DI 52510.015: Goodnight OCO/PSC Actions

changes
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~~Effective Dates: 02/08/2016 - Present~~
Effective Dates: 05/31/2018 - Present
TN 2 (04-99)
DI 52510.015 Goodnight OCO/PSC Actions
A. Policy
Alerts are generated in OCO when an individual requests Goodnight review. The alerts will be used to locate and retrieve Goodnight class claims.
B. Procedure - alert/query package
The alert/query package consists of a CATS alert cover sheet, SSIRD, AR-25, MBR FACT, OHAQ, DDSQ, DDBQ, and SEQY. PCACS, PPL ROQS (PPL ROQS) queries query can be obtained on NS Elite for the most current folder location. OCO will take the following action on the alerts that are generated.
* Associate the alert/query package with the reply form.
* If the alert contains the remark “LATE RESPONDER - GOOD CAUSE DETERMINATION NEEDED”, forward the alert/query package to the FO via an SSA-559 for development of good cause for late filing. Annotate the SSA-559 “Good Cause Determination Necessary.”
NOTE: If there is any indication from any of the returned correspondence that the individual has mental impairments, the individual will be deemed to have good cause for late filing.
* After the alert/query package is associated with the reply form, route the packages as follows:
1. Title XVI only
* At least one folder in WB - OCO sends the alert/query package to WB. WB sends any folders they locate to the Utah DDS for class member eligibility screening.
* No folders in WB - OCO sends the alert/query package to the office which has the folder (i.e., the FO).
* At least one folder in WB and at least one folder in the FO
OCO sends the alert/query package to WB and instructs WB to associate the alert/query package with any folder(s) in WB and to forward the folder(s) to the FO to associate with any folder(s) in the FO.
2. Title II only - no folder in OCO
* One or more folders in the PSC or the alert is PSC jurisdiction - OCO sends the alert/query package to the PSC for association with the folder(s). The PSC sends folders that are retrieved to the Utah DDS for class member eligibility screening.
* All folders in the PSC - The PSC associates all folders and sends them to the Utah DDS for class member eligibility screening.
* At least one folder not in the PSC - The PSC follows OCO instructions shown in DI 52510.015B.2.b. and DI 52510.015B.2.c.
* All folders in the DDS or ODAR - OCO sends the alert/query package to the DDS or ODAR for association with the folders and for class member eligibility screening.
* All folders in the DDS or OHO - OCO sends the alert/query package to the DDS or OHO for association with the folders and for class member eligibility screening.
* One or more folders in the FO, no folders in the PSC - OCO sends the alert/query package to the FO. The FO associates the package with the folders and sends the folders that are retrieved to the Utah DDS for class member eligibility screening.
3. Title II only - one or more folders in OCO
* All folders in OCO - OCO associates the folders with the alert /query package and sends the folders to the Utah DDS for class member eligibility screening.
* One or more folders in the PSC or the alert is PSC jurisdiction - OCO sends the alert/query package to the PSC for association with the PSC folder(s). The PSC sends the folders that are retrieved to the Utah DDS for class member eligibility screening.
* All non-OCO folders in the DDS - OCO sends its folder(s) to the DDS for association with the folder(s) and for class member eligibility screening.
* One or more folders in the FO - OCO sends its folder(s) to the FO. The FO associates all folders and sends the folders that are retrieved to the Utah DDS for class member eligibility screening.
* No folders in the FO or the PSC, one or more folders in a location other than the DDS or ODAR.
* OCO obtains the folder(s) from all locations other than the DDS or ODAR.
* No folders in the FO or the PSC, one or more folders in a location other than the DDS or OHO.
* OCO obtains the folder(s) from all locations other than the DDS or OHO.
* OCO forwards the folder(s) to the Utah DDS for association with any folder(s) that the DDS may have and for class member eligibility screening.
C. Procedure - folder retrieval
OCO and the PSCs will retrieve Goodnight folders as follows:
1. Determining folder location
* Examine the case control query in the alert/query package to determine the existence and location of the Goodnight folder(s) and verify the SSN.
* If none of the queries and/or alerts yield a folder location, examine the MBR/SSR and STALE record to verify that the SSN is correct.
If there is no record under that SSN, send the individual the “SSN Verification Notice” (see DI 52510.095, Exhibit 7). Include a postage-paid return envelope addressed to LS. Send the alert/query package and a copy of the notice to LS at the address shown in DI 52510.010B.2.a.
* Process as a lost folder (see DI 52510.015C.5.), if the folder is not in the location shown on the case control system and a thorough folder search (within 120 days of the alert date) is unsuccessful.
2. Folder retrieval
* Locate and retrieve all available title II (and title XVI, if necessary) medical folders covered by the Goodnight timeframes (i.e., on or after 01/01/91, through 02/20/94) as well as all subsequent claims (even if they involve a favorable determination), except claims that are currently pending in the DDS or ODAR.
* Locate and retrieve all available title II (and title XVI, if necessary) medical folders covered by the Goodnight timeframes (i.e., on or after 01/01/91, through 02/20/94) as well as all subsequent claims (even if they involve a favorable determination), except claims that are currently pending in the DDS or OHO.
In concurrent title II/title XVI cases, do not request the title XVI folder if the title II folder contains the medical evidence.
* Associate all multiple claims folders.
* Review the available folder(s) to determine that the pertinent Goodnight claims have been obtained. If there is a missing folder(s), ascertain whether the missing folder(s) is a Goodnight folder by determining whether the determination date on Form SSA-831-U3 in the available folder is within the Goodnight timeframes.
* If the missing folder(s) is a Goodnight folder, follow DI 52510.015C.5.
* If the missing folder is not a Goodnight folder, annotate the alert “Goodnight Folder Located - Unable to Locate Other Folder.”
* Place the alert/query package and folder search documentation (i.e., Court Case Folder Retrieval Worksheet) in a manila holder and attach it to the front cover of the folder,and
Prong file the reply form on the right side of the folder and forward the folder(s) to the Utah DDS for class member eligibility screening.
3. Title II folder(s) not in files
If the title II folder(s) is not in the PC files:
* Request the folder(s) from the Federal Records Center, Federal Archives and Records Center or other PC storage location(s) as needed, and
* Diary and follow-up on the request as needed.
4. Claim pending - goodnight folder not located
If a current claim is pending and the Goodnight folder(s) cannot be located:
* Contact the FO, DDS or ODAR to find out whether the Goodnight claim(s) is associated with the pending claim.
* Contact the FO, DDS or OHO to find out whether the Goodnight claim(s) is associated with the pending claim.
* If the Goodnight folder(s) is with a pending claim and the pending folder is located in the:
* DDS, forward the alert/query package to the DDS for association with the folder. Annotate the alert “Associate with Current Claim Pending in Your Office - Goodnight Class Member Eligibility Decision Necessary Per DI 52510.020.”
* FO, forward the alert/query package to the FO for association with the folder. Advise the FO to send the folders to the Utah DDS for class member eligibility screening.
* ODAR, hearing office (HO), contact the HO directly. If the folder(s) is located in ODAR headquarters, send the alert/query package to: Office of Disability Adjudication and Review Office of Appellate Operations Attn: OAO Class Action Coordinator One Skyline Tower, Suite 701 5107 Leesburg Pike Falls Church, VA 22041-3200
* OHO, hearing office (HO), contact the HO directly. If the folder(s) is located in OARO headquarters, send the alert/query package to: Office of Disability Adjudication and Review Office of Appellate Operations Attn: OAO Class Action Coordinator One Skyline Tower, Suite 701 5107 Leesburg Pike Falls Church, VA 22041-3200
* If the Goodnight folder(s) is not associated with the pending claim, follow DI 52510.015C.5.
* If the claim is pending in court, return the alert to ODAR headquarters.
* If the claim is pending in court, return the alert to OARO headquarters.
5. Lost/Destroyed folders
If a pertinent Goodnight folder(s) cannot be located within 120 days of the alert date:
* Document all efforts to locate the Goodnight folder(s) on a Court Case Folder Retrieval Worksheet (see DI 52510.095, Exhibit 4).
* Prepare a “manila” folder jacket to hold the reply form, alert, related queries, and documentation of attempts to locate the Goodnight folder(s).
* When one or more Goodnight claims has been destroyed or declared lost, determine if the case may be screened-out solely on the basis of information shown on the queries, i.e., determination made outside of the Goodnight timeframes.
If the claim(s) can be screened-out:
* Complete a screening sheet (see DI 52510.095, Exhibit 8) and place a copy of the screening sheet in the manila holder or claims folder, if available.
* Send notice of non-entitlement to relief to the claimant, any representative, and a copy to class counsel (see DI 52510.095, Exhibit 5).
* Forward a copy of the completed screening sheet to OCO at the address shown in DI 52510.005B.3.b.
If the claim(s) cannot be screened out:
* Annotate the alert “UTL Prior Folder(s) - FO (enter FO code) Requested to Reconstruct.”
* Photocopy the annotated alert and send a copy of the alert to the Goodnight coordinator in LS. See DI 52510.010B.2.a. for address.
* Complete a screening sheet and forward a copy of the screening sheet to OCO.
* Send the manila folder via an SSA-559 to the servicing FO. Annotate the SSA-559 “Goodnight Lost Folder Case - Please Reconstruct. Forward Reconstructed Folder to the Utah DDS for Redetermination.” Provide the FO with specific information regarding the types of applications and dates needed for reconstruction.
NOTE: Entitlement to relief will be presumed in reconstructed cases if the queries indicate a medical denial on or after 01/01/91, through 02/20/94.
D. Procedure - subsequent fully favorable decisions
If a subsequent fully favorable decision covers the entire period at issue in the Goodnight class claim, take the following actions.
1. PC screener action
* If a title II case is screened-out because a fully favorable later allowance was made, review the folder to determine if full retroactive benefits were paid (i.e., all benefits payable based on the earliest Goodnight 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 Are Due.”
* Instruct the CA to include the following language in the notice:
* “This determination is based on a review of your claim under the Goodnight v. Apfel court case.”
2. CA action
* Prepare a new A101 or SSA-101-U3. Cite “Goodnight Court Case” as the reason for amending the award in item 11 on the A101 or SSA-101-U3.
* Send a copy of the A101 or SSA-101-U3 to the Litigation Staff. See DI 52510.010B.2.a. for address.
3. BA action
* Process the A101 or SSA 101-U3 to effectuate the payment of the additional benefits.
* Apply the usual withholding procedures and offsets.
* Follow the usual processing procedures including attorney fee petition/ agreement procedures.
E. Procedure - processing favorable Title II allowances
Take the following actions when reversing a title II denial to an allowance.
1. Allowances at the reconsideration level - non-DOFA A101 or SSA-101-U3
* Follow the usual procedures for processing title II denial cases reversed to allowances.
* Show “Goodnight Court Case” in the remarks field of the A101 or the SSA-101-U3.
* Prepare an SSA-573 to include the notice language shown on the SSA-865 provided by the DDS.
* Send a copy of the SSA-101-U3 or A101 to the Litigation Staff. See DI 52510.010B.2.a. for address.
2. Allowances at the ALJ or administrative appeals judge level
* Enter the remark “Goodnight Court Case” in item 11 of Form SSA-831-U3 and the statement “This determination revises the DDS determination of (date of the prior denial).”
* MCS EC
* Follow the usual procedures in processing title II allowances.
* Update all MCS screens.
* Enter “New” in the issue field and “Goodnight Court Case” in the remarks field of the DW01 screen.
* Suppress the notice and prepare a manual notice on an SSA-573 to include the appropriate language as described in DI 52510.020H. or DI 52510.020I.
* A101 or SSA-101-U3
* Enter “Goodnight Court Case” in the remarks field of the A101 or item 11 of the SSA-101-U3.
* Prepare a manual notice on an SSA-573 to include the appropriate language as described in DI 52510.020H. or DI 52510.020I.
* Send a copy of the A101 or SSA-101-U3 and a copy of Form SSA-831-U3 to the Litigation Staff. See DI 52510.010B.2.a. for address.
* Forward the case to a BA to effectuate payment in accordance with DI 52510.015D.3.
~~3. ODAR decision~~
3. OHO decision
~~If there is an ODAR decision in a subsequent claim, pay benefits without being bound by the ODAR decision; except the case may not be reopened and revised to a less than favorable finding.~~
If there is an OHO decision in a subsequent claim, pay benefits without being bound by the OHO decision; except the case may not be reopened and revised to a less than favorable finding.

POMS Reference

DI 52510.015: Goodnight OCO/PSC Actions