DI 52510.010: Goodnight FO Actions

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~~Effective Dates: 06/12/2015 - Present~~
Effective Dates: 05/31/2018 - Present
TN 2 (04-99)
DI 52510.010 Goodnight FO Actions
A. Procedure - inquiries
If the individual contacts the FO in regard to the Goodnight court case, follow the guidelines below.
1. In person
* If the individual has the reply form, instruct him or her to return the reply form to OCO in the postage-paid, pre-addressed envelop. Provide any assistance needed in helping the individual complete the reply form.
* If the individual lost the reply form or never received one or is requesting review based on the poster display, complete an SSA-795 (Statement of Claimant). The SSA-795 should state that the claimant is asking for a review of his or her disability claim based on the Goodnight court case and include the name, SSN, current address, and telephone number. Make sure the claimant/payee signs the SSA-795.
* Forward the SSA-795 to the:
Regional Office Center for Disability 1001 17th Street Denver, CO 80202 Attention: Goodnight Coordinator.
2. By telephone
* If the individual has the reply form, follow DI 52510.010A.1.
* If the individual lost the reply form or never received one or is requesting review based on the poster display, complete an SSA-5002 (Report of Contact (RC)). The RC should state that the claimant asked for a review of his or her disability claim based on the Goodnight court case and include the name, SSN, current address, and telephone number.
* Forward the SSA-5002 to the Regional Office, Center for Disability, Attention: Goodnight Coordinator. See DI 52510.010A.1.c. for address.
3. In writing
If the FO receives a written request for review, forward the request to the Regional Office, Center for Disability, Attention: Goodnight Coordinator. See DI 52510.010A.1.c. for address.
B. Procedure - late replies
An alert is generated in OCO when an individual files an untimely request for Goodnight relief. Take the following actions when a late responder alert is received:
* Develop “good cause” for late filing using the criteria in GN 03101.020.
NOTE: Alerts (see DI 52510.095, Exhibit 3) will contain the legend “LATE FILING - GOOD CAUSE DEVELOPMENT NECESSARY.”
* Make a finding as to good cause.
1. Good cause established
If good cause is established:
* File a copy of the good cause finding in the folder.
* Forward the folder to the Utah DDS. Advise the Utah DDS to screen for eligibility for class member relief.
2. Good cause not established
If good cause is not established:
* Prepare and send a good cause denial notice (see DI 52510.095, Exhibit 6) to the claimant, any representative, and a copy to class counsel. Also send a copy of the notice to:
Office of General Counsel Correspondence Control Staff Altmeyer Building, Room 617 6401 Security Blvd. Baltimore, MD 21207 Attn: Class Action Coordinator
* File the good cause finding and a copy of the notice in the folder.
* Hold all unfavorable good cause findings for 6 months. After 6 months, destroy the CATS alert and associated queries and return the folder to the appropriate component for filing.
C. Procedure - undeliverable notices
If an undeliverable potential class member notice is returned to the FO, forward the notice to OCO at the address shown in DI 52510.005B.3.b. No other action is necessary by the FO.
D. Procedure - folder retrieval
Take the following actions to locate and retrieve Goodnight folders:
* Review the queries.
* Locate and retrieve all available title XVI medical folders covered by the Goodnight timeframes, i.e., on or after 01/01/91, through 02/20/94, (this includes folders filed in other FOs) as well as all subsequent claims (even if they involve a favorable determination), except current claims that are pending in the DDS or ODAR.
* Locate and retrieve all available title XVI medical folders covered by the Goodnight timeframes, i.e., on or after 01/01/91, through 02/20/94, (this includes folders filed in other FOs) as well as all subsequent claims (even if they involve a favorable determination), except current claims that are pending in the DDS or OHO.
NOTE: If at least one folder is in WB and another folder(s) is in the FO, OCO will send the alert/query package to WB and instruct WB to associate the alert/query package with any folders located in WB and then to send the folder(s) to the FO to associate with any folders in the FO.
* Associate the alert/query package with the folder(s) that is retrieved and send to the Utah DDS. See DI 52510.005B.5.b. for address.
* If a folder cannot be located within 120 days of the alert date, follow DI 52510.010E.
NOTE: When a potential Goodnight claim cannot be located, the claimant becomes a class member entitled to relief if the queries indicate a medical denial on or after 01/01/91, through 02/20/94. It is imperative that the FOs conduct a thorough search to locate potential class claims. A thorough office search may also eliminate the need to unnecessarily reconstruct folders.
* If the DDS receives the wrong file or a file is missing medical evidence and requests FO assistance, exhaust all possible leads to retrieve the correct folder before beginning reconstruction.
* Document all efforts to locate a folder(s) on a Court Case Folder Retrieval Worksheet (see DI 52510.095, Exhibit 4).
E. Procedure - lost folders
Take the following actions when a folder(s) cannot be located:
* If after a thorough search (within 120 days of the alert date), the folder(s) cannot be located, initiate reconstruction (see GN 03105.010).
* Document all efforts to locate a folder(s) on a Court Case Folder Retrieval Worksheet (see DI 52510.095, Exhibit 4).
* Reconstruct folders when requested to by the PSCs, OCO or DDS.
* Send reconstructed folders to the Utah DDS.
F. Procedure - miscellaneous FO actions
1. Medical development
If the DDS requests folder update, take the following action:
* Process the SSA-883-U3 (Request for Evidence or Assistance (Disability Case)) prepared by the DDS.
* Contact the individual or his or her representative to obtain updates of the claimant's medical condition and medical sources.
* Use an SSA-3441-F6 (Reconsideration Disability Report) to obtain updated information.
* Use an SSA-3368-BK (Disability Report) when processing a reconstructed folder.
* Obtain an SSA-827 (Authorization for Source to Release Information to the Social Security Administration) for authorizations as necessary.
2. Work activity development
Initiate work activity development following DI 10501.025A.
NOTE: The FO must fully develop SGA if it began within 12 months of onset and continued throughout the Goodnight period to be developed. All other work activity will be developed by the FO after DDS adjudication.
3. Claimant has representative
Obtain an SSA-1696-U4 or other equivalent written statement if the claimant has a representative and no SSA-1696-U4 is in file. See GN 03910.040B for appointment of a representative.
NOTE: If the claimant has a representative, copies of all correspondence must be sent to that representative unless the claimant either appoints a different representative or states that he or she is no longer represented by the individual. Any development must be made through the representative unless the claimant states otherwise.
4. Change in date last insured
Notify the DDS of the new date last insured if it changed subsequent to the prior denial.
5. Claimant deceased
If the claimant is deceased, take the following actions:
* Apply existing procedures for determining distribution of any potential underpayment. See GN 02301.055A and SI 02101.001, as appropriate.
* If there is no eligible party to receive any potential underpayment, or there is no Medicaid issue, annotate the alert, if available, or record this information on an SSA-5002 and send the alert to LS at the address shown in DI 52510.010B.2.a.
NOTE: The Goodnight coordinator in LS is responsible for clearing the case from CATS.
* Return the folder(s) to the appropriate component for filing.
6. Whereabouts unknown/failure to pursue
If the class member's whereabouts become unknown or the class member does not wish to pursue his or her request for Goodnight review:
* Follow DI 11018.005.
* Annotate the alert “Whereabouts Unknown” or “Failure to Pursue”, as appropriate, and forward a copy of the alert to LS at the address shown in DI 52510.010B.2.a.
* Return the folder(s) to appropriate component for filing.
7. Class membership disputes
If either the claimant or class counsel contacts the FO regarding disputes about entitlement to class member relief, take the following action.
a. Claimant contacts the FO
If the claimant contacts the FO, advise the individual to contact class counsel. See DI 52510.001A.3. for address and telephone number.
b. Class counsel contacts the FO
If class counsel contacts the FO, advise class counsel to write to the Office of the General Counsel (OGC) at: Office of the General Counsel Correspondence Control Staff Altmeyer Building, Room 617 6401 Security Blvd. Baltimore, MD 21235-6401 Attn: Class Action Coordinator
G. Procedure - non-medical updates on favorable determinations
Take the following action to update title II and/or title XVI claims when a favorable determination is made by the DDS.
1. Title II
* Review all non-medical factors of entitlement.
* Develop for suspension, deduction, and termination events, including complete workers' compensation/public disability payment history, government pension offset, work deductions, etc.
* Obtain evidence needed for entitlement.
2. Title XVI
When processing a title XVI allowance, follow:
* SI 00603.002 if non-disability development was completed when the claim was processed initially.
* SI 00603.035 if non-disability development was deferred when the claim was processed initially.
3. SGA development
* Follow DI 13010.001 to determine if any work activity is SGA.
NOTE: All work activity must be fully documented to determine period of non-entitlement due to SGA.
* If SGA necessitates an onset change, return the folder to the DDS.
* If SGA resumed within 12 months of the established onset and continued throughout the Goodnight period to be developed, reopen and revise the DDS determination to an SGA denial determination. Annotate Form SSA-831-U3 in the remarks section “This Determination Revises the DDS Determination of (date of Form SSA-831-U3).” Send a copy of Form SSA-831-U3 to LS at the address shown in DI 52510.010B.2.a.
* If SGA does not preclude entitlement (e.g., SGA begins more than 12 months after established onset), establish 1619 status for title XVI, if applicable and trial work period or extended period of eligibility status for title II claims.
H. Procedure - processing affirmations
When processing a title II and/or title XVI affirmation:
* DO NOT input to the Modernized Claims System (MCS). Make systems input only for reversals.
* Take no action on the notice. (The DDS prepares and releases the notice.)
* Retain the folder(s) during the appeals period.
* Where no appeal is filed, route the title II folder(s) to the appropriate component for filing and retain the title XVI folder(s) in the FO.
I. Procedure - processing favorable title II benefits
1. Computing benefits
Consider the following when computing benefits:
* Medicare premiums;
* Overpayments;
* Attorney Fees - withhold 25% of past due benefits when the folder shows there is an attorney of record. Payment of this money is subject to a fee petition/agreement from the attorney or record.
* Offsets, including complete workers' compensation/public disability payment history, government pension offset, work deductions, etc.
2. Allowances
Title II allowances are processed as District Office Final Adjudication (DOFA).
* MCS Earnings Computation (EC) and MCS Claims Automated Processing System (CAPS)
* Annotate the Development Worksheet (DW01) by entering “New” in the Issue field and “Goodnight Court Case” in the remarks field.
* Suppress the notice and prepare a manual notice including the language shown on the SSA-865 supplied by the DDS.
* Send a copy of Form SSA-831-U3 and a copy of the MCS System Menu screen with the remark “Final Trigger Processed” to the LS at the address shown in DI 52510.010B.2.a.
* A101 or SSA-101-U3
* Enter “ Goodnight Court Case” in the remarks field on the A101 or in item 11 of Form SSA-831-U3.
* Prepare a manual notice using an SSA-573 and include the language shown on the SSA-865 supplied by the DDS.
* Send copies of Form SSA-831-U3, A101 or SSA-101-U3 to the LS at the address shown in DI 52510.010B.2.a.
* Follow appropriate attorney fee petition/agreement procedures.
* Route the case to OCO or the appropriate PSC under the cover of an SSA-3601 or SSA-3293, as appropriate. Check the “other” block and enter in the remarks section“Goodnight Court Case Class Action - Case Should Be Processed Per DI 52510.015E.”
* Prepare an SSA-1418 for folder movement.
J. Procedure - processing favorable title XVI payments
1. Computing payments
Consider the following when computing payments:
* Overpayments;
* Offsets (GN 02610.010B, GN 02610.064, and SI 02006.001)
2. Interim Assistance Reimbursement (IAR) involved
Follow SI 02003.000 when IAR is involved.
3. Initial denial posted (e.g., N-30)
a. Initial denial posted
* T-30 prior record (if needed - see SM 01801.001).
* Process a start date record with an SSA-450-SI.
b. No record online
* Follow routine procedures for establishing a record.
* Process an SSA-450-SI per SM 01005.000.
* Show Goodnight in the CG field.
4. Record in T-50 or T-51 status
If the record is in T-50 or T-51 status, prepare an SSA-450-SI per SM 01005.001 to establish a new record.
5. Record in T-30 or T-31 status
Refer to SM 01005.020D if the record is in T-30 or T-31 status.
6. Initial denial - record in pay status based on subsequent claim
* T-30 the C01 record and re-establish an SD record with the Goodnight case filing date.
* Process A-OTP to pay retroactive amount back to Goodnight DOE per SM 01901.150.
7. Notices
Prepare and release the appropriate SSI notice, with a copy to the representative, if applicable.
K. Procedure - processing favorable concurrent title II/XVI payments
Process each title under the procedures provided in DI 52510.010I and DI 52510.010J, as appropriate, making sure that any applicable offset is applied.
See GN 02610.005, GN 02610.010B, and GN 02610.064 for offset considerations.
L. References
Manual notices, NL 00801.010 Notice language, NL 00804.100 Information on start date records and notice suppression, NL 00801.015 IAR, SI 02003.000

POMS Reference

DI 52510.010: Goodnight FO Actions