I-1-7-10.Preadjudication Actions — General

Last Update: 9/14/05 (Transmittal I-1-56)

A. Initial Notice and Response Process

Upon receipt of a court order directing relief or a settlement agreement, the Office of Program Law (OPL) in the Office of the General Counsel (or other component as decided on an individual class action case basis) obtains an updated systems selection. This database of potential class members is used when SSA is required to send systems-generated notices to all potential class members. The notice includes a postage-paid reply form, which is usually returned to OCO (or, for non-disability issue cases, to another location). Those individuals who respond to the notice within a specified time period are eligible to have their cases screened for class membership relief.

For those individuals who respond untimely, unless otherwise provided in the court order or settlement agreement, OPL or other designated component generates an alert to the FO to develop for good cause for responding untimely and to determine, pursuant to 20 CFR §§ 404.911 and/or 416.1411, whether good cause exists. In cases involving a mental impairment, FOs must also consider the requirements of Social Security Ruling 91-5p (Titles II and XVI: Mental Incapacity and Good Cause for Missing the Deadline to Request Review). For individuals whose notices are undeliverable, OPL or other designated component may, depending on the requirements of the court order or settlement agreement, arrange for a second mailing if an updated address can be secured.

B. Alert Process

1. OPL and the Office of Earnings, Enumeration, and Administrative Systems (OEEAS) Actions

Unless a timetable for completing a class action workload is mandated by a court order or settlement agreement, OPL, in consultation with ODP, OPSOS and the SSA ROs, or OHA, will establish the timetable for the DDS or OHA adjudicators, respectively, to implement class action relief within a reasonable period. This timetable will be based on current workloads, the size of the additional workload, and the requirement that adjudicators give equal priority to all of their workloads. Failure to complete a class action workload within a reasonable time period could result in a court imposing a timetable or sanctions.

On the basis of input from OCO, ODP, OPSOS and the ROs, OPL notifies OEEAS on a flow basis, as responses to the class action notices in disability cases are received from the potential class members, to generate folder “alerts” for the responding individuals, including those for whom good cause for a late response has been found (see I-1-7-90 Exhibit for a sample alert). OEEAS prepares and delivers to OCO, a tape from CATS of the cases to be alerted. In addition to the alert tape, OEEAS also provides tapes of various queries and claim file location information. Tapes of queries containing earning record information may also be provided. (The alert and queries are referred to as an “alert package.”)

2. OCO Actions

OCO prints the tapes, which produce the alerts and queries. OCO or the Wilkes-Barre Folder Servicing Operation (FSO), as appropriate, then retrieves the claim files of alerted cases in its possession and forwards them for screening to the appropriate location, usually either the PSC, DDS or OHA. OCO forwards alerts for cases not in its possession to the current claim file location.

If the component receiving the alert no longer has possession of the claim file, the component forwards the alert to the new claim file location. If the component having possession of the alerted claim file is not a screening component, e.g., the component is a storage component only, the component forwards the claim file (when it is ready for release) to the location identified in the “Ship to” field on the alert.

NOTE:

The process described above is the one generally followed in class actions involving disability issues. However, there may be exceptions. For example, in Stieberger v. Sullivan, after the alerts are generated, SSA will not initially retrieve claim files, but will instead prepare green folder jackets that contain a reply form, the alert package that includes the earnings record, and any medical or other evidence or forms submitted with the reply form. Generally, class actions involving non-disability issues are worked without retrieving claim files.

OCO will forward alerts to OHA when a potential class member claim or a current claim is pending or stored at OHA. If the claim is located in a hearing office (HO), OCO will forward the alert directly to the HO for processing. If the claim is located in OHA Headquarters, OCO will forward the alert to OAO at the following address:

OHA Class Action Coordinator
Office of Hearings and Appeals, SSA
5107 Leesburg Pike, Suite 1400
Falls Church, VA 22041-3200

3. OHA Actions

If there is a current claim pending or stored at OHA Headquarters, the OHA Class Action Coordinator will receive the alert and related class member claim file(s). The Coordinator will determine which OHA component has the current claim(s) and forward for screening as follows.

  • If the claim has been sent to an HO on remand, the Coordinator will forward the alert and the prior claim file(s) to the HO for screening.

  • If the claim is before the Appeals Council, or stored in OAO's Mega-site facility in Springfield, Virginia, the Coordinator will forward the alert and the prior claim file(s) to the appropriate OAO branch for screening.

  • If the OHA Class Action Coordinator receives an alert for a claimant who has a civil action pending, either on the alerted case or on a current or prior claim, the Coordinator will forward the alert and any accompanying claim file(s) to the appropriate OAO Court Case Preparation and Review Branch (CCPRB).

If the Coordinator (or the designee) is unable to locate the current claim file within OHA, the Coordinator (or the designee) will broaden the claim file search and arrange for claim file retrieval, alert transfer or claim file reconstruction, as necessary.

NOTE:

The OHA Class Action Coordinator is responsible for controlling and reconciling the disposition of class alerts shipped to OHA for association with pending or stored claims. The Coordinator should maintain a record of all alerts received and the location, if any, to which alerts are transferred. This information will be necessary to do the final class membership reconciliation.

C. Reconstruction Procedures

Generally, a claim file will be considered lost if it cannot be located within 120 days of the date the file search is initiated. OCO, the other PCs, or the Wilkes-Barre FSO, as appropriate, will request any necessary reconstruction of prior claim files if needed to make screening determinations. These components obtain the required potential class member claims within the class member timeframes, or arrange for their reconstruction, before forwarding cases for screening. Therefore, OHA reconstruction requests for potential class member cases should be few.

However, when reconstruction is necessary, OHA will determine whether available systems data or other information provides satisfactory proof that the particular claim would not be entitled to class relief, e.g., the FO denied a disability claim on a technical basis. (I-1-7-11 B.2. describes screening procedures for such cases.) If it becomes necessary for OHA to request reconstruction, the OHA component will forward the alert package and any accompanying prior or current claim file(s) (if the claim file(s) is not needed for adjudication purposes) to the servicing FO, along with documentation of attempts to locate the file and a covering memorandum requesting that the reconstructed file be forwarded to OHA. HOs will route any reconstruction requests directly to the servicing FO and send a copy of the covering memorandum to the OHA Class Action Coordinator, who will update CATS.

The HO or OAO will not delay action on a pending non-class claim when a prior potential class claim is being reconstructed for screening purposes, unless the prior claim is needed to adjudicate the pending claim. If OHA completes action on the pending claim before receipt of the reconstructed folder, the HO or OAO, as appropriate, will forward the following directly to the servicing FO using a covering memorandum:

  • the class action material, including the alert package, if still in its possession;

  • unneeded claim files, if any, and

  • a copy of the reconstruction request.

The HO or OAO will send a copy of the covering memorandum to the OHA Class Action Coordinator, along with a copy of the action taken on the pending claim.

If the claim file to be reconstructed had proceeded to the OHA level, the FO must attempt to obtain copies of the ALJ's decision or dismissal order and the Appeals Council's disposition, if any, along with the duplicate application, etc. OHA will coordinate any problems arising from the reconstruction procedures with the appropriate Regional Commissioner's office. HO personnel or the OAO branch will identify in the reconstruction request the OHA location of any existing claim file(s) being retained for adjudication purposes, and the date(s) of the claim(s) involved. HO and OAO personnel should follow the instructions outlined in the Associate Commissioner's April 10, 2003 memorandum to all OHA field office and OAO employees regarding folder reconstruction requests.