TN 35 (08-93)

A. Introduction

As a result of class action court decisions, SSA is at times required to readjudicate its past determinations. The special review criteria required by a court's order are not generally well known in areas outside of the State(s) affected by that order.

This becomes a problem if a claimant has moved out of the area affected by the court's order since DDS/FO personnel in the new State may not be familiar with the pertinent review criteria.

B. Policy

1. Jurisdiction

Court-ordered reviews of class members' claims are generally the jurisdiction of the DDS which made the determination to be reviewed.

This is true even if the claimant has moved out of that DDS's usual area of jurisdiction.

Exceptions are:

1. The State in which the claimant now lives will have jurisdiction, if the court order also is applicable in that State (e.g., in nationwide, region-wide or circuit-wide classes).

2. If a face-to-face review is appropriate (cessation cases), the “resident” DDS will have jurisdiction.

3. If the court order requires otherwise (e.g., review by the resident DDS is mandated).

2. Initial payment

Both preceding and following court-ordered reviews, any benefits which can be paid (e.g., on partially favorable determinations) will be, prior to the processing of any appeal requests, folder referrals (see 3.), etc.

3. Subsequent (current) claim pending adjudication or appeal

If there is a subsequent (current) claim involving common issues pending in:

1. A DDS or DHU which has court case jurisdiction (see DI 32502.001B.1., above):

   • The class action claim and the subsequent claim will be combined in that DDS.

   • That DDS will process on a priority basis (to the extent possible) a determination or determinations covering both the court-ordered review and the subsequent (current) claim.

2. Another State (DDS, DHU, or FO):

   • The subsequent (current) claim will be sent to the State having responsibility for the court case for association with the claim(s) to be reviewed under the class action. (NOTE: If OHA has jurisdiction for the court case, see d.). Prior to referral, however, if the evidence to do so is readily available, the current claim will be adjudicated and paid without delay (if a favorable determination is processed). If this is to be done, notify the State with court case review jurisdiction (or OHA) of the reason for the delay. Additionally, customary processing of the subsequent (current) claim should never be delayed in anticipation of a class action alert.

   • If a subsequent (current) claim is referred for association with a class action claim, the claimant will be notified by the referring DDS, DHU, or FO using appropriate language. For example:

     “We have sent your new (disability/Supplemental Security Income/ Social Security disability and Supplemental Security Income) claim(s) to the ( name of new State DDS) to review your disability under the ( name of class action) class action court case. (Name of new DDS) has responsibility for your claim.

     The review may cover the same period and issues raised by your earlier application. The (DDS) will process your claims and they will contact you.”

   • The State responsible for the court-ordered review will combine the claims for processing. If the subsequent claim is unadjudicated, the combined claims should be processed on a priority basis (to the extent possible).

   EXCEPTION: If the claimant alleges a terminal illness on the current claim, the resident DDS has jurisdiction of that claim and the court case review. If another subsequent claim or court-ordered review case is pending at OHA or a court, contact OHA's court case coordinator to discuss processing.

3. OHA: Class members' (or potential class members') claims folders will be sent for association with the OHA claim (see DI 32502.001B.4., below).

   After screening the case for class membership, OHA will:

   • Prepare and mail a non-member notice; or

   • Combine the claims and render an all-inclusive decision(s); or

   • Dismiss the request for hearing on the subsequent claim and return both claims to the DDS having jurisdiction of the court case (see DI 32502.001B.5., below) for combined processing; or

   • Decide not to combine the claims. The appropriate folder(s) will be forwarded to the DDS (see DI 32502.001B.1., above) for independent processing of the court-ordered review.

4. A location other than OHA, where OHA has review jurisdiction for the court-ordered review:

   If a subsequent (current) claim is referred to OHA for association with a court-ordered review case, the claimant will have been notified using appropriate language. For example:

   “We are sending the (disability/Supplemental Security Income/Social Security disability and Supplemental Security Income) claim(s) you filed on (date of filing(s)) to the (name of hearing office), which has responsibility for your claim, to review it under the (name of class action) class action court case.

   The review may cover the same time period and issues as your earlier claim.

   The Hearing Office may process your claims at the same time. They will contact you.”

4. Class action claim referred to OHA

Where a DDS is transferring a class action claim to OHA (e.g., because it finds that a current claim is pending in OHA) and the claimant knows that his or her claim is in the DDS, the DDS must notify the claimant of the transfer using the appropriate language. For example:

“We are sending the (disability/Supplemental Security Income/Social Security disability and Supplemental Security Income) claim(s) you filed on ( date of filing) to the (name of hearing office). We are doing this because you asked us to review your disability under the ( name of class action) class action court case.

The review may cover the same period and issues involved in the claim you recently filed. That claim is pending in the (name of hearing office).

The Hearing Office may process your claims at the same time. They will contact you.”

5. Claims returned from OHA

If OHA dismisses a request for hearing on a subsequent (current) claim and remands both claims to the DDS (see DI 32502.001B.3.c., above), the DDS will prepare a subsequent determination covering both, if appropriate.

6. Subsequent DDS, DHU or OHA determination decision exists

A subsequent denial (cessation) determination/decision is not binding with respect to court-ordered reviews, unless it was made under the court-ordered criteria.

7. Work/Medical development

Development of work activity and/or medical evidence will be coordinated with resident FOs and DDSs, as appropriate.

8. QA review

Selection of claims for QA review will be unaffected (unless a change is specifically mandated by the court order).

9. Appeals

Appeal requests will be the jurisdiction of a DHU or OHA hearing office servicing the claimant's residence, as usual.

C. References

Since the processing criteria in court-ordered reviews vary, procedures specific to each class action will be in the individual DDS POMS guides for that class action.