Citations:

Hyatt, et al. v. Shalala, United States (U.S.) District Court for the Western District of North Carolina

TN 1 (11-00)

A. Background

1. Issuance of court order

On March 21, 1994, the U.S. District Court for the Western District of North Carolina issued an order in Hyatt, et al. v. Shalala, which provided relief to certain individuals who alleged pain and had their title II and/or title XVI disability benefits denied or terminated by the North Carolina Disability Determination Section (NCDDS), or an Administrative Law Judge (ALJ) or the Administrative Appeals Judge (AAJ) on or after July 7, 1981, and before November 14, 1991.

NOTE: To be eligible for relief under the court order based on an ALJ hearing or AC decision:

• the individual must have lived in North Carolina at the time of the ALJ or AC decision, or

• the individual must have received a decision by an ALJ based upon a hearing that occurred at a time when the individual resided in North Carolina, or

• the AC decision must have been initially mailed to a North Carolina address.

2. Subsequent order

On October 21, 1999, the U. S. District Court for the Western District of North Carolina issued an order in Hyatt v. Apfel, which provided relief to certain individuals who had been denied class membership and a new determination/decision under the March 21, 1994 (Hyatt III) order. This October 21, 1999 order says SSA may not deny class membership when:

1. subsequent claim was adjudicated by an ALJ/AAJ on or after August 6, 1990 or by the DDS on or after November 14, 1991, unless

   • is clear that the DDS/ALJ/AAJ reopened and readjudicated the entire period covered by the Hyatt III claim (see GN 04001.001and SI 04070.001 for additional information about reopening), and

   • the notice of determination/decision identified the claim that had been reopened and readjudicated, or

2. The claimant was a Hyatt (HY) responder and before receiving a final determination/decision under HY, withdrew or failed to pursue HY relief; or

3. A subsequent claim also adjudicated a Hyatt III claim based upon an amended alleged onset date of disability, unless the Hyatt III claim was reopened and was in the process of being adjudicated at the time the claimant amended his/her onset date.

3. Class counsel

The class counsels are:

      (and)

      (and)

B. Policy

All claims, including those previously denied class membership under the March 21, 1994 Court Order are class members as a result of the October 21, 1999 Court Order, except for the exclusions identified at DI 42548.001B.3.

Class members who properly respond to the Hyatt notice and who meet the following criteria have the opportunity to have their claims reviewed. The type of review that a class member is entitled to depends on whether he/she is a member of the Primary Subclass or the Settlement Subclass. Copies of all Hyatt III determinations/decisions must be sent to claimant's attorney, if any, and class counsel.

1. Primary subclass

Subject to the exclusions in DI 42548.001B.3., the Hyatt Primary Subclass consists of all individuals:

• whose claims which included allegations of pain were finally denied or terminated on or after July 7, 1981, and before August 6, 1990;

• provided however, that an ALJ decision issued before August 6, 1990, shall be deemed final for the subclass membership purposes if the Appeals Council denied a request for review of the ALJ decision on or after August 6, 1990.

NOTE: Members of the Primary Subclass will have their claims reopened. Primary Subclass members receive full appeal rights. Also, claimant is a Primary Subclass member even if his/her Hyatt III claim was reopened or readjudicated in a decision on a subsequent application after August 6, 1990.

2. Settlement subclass description

Subject to the exclusions DI 42548.001B.3., the Hyatt Settlement Subclass consists of all individuals whose claims, which included allegations of pain, were finally denied or terminated by the NCDDS on or after August 6, 1990, and before November 14, 1991.

NOTE: Not all members of the Settlement Subclass are entitled to a review. Only Settlement Subclass members whose claims were finally denied or terminated at the initial or reconsideration level of review are entitled to a review of their class claims. The type of review is a disability redetermination. Settlement Subclass members have limited appeal rights.

3. Exclusions

a. The claimant is not eligible for class membership review based on the March 21, 1994 Order if:

The individual received any Class Membership Notice pursuant to either the prior Hyatt orders dated June 25, 1985, or December 10, 1987, but failed to timely respond to that Class Membership Notice. (Individuals who failed to file a response to these notices may have their Hyatt III claims reviewed if they establish good cause for not responding sooner. Failure to receive a notice may constitute good cause.)

NOTE: A claim will not be excluded as a Class Claim for failure to respond to a notice pursuant to the Order dated June 25, 1985, if an individual establishes that he/she responded to a notice issued pursuant to the Hyatt order dated March 27, 1984. Good cause notices to the “postcard” responders were processed through CO.

Also, an AAJ denial of a request for review, while not the “final” decision of the Commissioner, must be considered as a decision if it would permit class membership, e.g., if the ALJ's decision was before 7/7/1981 and the AAJ denied review during the Hyatt III period, the claimant is entitled to Hyatt III relief. An AAJ denial of request for review must not be considered a decision if it would preclude class membership, e.g., if the ALJ's decision was before 8/6/1990 and the AAJ denied review on or after that date, the claimant is also entitled to Hyatt III relief..

b. Screening for class membership eliminated

As a result of the October 1999 court order, SSA has decided to no longer screen claims for Hyatt III class membership. Consequently, class membership screening has been eliminated. Thus, all future claims will receive a Hyatt III merits determination/decision, unless in the processing of a claim, it is found that Hyatt III relief is clearly inappropriate. That is if:

• No application for disability benefits under title II and/or title XVI was filed; or

• No final medical determination was issued by a NC adjudicator (DDS, ALJ AAJ) between 07/07/1981 and 11/13/1991. (Also a non-medical determination/decision is one based upon fraud, insufficient quarters of coverage, excess income or resources, substantial gainful acitivity (SGA) or any other reason not related to proof of disability, unless the claim was a concurrent claim filed in connection with a class claim. In the preceding sentence the term “final” does not include Hyatt III claims reopened and readjudicated prior to September 30, 1999. Such claims are entitled to Hyatt III relief.