Citations:

Goodnight, et al., v. Apfel, United States (U.S.) District Court for the District of Utah, Central Division.

TN 2 (04-99)

A. Background

1. Class certification

On 10/27/93, the court certified a class in this action defined as “ [a]ll persons who applied for and were denied the receipt of title II or title XVI disability benefits by the [Utah Disability Determination Services (DDS)]since 10/09/84. The class excludes persons who appealed the [Utah DDS's]determinations beyond the [Utah DDS], persons who were denied benefits because they have returned to substantial gainful activity (SGA), and persons who are not eligible for disability benefits for reasons not related to disability.”

2. Settlement agreement

On 07/30/98, the U.S. District Court for the District of Utah, Central Division, entered the 07/29/98, settlement agreement in the Goodnight, et al., v. Apfel class action lawsuit. The settlement agreement provides relief to those potentially eligible class members whose claims for disability benefits under title II and/or title XVI of the Social Security Act were finally denied at steps two, four or five of the sequential evaluation process by the Utah DDS on or after 01/01/91, through 02/20/ 94, and (a) whose determinations for disability benefits were based in whole or in part on a mental impairment as indicated in the primary or secondary diagnosis blocks 16A or 16B on Form SSA-831-U3/C3; or (b) whose Form SSA-831-U3/C3 was signed by Utah DDS employees Doctor Manya Atiya or Doctor Rebecca Dalisay. See DI 52510.001B.1. and DI 52510.001B.2.

3. Plaintiffs' counsel

The plaintiffs' counsel is:

• Brent V. Manning, Esq.
  Manning Curtis Bradshaw & Bednar, LLC
  3rd Floor, New House Building
  10 Exchange Place
  Salt Lake City, Utah 84111
  Telephone: 801-363-5678

NOTE: Potentially eligible class members with any questions about possible rights under the Goodnight settlement agreement may contact the plaintiffs' counsel in the Goodnight case at the address shown above.

B. Policy

1. Class members eligible for relief

Subject to the exclusions in DI 52510.001B.2., Goodnight class members eligible to request relief under this agreement include individuals:

• who had a claim for title II and/or title XVI disability benefits denied at steps two, four or five of the sequential evaluation process by the Utah DDS at the initial or reconsideration levels on or after 01/01/91, through 02/20/94, and

• whose determinations for disability benefits were based in whole or in part on a mental impairment as indicated in primary or secondary diagnostic blocks 16A or 16B on Form SSA-831-U3/C3; or

• whose Form SSA-831-U3/C3 was signed by Utah DDS employees Doctor Manya Atiya or Doctor Rebecca Dalisay.

2. Exclusions

An individual is not eligible to request relief under this agreement if:

• that individual has already received a subsequent award of benefits with respect to the same period of time at issue in the class claim (the period of time at issue in the class claim could be prior to 01/91. The adjudication of the claim only had to occur on or after 01/01/91, through 02/20/94); or

• that individual appealed the denial of his/her class claim to an administrative law judge (ALJ), the Appeals Council (AC) or court; or

• that individual received a subsequent disability determination after 02/20/94, that adjudicated the same time period covered by the class claim; or

• the individual's claim file contains a Psychiatric Review Technique Form (PRTF) and Mental Residual Functional Capacity (MRFC) form each completed in its entirety by a Utah DDS psychiatrist or psychologist employed by the Utah DDS on or after 01/01/91, through 02/20/94, as determined pursuant to DI 52510.020B.; or

• the individual fails, without good cause, to timely request a redetermination by responding to the notice requirements in DI 52510.005B.2.

3. Disability redetermination

Goodnight class members eligible for relief will have his/her claim(s) redetermined at the reconsideration level unless consolidated at the Office of Hearings Operations (OHO) level. This review consists of a review of the evidence of record to determine if the class member was disabled during the period covered by the class claim.

If the claim file evidence is inadequate to assess the potentially eligible plaintiff's impairment(s) during the time period covered by the class claim, the Utah DDS shall attempt to secure and/or develop any further evidence that may be necessary, in accordance with normal claims development procedures. In addition, a potentially eligible plaintiff will be permitted to submit any additional evidence relevant to the time period being redetermined in the class claim and such evidence will be considered in making the redetermination.

If the redetermination results in a finding that the individual was disabled during the period covered by the class claim, the Utah DDS will reopen the Goodnight claim(s) and assess disability from the date of the original Goodnight claim(s) through the date of the new determination or the onset date of a more recent allowance.

If a claim is reopened, SSA will attempt to obtain updated medical records and the potentially eligible plaintiff shall cooperate in accordance with the requirements set forth in 20 C.F.R. 404.1512-1519(p) and 416.912-919(p).

See DI 52510.020 for a complete discussion of DDS processing of Goodnight class claims.

4. Folder consolidation

If a class member has a subsequent disability claim active and simultaneously pending at any administrative level of review at the time his/her class claim(s) is being reviewed, the Social Security Administration (SSA) may, at its option, consolidate all such claims and review them simultaneously, provided that such consolidation would not unreasonably delay a decision on the current claim.

5. Appeal rights

Class members have 60 days from receipt of the notice of the disability determination to appeal, unless such time is extended because good cause is shown for missing the deadline. Class members may appeal his/her reconsideration level determination to an ALJ and further administrative and judicial review in accordance with 42 U.S.C.§405(g) and 20 C.F.R. parts 404 and 416.

NOTE: The first level of appeal for cases readjudicated upon consolidation at the ALJ level is to the AC.

6. Review jurisdiction

The Utah DDS normally has review jurisdiction for Goodnight cases, even if the individual has left Utah. See DI 12502.001, and DI 32502.001 for a complete discussion of jurisdiction.

7. Representative involved

If the claimant has a representative, copies of all correspondence must be sent to the representative unless the claimant either appoints a different representative or states that he/she is no longer represented by the individual. See GN 03910.040B. for procedures regarding the appointment of a representative.

An SSA-1696-U4 or other equivalent written statement must be obtained if one is not in file. Any development requests will be made following the guides in DI 22505.001. Case development requests must be made through the representative unless the claimant indicates otherwise (see DI 31001.001).