fully favorable decisions, proceed as follows:
* PC screener actions:
* If a title II case is screened out because a fully favorable later allowance was made, be sure that full retroactive benefits were paid (i.e., all benefits payable on the earliest State of New York application).
* If full retroactive benefits were not paid, send the folder to a CA for processing and annotate the route slip “Fully favorable medical decision - retroactive payments due.”
* Provide the following language for the CA to use: “This determination is based on a review of your claim as ordered by the court in the case of State of New York v. Sullivan (the exercise test court case).”
* If the case is title XVI refer the case to the FO for processing the additional payment.
* CA action - Cite “ State of New York Court Case” as the reason for amending the award in item 11 of the SSA-101-U3.

POMS Reference

DI 42594.015: Obtaining, Screening, and Routing Folders