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SI 04050.040: Title XVI Court Reversals

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  • Effective Dates: 12/02/2014 - Present
  • Effective Dates: 11/08/2017 - Present
  • TN 1 (08-99)
  • SI 04050.040 Title XVI Court Reversals
  • A. Process — title xvi disability and title ii/xvi concurrent cases
  • 1. OGC
  • OGC forwards court reversal decisions, (i.e., final orders issued by Federal Courts reversing the Commissioner's determination(s)) to the LS.
  • OGC forwards court reversal decisions, (i.e., final orders issued by Federal Courts reversing the Commissioner's determination(s)) to the effectuating component that prepares program policy and procedure so these components may determine whether to appeal the court’s decision.
  • 2. LS and Program Component
  • 2. When the Decision Is Not Appealed
  • LS then forwards copies of each reversal decision to the effectuating component. LS forwards copies to components that prepare program policy and procedure so these components may determine whether to appeal the court's decision.
  • In concurrent (title II/title XVI) disability cases,LS sends a copy of the reversal decision to OCO (or the servicing PSC) and to the SSI-effectuating component via the Regional Litigation Coordinator. In title XVI-only cases, OGC sends a copy of the reversal decision to the regional effectuating component via the Regional Litigation Coordinator.
  • 3. When the Decision Is Not Appealed
  • In concurrent (title II/title XVI) disability cases,LS sends a copy of the reversal decision to OCO (or the servicing PSC) and to the SSI-effectuating component via the Regional Litigation Coordinator. In title XVI-only cases, LS sends a copy of the reversal decision to the regional effectuating component via the Regional Litigation Coordinator.
  • 4. Attorney Fee
  • 3. Attorney Fee
  • Should the case involve an attorney fee, OCO sends OGC a copy of Form SSA-1129-U3 (Attorney Fee Case — Past Due Benefit Summary).
  • See SI 02006.200 ff. for attorney fee offset.
  • 5. Responsibility For Effectuation
  • 4. Responsibility For Effectuation
  • We send a copy of the title XVI award notice(s) to the Regional Litigation Coordinator, who is responsible for tracking the effectuation of title XVI reversal decisions, in accordance with any regionally established procedures. The Regional Litigation Coordinator will notify LS after all title XVI effectuation actions have been completed and will provide the dates and amounts of payments. See GN 03106.060, Effectuating Component Responsibility.
  • We send a copy of the title XVI award notice(s) to the Regional Litigation Coordinator, who is responsible for tracking the effectuation of title XVI reversal decisions, in accordance with any regionally established procedures. The Regional Litigation Coordinator will notify OGC after all title XVI effectuation actions have been completed and will provide the dates and amounts of payments. See GN 03106.060, Effectuating Component Responsibility.
  • 6. If the Decision Is Appealed
  • 5. If the Decision Is Appealed
  • If the Commissioner is appealing the reversal decision, LS will notify the appropriate OCO manager in the Division of Appealed Claims (DAC) (or PSC Reconsideration Branch Chief) and the Regional Litigation Coordinator. The Regional Litigation Coordinator will notify the FO not to effectuate while the appeal is pending.
  • If the Commissioner is appealing the reversal decision, OGC will notify the appropriate OCO manager in the Division of Appealed Claims (DAC) (or PSC Reconsideration Branch Chief) and the Regional Litigation Coordinator. The Regional Litigation Coordinator will notify the FO not to effectuate while the appeal is pending.
  • B. Process — title xvi non-disability cases
  • 1. Role of OGC
  • OGC's role is the same as in title XVI disability cases as described in SI 04050.040A.1.
  • 2. LS and Program Components
  • 2. OGC and Program Components
  • OGC sends all reversals and decisions in title XVI cases to LS. LS transmits a copy of each decision to policymaking components and to the appropriate Regional Litigation Coordinator. On the copy that it sends to the Regional Litigation Coordinator, LS will indicate the FO code. The Regional Litigation Coordinator will forward the reversal decision to the FO.
  • OGC sends all reversals and decisions in title XVI cases to LS. LS transmits a copy of each decision to policymaking components and to the appropriate Regional Litigation Coordinator. On the copy that it sends to the Regional Litigation Coordinator, OGC will indicate the FO code. The Regional Litigation Coordinator will forward the reversal decision to the FO.
  • The FO obtains the claims folder from ODAR, Mega-Site (703) 605-8930. (Folders retained by the Mega-Site show a folder location of “5017” on the ODAR Case Control System OHAQ query.)
  • The FO obtains the claims folder from OHO, Mega-Site (703) 605-8930. (Folders retained by the Mega-Site show a folder location of “5017” on the OHO Case Control System OHAQ query.)
  • LS sends a copy of the court order to the appropriate Regional Litigation Coordinator. The Regional Litigation Coordinator is responsible for tracking the effectuation of title XVI reversal decisions in accordance with any regionally established procedures. The Coordinator will forward the court order to the FO and will track the effectuation of the reversal decision.
  • OGC sends a copy of the court order to the appropriate Regional Litigation Coordinator. The Regional Litigation Coordinator is responsible for tracking the effectuation of title XVI reversal decisions in accordance with any regionally established procedures. The Coordinator will forward the court order to the FO and will track the effectuation of the reversal decision.
  • C. Procedure
  • 1. Effectuate the Decision Promptly
  • Expedite all actions, and, where necessary, “walk the action through” all the processing steps. See SI 04030.070 for redeterminations after reversals. See GN 03106.060E. for information on obtaining the folder
  • 2. Effectuation Is Delayed
  • Should effectuation of a reversal decision be delayed beyond 95 days from the date of the final court order, notify the claimant(s) in writing that payment will be delayed. In the notice, indicate the reason for the delay and send informational copies to the appellant's attorney (if any), to Office of General Counsel, Correspondence Control Staff, Altmeyer Room 617, 6401 Security Blvd., Baltimore, MD 21235, Attn: Class Action Coordinator. Also, send a notice if payment under either title, or under both titles, will be delayed. See GN 03106.099 for exhibit of the 95 day letter.
  • D. Reference
  • Redeterminations After Reversals, SI 04030.070
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