Audience:

DDS:

ADJ, DHU

DO/BO/TSC:

CR, CR TII, CR TXVI, FR, OA, OS, RR

OCO-ODO-IND:

CATA, DEC, DS, ISTA

OCO-ODO-SHARE:

CA, DE, IS, RECONE, RECONR

OCO-OIO:

CATA, FCR, FDE, RECONE, RECONR

PSC:

CA, CRTA, CS, DE, DEC, ICDS, IES, ISRA, RECONR

Citations:

20 CFR 404.903, 404.985, 410.615, 410.670c, 416.1403, 416.1485, 422.406, 422.410, 422.430, 422.432

TN 4 (08-03)

Citations:

20 CFR 404.985 and 416.1485

20 CFR 404.985(b)(2) and 416.1485(b)(2)

20 CFR 404.903(o) and 416.1403 (a)(10)

A. Background

In 1990, the Social Security Administration (SSA) published final regulations in the Federal Register regarding its acquiescence policy. These rules reflected a policy first adopted by SSA in 1985. These regulations explained that upon receipt of a circuit court decision, SSA determines whether the court’s holding (specific legal principle(s) to be drawn from the opinion which was essential to the resolution of the case) conflicts with SSA’s interpretation of the Social Security Act or its regulations.

If SSA determines that the holding conflicts with SSA’s interpretation of the Social Security Act or SSA’s regulations and SSA does not seek further judicial review or has been unsuccessful in seeking further review, it will issue an acquiescence ruling (AR). The AR will explain the court’s holding, and contain a statement of how the court’s decision differs from SSA policy and how SSA adjudicators are to apply the court’s holding, instead of SSA’s nationwide policy, when deciding claims within the applicable circuit. These regulations also explained how individuals whose claims were adjudicated between the date of the court decision and the issuance of the AR could ask to have their case readjudicated based on the AR.

In May 1998, these regulations were revised. The new regulations provided two major changes. First, they established a 120-day time frame (from the date SSA receives the court decision) for SSA to release an AR to the Federal Register for publication. Previously there was no timeframe. Second, while SSA is determining whether an AR is needed (during the 120-day timeframe), the regulations established a process for adjudicators to identify and code cases within States covered by the applicable circuit court that possibly could be affected by the issuance of an AR. If an AR is published, we send the notice contained in GN 03501.047 (Exhibit 2) to the individuals whose cases possibly could be affected by the AR. The notice explains what an individual needs to do to request a “readjudication” to have the AR applied to his or her case. Previously, individuals had the right to request readjudication but there were no procedures in place to provide personal notice of this right to individuals possibly affected by the AR.

B. Policy

1. When We Receive a Circuit Court Decision

Once SSA receives a Circuit Court decision, we determine whether it may require an AR. If we believe there is a possibility that an AR will be needed, an Emergency Message (EM) is prepared and released to all appropriate adjudicators. The EM instructs them to code pending claims which possibly could be affected if an AR is subsequently issued. The EM briefly explains:

• the court’s decision;

• the possible need for an AR;

• the criteria the adjudicator must consider in determining whether the case should be coded;

• the code used to identify the claim; and

• the process to follow. (See GN 03501.002 for specific coding instructions.)

2. Effective Date of Acquiescence Rulings

Acquiescence Rulings will generally be effective on the date of their publication in the Federal Register and will apply to all determinations and decisions made on or after that date unless the AR is later rescinded. Cases coded prior to the issuance of the AR and which are readjudicated under the AR will have the AR applied to them during the readjudication process.

C. Procedure

1. Handling Requests for Readjudication After Issuance of an AR

Once we decide that a particular holding of a Circuit Court case conflicts with our interpretation of the Social Security Act or our regulations, we will issue an AR. An exception to this is if we decide to seek further judicial review.

a. Claimants Identified by Coding Process

Once an AR has been issued, the Office of General Counsel, Office of Program Law (OPL) will issue a second EM to the affected components telling them to stop coding. We will later send out another EM advising affected components that the notices are being sent and give them any additional information or instructions.

When we notify claimants possibly affected by the AR, the notice will include language explaining the following information (GN 03501.047- Exhibit 2):

• the Circuit Court case name and the publication date of the AR.

• what the Circuit Court decision found and the States to which it applies.

• how to contact the local field office and request a new determination or decision based on application of the AR to the individual’s claim.

If the claimant contacts the field office (FO) about having the AR applied to his or her claim, the FO will process the request as discussed in subsections GN 03501.001C.1.b through 5 below.

If an individual contacts the national 800 number, the 800 number agent will take the following actions:

• schedule a postentitlement (PE) appointment if one is available, otherwise, send a manual development worksheet.

• include in REMARKS the title and/or number of the AR (e.g., AR01-1(3) Sykes v. Apfel) and the reason he or she believes that applying the AR could change the decision in his or her case. The claimant may provide a statement that cites the AR or the holding or portion of the circuit court decision which could change the decision in his or her case.

• provide the caller with the address for the servicing FO if he or she indicates that he or she would like to submit evidence.

b. Self-Identified Claimant (i.e., Claimants who were not sent a readjudication notice) - Requesting Readjudication after Issuance of the AR

Readjudication may apply to claimants with pending claims (i.e., cases awaiting adjudication on administrative review or adjudicated cases in which the time to request administrative review has not expired) and also to claimants with lapsed claims because a timely appeal was not pursued. The time limits for reopening do not apply to a request for readjudication.

• If a self-identified claimant contacts the FO about having the AR applied to his or her claim, obtain information from the claimant, as appropriate, about how application of the AR could change the decision in his or her case.

• Follow the procedures in GN 03501.001C.2. through GN 03501.001C.5.

NOTE: If an AR has not yet been issued and a claimant inquires about the application of a potential AR or circuit court decision to his or her case, follow the coding procedures under GN 03501.002.

2. For ARs with Medical/Vocational Issues

a. The servicing FO will:

• obtain information from the claimant, as appropriate, about how applying the AR could change the decision in his or her case. The claimant may provide a statement that cites the AR or the holding or portion of the circuit court decision which could change the decision in his or her case.

• accept any evidence the claimant wishes to submit.

• obtain the folder.

• apply the normal procedures for securing folders or finding lost folders.

• reconstruct the folder, if necessary, if it is not retrieved within 180 days of the request for readjudication or at any point that it is clear that the folder can not be located. See instructions in GN 03501.001C.4.

• not develop the claim at this point. Any additional development that might be needed will be determined and initiated by the adjudicator where the readjudication request was forwarded.

b. Routing

For readjudication requests where no subsequent application or appeal is pending, proceed as follows:

• Complete the transmittal flag and input the case control folder movement information. (See Exhibit 1 - GN 03501.046)

• Determine the last location the claim was adjudicated, and forward the folder and new material to that location.

• The adjudicator at the location where the folder is forwarded will then decide if application of the AR could change the determination or decision.

• For readjudication request where a subsequent application or appeal is pending, proceed as follows:

  • Send the prior folder and new material to the office where the claim is pending.

  • The readjudication may be held until adjudication of the pending claim or appeal. See GN 03501.015B.2.

3. For ARs Whose Issues are Other than Medical/Vocational

a. The servicing FO will:

• obtain information from the claimant, as appropriate, about how application of the AR could change the decision in his or her case. The claimant may provide a statement that cites the AR or the holding or portion of the circuit court decision which could change the decision in his or her case.

• accept any evidence the claimant wishes to submit.

• obtain the folder only when necessary. Otherwise, develop the relevant case background and prior administrative history that is needed using appropriate queries such as the MBR, SSID, DDSQ, SEQY, DEQY, ODAR query and MCS and MSSICS screens. The period covered by a readjudication is the same period that was covered by the determination or decision to be readjudicated.

• apply normal procedures for securing folders or finding lost folders.

• reconstruct the folder, if necessary, if it is not retrieved within 180 days of the request for readjudication or at any point that it is clear that the folder cannot be located. See instructions in GN 03501.001C.4.

• decide where the case was last adjudicated, if no current claim or appeal is pending.

• decide whether to grant the individual’s request to readjudicate the claim, if the FO was the point of last adjudication. See GN03501.015C.

b. If the request for readjudication is denied by the FO:

• Send a notice to the claimant advising that the request is being denied. (See GN 03501.015D.3. and GN 03501.015D.4).

• Return the folder to its original location. The claimant does not have appeal rights with respect to the denial of a request for readjudication.

c. If the case was last adjudicated at a location other than the FO and no subsequent application or appeal is pending, route as follows:

• Complete the transmittal flag and input the case control folder movement information. (See Exhibit 1 - GN 03501.046)

• Forward the folder and new material to the location where the claim was last adjudicated.

• The adjudicator at the location where the folder is forwarded will then grant the request for readjudication if application of the AR could change the determination or decision. (See GN 03501.015C)

d. If the case was last adjudicated at a location other than the FO and a subsequent application or appeal is pending, route as follows:

• Send the prior folder and new material to the office where the claim is pending.

• The readjudication may be held until adjudication of the pending claim or appeal. See GN 03501.015B.2.

4. Lost Folder Cases-FO Reconstruction

• Use appropriate queries such as the MBR, SSID, DDSQ, ODAR query, SEQY, DEQY to investigate the prior administrative action. For example, in a disability case, you would look for the last unfavorable or partially unfavorable decision during the period from the date of the circuit court decision through the date of the issuance of the AR.

• Reconstruct the folder using instructions in GN 03105.020.

• It is not necessary to obtain a duplicate application.

• For ARs involving non-disability issues, folder reconstruction is necessary only when the folder is necessary to readjudicate the claim.

5. DDS Receipt and Clearance Instructions

a. Receipt

Lapsed cases - A lapsed case is one in which a timely appeal has not been pursued. Receipt the case at the initial or reconsideration level as indicated on the transmittal flag.

Cases with pending claims - If a subsequent claim is currently pending, input the readjudication request using a Beneficiary Identification Code (BIC) of AR (Assistance Request).

b. Clearance

Systems Override - Input the system override (S) code “C” on cases eligible and ineligible for readjudication clearances.

Other Clearance Instructions - Other than this system, clear cases eligible and ineligible for readjudication in the normal manner.

c. Disposition of folder after review

If a case is not selected for Quality Assurance (QA) review, route the case to the servicing FO or, if a case is selected for QA or Pre-Effectuation Review (PER), to the Disability Quality Branch (DQB).

For all other cases, follow normal folder routing procedures.