|Identification and Routing of Pipeline Cases|
|TDDS Processing of Pipeline Cases|
|OHA Processing of Pipeline Cases|
|Samuels Code 167 Case Reason for Non-Review|
|Notice of Review (Initial Entitlement Cases)|
|Notice of Review (Cessation Cases)|
ISSUED: July 9, 1993
This Temporary Instruction (TI) provides guidance for OHA processing of Tennessee Disability Determination Section (TDDS) Samuels “pipeline” cases that proceeded on appeal to OHA and that OHA adjudicated prior to August 24, 1987, the effective date of the OHA Samuels instructions issued in HALLEX I-5-4-18.
Although the TI affects only decision makers processing Samuels pipeline cases, decision makers throughout the country must be familiar with the TI because of potential case transfers or a claimant's change of State residence.
The Program Operations Manual System instructions for TDDS processing of Samuels cases became effective on November 17, 1986. However, the TDDS did not achieve full implementation of the instructions until February 1, 1987. Accordingly, the TDDS listed cases that it adjudicated on or after November 17, 1986, but before February 1, 1987 (determined by the date the SSA-831 was signed), for subsequent review under the Samuels instructions. These cases are known as “pipeline” cases or “Code 167” cases (see item 26 of the SSA-831-U3), because they were adjudicated subsequent to the issuance of the Samuels POMS instructions and prior to February 1, 1987, the date the POMS were fully implemented in the TDDS.
Some cases alerted as pipeline cases may already have been alerted, screened and processed as OHA-jurisdiction Samuels class members, because those cases that proceeded on appeal to OHA may have been adjudicated prior to the August 24, 1987 date of issuance of the OHA Samuels instructions (TI 5-4-18). Prior processing as an OHA-jurisdiction Samuels class member depends on whether the claimant: 1) received a notice of potential class membership and 2) responded to that notice.
Unlike the processing of Samuels class member claims, SSA will not send advance notice of the possibility of review in pipeline cases. However, SSA will release alerts for all listed pipeline cases. The alert will identify the case as a pipeline case by the notation “Code 167” on the face of the alert and will identify the TDDS as the reviewing office.
At the request of the Office of the Deputy Commissioner for Programs' Litigation Staff, the Office of Information Management will prepare a tape from the Civil Action Tracking System of cases to be alerted. The Office of Disability and International Operations (ODIO) will directly receive and print the tape, which will produce an alert and folder location information for each case. ODIO will associate the alerts with claim folders in its possession and forward those cases directly to the TDDS for processing. ODIO will forward alerts for cases not in its possession directly to the folder location for association and, unless the case is pending or associated with a pending claim, for forwarding to the TDDS (see Parts V.C. and D. for OHA actions on receipt of an alert for a pending case or for a case associated with a pending claim).
The TDDS must review all alerted cases to determine if they were fully processed under the Samuels criteria. Although pipeline cases are not eligible for Samuels class membership (unless, as indicated above, the claimant responded to a notice of potential class membership at the OHA level), they are entitled to adjudication under the Samuels criteria (see the TDDS Samuels checklist at Attachment G in HALLEX I-5-4-18-A, issued May 30, 1989).
For cases that did not proceed to the OHA level, the TDDS will determine if further action under Samuels is necessary and, if so, will notify the claimant and proceed with a redetermination. If no action under Samuels is necessary, the TDDS will not prepare a notice to the claimant (because the claimant has not been notified of the possibility of review). Rather, the TDDS will prepare a statement (similar to Attachment 1) and return the case to its storage location.
Because pipeline cases are not eligible for class membership (except as indicated above), the TDDS will not complete a class membership screening sheet and the notice of review will not refer to class membership.
The TDDS will notify claimants who receive unfavorable redeterminations of their right to request a hearing before an Administrative Law Judge (ALJ).
The TDDS will prepare a statement (similar to Attachment 1) and return to the storage location, the following pipeline cases that proceeded to the OHA level:
cases that received fully favorable ALJ or Appeals Council decisions;
cases that received either any TDDS reconsideration action on or after February 1, 1987, or any OHA action on or after August 24, 1987, the effective date of OHA's Samuels instructions; and
cases that have already been redetermined as Samuels class members.
Additionally, the TDDS will prepare a statement similar to Attachment 1 for pipeline cases in which the adjudication of a subsequent claim, at any administrative level, considered, using the Samuels criteria, the complete time period at issue in the pipeline case.
The TDDS will forward all other OHA cases, except for ALJ dismissals, to OHA's Office of Civil Actions (OCA), Division III, for the actions stated below. The TDDS will review ALJ dismissals (processed prior to August 24, 1987) to determine if further TDDS action under Samuels is necessary.
OCA Division III personnel will take the following actions on cases forwarded by the TDDS (see Parts V. C. and D. for OHA processing of alerts only):
Review the case for compliance with the substantive, medical development and procedural (including documentation and special decisional language) requirements of HALLEX I-5-4-18-A, issued May 30, 1989 (see the TDDS Samuels checklist at Attachment G of that instruction).
If the case is in compliance, complete the statement in Attachment 1, checking item 4. Place the original in the claim folder and forward one copy to the Division of Litigation Analysis and Implementation (DLAI), Suite 702, Attn: Samuels coordinator. Forward another copy to plaintiffs' counsel at the address on the statement. Return the folder to its storage location.
If the case is not in compliance, send the notice in Attachment 2 or 3, as appropriate, to the claimant and the representative of record, if any (follow HALLEX I-5-4-18, A, Part VI. B., concerning representation). Also send a copy of the notice to the Samuels coordinator in DLAI. Because the benefit of a protective filing date for new claims was negotiated only for Samuels class members, the protective filing date instructions in Parts VI. B. and VII. A. of HALLEX I-5-4-18, A, are not applicable in pipeline cases.
Forward the case to the servicing hearing office (HO). On the covering route slip, annotate “Samuels Pipeline Case” and indicate the area(s) deficient with respect to the Samuels requirements. Also annotate the route slip if a subsequent claim (which did not form a basis for non-review), or a class member claim, is pending at any administrative level or in court.
Pipeline cases are subject to the substantive, medical development and procedural (including documentation and special decisional language) requirements of HALLEX I-5-4-18-A (see the TDDS Samuels checklist at Attachment G of that instruction). However, because the benefit of a protective filing date for new claims was negotiated only for Samuels class members, the protective filing date instructions in Parts VI. B. and VII. A. of HALLEX I-5-4-18-A are not applicable in pipeline cases.
Consistent with Samuels practice, ALJs will issue redetermination decisions in initial entitlement pipeline cases. However, ALJs will follow Acquiescence Ruling 92-2(6), published March 17, 1992, concerning the scope of review for the medical cessation cases of all Sixth Circuit residents.
On release of a decision or dismissal, HO personnel will forward a copy to:
Division of Litigation Analysis and Implementation
5107 Leesburg Pike
Falls Church, VA 22041-3200
ATTN: Samuels Coordinator
OCA will directly receive alerts for any pipeline cases that may be currently located in OHA. Pipeline cases that are pending in OHA or stored in OHA pending appeal are under OHA's jurisdiction and must continue to be processed under Samuels. Therefore, OCA will forward alerts to the components (inside or outside of OHA) having current possession of the folder. OHA components receiving these alerts will flag the pipeline case for continued Samuels processing by attaching the alert to the outside of the claim folder.
The alerted pending or stored pipeline cases should have already received an ALJ decision under Samuels and should require no further review. However, the OHA component having possession of the folder will also forward a copy of the ALJ (or Appeals Council) decision (or dismissal order) to DLAI (at the address indicated in A. and B.) for reporting purposes. The appropriate personnel will also annotate the face of the alert with the fact and date of forwarding a copy of the decision or dismissal order to DLAI.
If the case alerted as a pipeline case is pending screening in OCA Division III because it was previously alerted as a potential Samuels class member case, Division III personnel will first screen for Samuels class membership. If the claimant is a class member, Division III personnel will continue with Samuels class member processing. Division III personnel will also prepare the statement in Attachment 1, checking item 5. and taking the related actions in section V. A. above, except for forwarding the folder to the storage location. If the claimant is not a Samuels class member, Division III personnel will send the notice of non-class membership and take related actions except for forwarding the folder to the TDDS (for potential review by plaintiffs' counsel of the class membership issue). Division III personnel will then review the case for any necessary processing as a pipeline case, following the procedures in V. A. above. Additionally, if no processing is necessary, Division III personnel will forward the case to the TDDS to await potential review by plaintiffs' counsel of the class membership issue.
OHA may receive alerts for pipeline cases that did not proceed on appeal to OHA but are in OHA's possession for other reasons, e.g., the case is associated with a subsequent claim.
If the pipeline case is associated with a claim pending at the hearing level, the HO will review the pipeline case and 1) complete the statement in Attachment 1 and follow the related procedures in Part V. A. above; or 2) follow the Samuels consolidation procedures in HALLEX I-5-4-18-A.
If the pipeline case is associated with a claim stored in the Office of Appellate Operations (OAO), OAO personnel will forward all folders to OCA Division III for review and appropriate action, usually the completion of the statement in Attachment 1 and related actions (see Part V. A.). If further action under Samuels is necessary, Division III personnel will forward it to the TDDS (using the address on the alert) unless it appears that the folder may be needed for appeal purposes. Division III personnel will annotate the covering route slip concerning the area(s) deficient with respect to the Samuels requirements. If the folder cannot be released pending potential appeal, Division III personnel will: 1) place the annotated route slip in the folder; and 2) attach the flag at Attachment 4 to the outside of the folder, for forwarding the folder to the TDDS at the close of the OHA retention period.
If the pipeline case is associated with a claim pending in OAO, OAO personnel will: 1) review the pipeline case; 2) complete the statement in Attachment 1 if appropriate and take related actions (see Part V. A.); or 3) if further action under Samuels is necessary, forward the case to the TDDS (using the address on the alert) unless the folder is needed for adjudication purposes. OAO personnel will annotate the covering route slip concerning the area(s) deficient with respect to the Samuels requirements. If the folder is needed for adjudication purposes, OAO personnel will: 1) place the annotated route slip in the folder; and 2) attach the flag at Attachment 4 to the outside of the folder, for forwarding the folder to the TDDS at the close of the OHA retention period.
HO personnel should direct any questions to their Regional Office (RO). RO personnel should contact the Division of Field Practices and Procedures in the Office of the Chief Administrative Law Judge at (703) 305-0022.