TN 1 (11-00)

A. Process - Responsibilities

1. General

All prior claims denied medically within the Hyatt III timeframe (on or after July 7, 1981, and before November 14, 1991) must be obtained.

EXCEPTION: The title XVI portion of concurrent title II/title XVI claims will not be obtained since the medical evidence should be in the title II folder.

Folders not located within 120 days of the date the search began are considered lost and the folder(s) must be reconstructed.

2. PC responsibility

The PC is responsible for locating claims folders, determining what folders are lost or destroyed, when reconstruction is necessary and designating someone to authorize reconstruction.

3. FO responsibility

FO responsibilities include:

• Obtaining prior folders when requested by the DDS.

• Reconstructing folders when unable to locate (UTL) Hyatt III folders.

• Contacting the class member, or representative to update the folder.

• Developing “good cause” for late responders.

4. DDS responsibility

DDS responsibilities include:

• Determining whether all needed Hyatt III folders have been obtained.

• Requesting FO assistance to obtain needed Hyatt folders.

• Reconstructing the medical evidence and making the determination based on all available evidence (reconstructed and current). (If a class claim is adjudicated based on reconstructed material, the retrieval of a previously missing folder may warrant reopening the determination. See DI 27501.005.)

• Forwarding folders to OBP/LS if claimant is obviously not eligible for a Hyatt III review. (See DI 32548.001B.3.b.)

B. Policy - guidelines

To determine whether additional Hyatt folders are involved and if all the folders have been obtained; the following guidelines are applied.

1. Folder retrieval necessary

When it is clear that a claim for an earlier Hyatt III period exists (e.g., from information contained in the DDS folder, from queries, from information provided by the claimant etc.) and the folder for that period has not been obtained, return the Hyatt III claims to the FO for retrieval or reconstruction, (if necessary) of the missing Hyatt III claim.

2. Folder retrieval not necessary

Folders are not retrieved when the DDS has:

1. The earliest Hyatt III folder and can make a fully favorable allowance back to the earliest alleged onset date under Hyatt III.

2. At least one of several Hyatt III folders (not the earliest folder) can establish the earliest possible onset based on the facts of the case.

C. Process

When none of the one or more Hyatt III class member folders can be located after a thorough search by the PC or FO, evidence for the entire Hyatt period must be reconstructed and a determination made based on all available evidence.

In most cases, reconstruction efforts will have already begun before the folder arrives in the DDS. However, if the DDS has one or several Hyatt folders in its possession, and determines that reconstruction of an earlier period is necessary, see DI 32548.010E.2 .

D. Procedure - reconstructed folder received from FO or folder reconstruction not possible

If a reconstructed folder is received from the FO or folder reconstruction is not possible proceed as follows.

1. DDS records

For DDS records:

• Check residual files for material relating to the prior medical determinations/decisions (copies of the SSA-831, CE reports, etc.).

• Document the file regarding the availability of such material.

2. Claimant/Representative contact

For claimant/representative contact:

• Follow DI 32548.015D.3. and DI 32548.015D.4.

• Complete an SSA-3369 covering all relevant vocational evidence for the Hyatt III time period.

3. Case development

For case development:

1. Redevelop the medical evidence from all medical sources who treated the class member during the period under review and any additional evidence claimant may provide.

2. Follow normal case development procedures to obtain information for the entire Hyatt III period. If the claim being reviewed is a Primary Subclass claim, the claim is reopened. The Hyatt III period is the effective date of the earliest class application to the present. If the claim being reviewed is a Settlement Subclass claim, the claim is redetermined and only reopened in the event that the redetermination shows that the claimant is disabled. The Hyatt III period for a settlement subclass claim is the effective date of the application on the class claim through the date class claim was previously adjudicated. See DI 32548.020 - DI 32548.025 for general development instructions. In all cases, the claimant must be notified of the reason for the review, and be given the opportunity to submit additional evidence. Consequently, the second paragraph of the development notices 0651, 0652, 0653 and 0654 must read as follows:

   “We are currently looking at your case as the result of a class action court case in North Carolina called Hyatt. Your case will be reviewed even if we looked at it earlier and sent you a letter saying you were not entitled to a review.”

   Development notices 0655, 0656, and 0657 must contain the following introductory paragraph:

   “As we previously advised you, we are looking at your case again as a result of a class action court case in North Carolina called Hyatt. Your case will be reviewed even if we looked at it earlier and sent you a letter saying you were not entitled to a review.”

3. If a class claim is being reopened and the class claim cannot be found or reconstructed, readjudicate the claim based on current evidence. If a claim is being redetermined, the claim is adjudicated based on the evidence relevant to the time period being reviewed and any additional evidence the claimant wishes to submit. For these claims, absent substantial contrary evidence, infer that the class member was disabled as of the earliest date upon which all other requirements for disability benefits were met based on the class claim application if the class member has been found disabled on a subsequent title II or title XVI claim. Substantial contrary evidence may include, but is not limited to, traumatic onset of disability or a new impairment, or contrary medical judgment. If the class member has not been found disabled on a subsequent claim, presume that the class member"s past condition and impairments were as they are currently if such a presumption is reasonably based on the nature of the impairment.

4. Prepare a determination in accordance with DI 32548.020 - DI 32548.025.

E. Procedure - folder received from PC, other folders not located

If the folder(s) was received from the PC and other folders have not been located, proceed as follows.

1. DDS records

For DDS records:

• Check residual files for material relating to the prior medical decisions (copies of the SSA-831-U3, CE reports, etc.).

• Document the file regarding the availability of such material.

2. Necessity of other prior folders

If other prior folders are needed:

1. Review to determine the application dates of prior filings (i.e., are they before or after the filing date of the folder in DDS possession).

2. Determine whether the additional folders are needed for adjudication.

   • Compare the application date of the located file against the application dates of the missing folders (possible leads are the queries provided by the PC, the SSA-16-F6, SSA-3368-BK, Reports of Contact, etc. contained in the available folder).

   • Review the medical evidence to determine if the entire Hyatt period can be adjudicated with the available folder.

3. Identify the folder(s) needed and request the FO to obtain if other Hyatt folders are needed for adjudication. Then:

   • Return the folders to the FO with the request specifying the application dates and title of claim the FO needs to obtain. FO will either retrieve or reconstruct the needed folder(s).

   • Clear the folders using the transfer decision (DEC=TR).

F. References

Disability Case Development for Medical and Other Evidence, DI 22501.001

Vocational evidence, DI 22515.000