I-1-7-9.Scope and Effect of Review
Last Update: 9/14/05 (Transmittal I-1-56)
If review is required based on the court order or settlement agreement, SSA will either reopen or redetermine class member claims. The terms reopening and redetermination are not specifically defined in the regulations with respect to the scope of review in class action settlements. They are terms of art that refer to the time period at issue in the review, as described below.
Upon the receipt of a revised merits determination, a class member will often receive appeal rights based on the provisions of the court order or settlement agreement.
A reopening is a determination in which the adjudicator considers the issues in an otherwise final determination or decision through the date of the adjudication, i.e., through the current date, or, when appropriate, through an earlier date (e.g., when the claimant alleges a closed period of disability, when insured status expires before adjudication, or when considering a period of time before allowance on a subsequent application).
A redetermination is a determination in which the scope of review is limited to the period that:
begins with the alleged onset date or, if later, the earliest date of potential entitlement; and
ends with the date of the last final determination or decision that forms the basis for class membership or, if earlier, the date insured status or the prescribed period was last met.
If the claim file evidence is inadequate to assess the potentially eligible claimant's impairments during the time period covered by the class claim, the adjudicator will attempt to secure or develop any further evidence that may be needed, in accordance with normal development procedures. However, if an adjudicator determines that a claimant was disabled on or before the ending date of the period under review, the adjudicator will proceed with full reopening of the claim, i.e., the adjudicator will consider the issues from the alleged onset date on the earliest class claim (or date of application in Title XVI cases) to the onset date of the more recent allowance or through the current date or through an earlier date when appropriate (see I-1-7-9 B).
D. Scope If Multiple Applications Are Subject to Class Membership
If a class member filed multiple applications that are subject to class membership, the scope of review in a reopening case extends through the date of the last final determination or decision on the most recent claim that forms the basis for class membership. However, in a multiple application situation, if the claimant alleges different onset dates or alleges that disability ceased, it may be necessary to consider disability for separate periods of time.
Claimant filed two applications within the time period covered by the class action order. In the first application dated March 8, 2001, the claimant alleged disability commencing August 6, 2000. The application was denied initially on April 15, 2001, and was not appealed. In a second application, dated May 18, 2002, the claimant alleged a new period of disability commencing May 2, 2002. The claimant pursued this application through the hearing level with a decision issued on February 10, 2003. In a redetermination situation, there are two time periods that need to be reviewed — August 6, 2000 through April 15, 2001, and May 2, 2002 through February 10, 2003. If the adjudicator should find that the claimant was under a disability at any point within the two time periods, he or she would then adjudicate the case from the onset date established through the current date.