I-5-4-11.Johnson, et.al., v. Sullivan
Table of Contents
I |
Purpose |
II |
Background |
III |
Guiding Principles |
IV |
Definition of Class |
V |
Determination of Class Membership and Preadjudication Actions |
VI |
Processing and Adjudication |
VII |
Case Coding |
VIII |
Reconciliation of Implementation |
IX |
Inquiries |
Attachment 1 |
Final Judgment Order dated April 3, 1991 |
Attachment 2 |
JOHNSON COURT CASE FLAG/ALERT |
Attachment 3 |
Route Slip or Case Flag for Screening |
Attachment 4 |
Johnson Screening Sheet |
Attachment 5 |
Route Slip for Routing Class Member Alert (and Prior Claim Folder(s) to ODIO or PSC -- OHA No Longer Has Current Claim |
Attachment 6 |
Johnson Non-Class Membership Notice |
Attachment 7 |
Route Slip for Non-Class Membership Cases |
Attachment 8 |
Acting Associate Commissioner's Memorandum Dated February 21, 1991, Entitled “The Standard for Evaluating 'Not Severe' Impairments.” |
Attachment 9 |
Johnson Class Member Flag for Headquarters Use (DDS Readjudication) |
Attachment 10 |
Johnson Cases Member Flag for HO Use (DDS Adjudication) |
Attachment 11 |
ALJ Dismissal to DDS |
Attachment 12 |
Notice Transmitting ALJ Order of Dismissal |
Issued: August 6, 1992, Revised March 21, 1997
I. Purpose
This Temporary Instruction (TI) sets forth procedures for implementing the
April 3, 1991 order of the United States District Court for the Northern
District of Illinois in the Johnson, et al. v.
Sullivan class action involving the “not severe”
impairment issue.
Adjudicators throughout the country must be familiar with this TI because
Johnson class members who now reside outside of
Illinois must have their cases processed in accordance with the
requirements of the court's order.
II. Background
On December 7, 1983, the United States District Court for the Northern
District of Illinois certified a class challenging the Secretary's
regulations, policies and practices for evaluating disability claims at
step two of the sequential evaluation.
On September 19, 1984, the district court found the Secretary's severity
regulations invalid and enjoined the Secretary from using step two of the
sequential evaluation. After the court denied the Secretary's motions to
vacate the injunction and amend its judgment, the Secretary appealed to
the Seventh Circuit.
The Court of Appeals stayed implementation of class relief pending appeal,
but affirmed the district court's jurisdictional and substantive rulings
on all issues. A panel of circuit court judges denied the Secretary's
petition for rehearing and, subsequently, the Court of Appeals denied the
Secretary's suggestion for rehearing in banc by
an evenly divided vote. In February 1985, the Secretary petitioned the
Supreme Court for a writ of certiorari. While the
petition was pending, the Supreme Court upheld the facial validity of the
severity regulations in Bowen v. Yuckert, 482
U.S. 137 (1987). The Supreme Court then granted the Secretary's petition
in Johnson, vacated the Seventh Circuit's
judgment and remanded for further consideration in light of
Yuckert. On remand, the Seventh Circuit vacated
the district court's injunction to the extent that it prohibited the use
of step two of the sequential evaluation and remanded the case to the
district court.
On October 6, 1988, the district court issued a decision on the merits.
The decision found that the issue of the Secretary's misapplication of the
severity regulations was not suitable for class action litigation.
However, the court also found that the Secretary's pre-December 1, 1984
policy of not considering the combined effect of individual “not
severe” impairments violated the Social Security Act. On June 16,
1989, the district court issued a final order that resolved the remaining
implementation and jurisdictional issues and relied on the Supreme Court's
decision in Bowen v. City of New York, 476 U.S.
467 (1987), to waive administrative exhaustion and toll the 60-day
statute of limitations in 42 U.S.C. § 405(g). The final order
established the beginning date of the class as February 26, 1979, the
date the “combined effect” regulation became effective.
After staying implementation of class relief pending appeal, the United
States Court of Appeals for the Seventh Circuit, on December 28, 1990,
issued a unanimous in banc decision upholding the district court's earlier
ruling that the Secretary's “combined effect” policy violated
the Social Security Act. Although the Seventh Circuit also upheld the
lower court's ruling that the Secretary waived the 42 U.S.C. § 405(g)
60-day statute of limitations by failing to raise the issue in a timely
manner as an affirmative defense at the onset of the litigation, it found
the equitable tolling doctrine in City of New York inapplicable to
the facts in the case. The Court of Appeals also found City of New
York inapplicable with respect to waiver of administrative exhaustion
for lapsed claims, i.e., claims no longer pending or appealable at the
time the class complaint was filed. Accordingly, the Seventh Circuit
instructed the district court to reconfigure (reduce) the Johnson class
to exclude claimants who did not exhaust their administrative remedies 60
days prior to the filing date of the class complaint (August 11, 1983).
On April 3, 1991, the district court issued a final judgment order. That
order modified the class definition and set forth the terms for the
implementation of class relief (Attachment 1).
III. Guiding Principles
Under Johnson, the Commissioner will reopen and
readjudicate the claims of those persons who (1) respond to notice
informing them of the opportunity for review and (2) are determined to be
class members after screening (see Part V below). Regardless of the state
of the claimant's current residence, the Illinois Disability Determination
Service (DDS) will, in most cases, screen for class membership and
perform the court-ordered readjudications at the reconsideration level,
regardless of the level of administrative review that last decided the
claim. OHA will screen cases and perform readjudications under limited
circumstances (see Part V.B. below). Class members who receive adverse
readjudication determinations will have full appeal rights (i.e.,
Administrative Law Judge (ALJ) hearing, Appeals Council and judicial
review).
Johnson does not require any change in OHA's current adjudicatory policies
or practices because
Social
Security Ruling (SSR) 85-28 remains the proper standard for
adjudicating claims at step two of the sequential evaluation.
IV. Definition of Class
Except as noted below, the Johnson class includes
all persons who resided in Illinois during the following timeframes and:
whose disability benefits were denied or terminated at step two of the
sequential evaluation at any administrative level on or after June 12,
1983, through May 1, 1985; or
whose disability benefits were denied or terminated at step two on or
after August 20, 1980, through June 11, 1983, and who exhausted their
administrative remedies (i.e., pursued their claims through the Appeals
Council level of review); or
whose disability benefits were denied or terminated at step two between
February 26, 1979, and August 19, 1980, inclusive, and who exhausted their
administrative remedies (i.e., pursued their claims through the Appeals
Council level of review), and who were listed under “code
922” by the Illinois DDS. (This code appears on the SSA-831-U3 or
833-U3 and identifies step two denial or cessation claims adjudicated at
the initial or reconsideration levels.)
A person is not a class member if:
(1) the last administrative denial or termination the individual received
on the Johnson claim was not based on step two of the sequential
evaluation; or
(2) the last administrative denial or termination the individual received
on the Johnson claim was issued after May 1, 1985; or
(3) the individual had a subsequent claim denied after May 1, 1985, and
the onset date alleged in connection with the subsequent claim is on or
before the onset date alleged in connection with the Johnson claim.
V. Determination of Class Membership and Preadjudication Actions
A. Non-OHA
Actions
1. Notification
On June 3, 1991, SSA sent notices to all potential class members
identified by computer run. Individuals had 60 days from the date of
receipt of the notice to request that SSA readjudicate their claims under
the terms of the Johnson court order.
Notices returned as undeliverable will be mailed a second time. The Office
of Disability and International Operations (ODIO) and the Program Service
Centers (PSCs) will send all untimely responses to the servicing Social
Security field office to develop good cause for the untimely response.
Good cause determinations will be based on the standards in
20 CFR §§
404.911 and
416.1411.
2. Alerts
and Folder Retrieval
Litigation Staff in the Office of Policy and Planning is tracking all
response forms and sending alerts to ODIO and the PSCs to use in locating
claim files. Alerts will be generated first for termination cases. See
Attachment 2 for a sample Johnson alert. In most instances, ODIO or the
PSCs will associate the Johnson alert and the claimant's response form
with the claim file(s) and forward the file to the Illinois DDS for
screening and readjudication.
3. Alerts
Sent to OHA
If ODIO or the PSCs determine that a current claim, i.e., either a
potential class member claim or a subsequent claim, is pending appeal or
stored at OHA, it will forward the alert to OHA, along with any prior
claim file(s) not in OHA's possession, for screening, consolidation
consideration and readjudication (if consolidated).
ODIO or the PSCs will send all alerts potentially within OHA jurisdiction,
and related prior claim files, if any, to the Office of Appellate
Operations (OAO) at the following address (case locator code 5007):
Office of Hearings and Appeals
Office of Appellate Operations
One
Skyline Tower, Suite 701
5107 Leesburg Pike
Falls Church, VA
22041-3200
ATTN: OAO Class Action Coordinator
The OAO Class Action Coordinator is responsible for controlling and
reconciling the disposition of class alerts shipped to OHA Headquarters
for association with pending or stored claims. The OAO Class Action
Coordinator will maintain a record of all alerts received and the
location, if any, to which they are transferred. This information will be
necessary to do the final class membership reconciliation.
4. Folder
Reconstruction
Generally, ODIO or the PSCs will initiate any necessary reconstruction of
prior claim files through the servicing FO. Consequently, OHA requests for
reconstruction of potential Johnson class member cases should be rare.
Prior to requesting reconstruction, OHA will determine whether available
systems data or other information provides satisfactory proof that the
claim would not confer class membership.
However, if it becomes necessary for OHA to request reconstruction, the
OHA component (the Hearing Office (HO) or the OAO Branch) will forward the
alert and any accompanying 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 FOs. The OAO branch
will also route reconstruction requests directly to the servicing FOs and
send copies of the cover memorandums concerning all reconstruction
requests to the OAO Class Action Coordinator. For CATS purposes, HO
personnel and the OAO Class Action Coordinator will forward a copy of the
reconstruction request memorandum to Litigation Staff at the following
address:
Litigation Staff
Office of Policy and Planning
3-K-26 Operations
Building
6401 Security Boulevard
Baltimore, MD 21235
ATTN:
Johnson Coordinator
The HO or OAO will not delay action on a pending claim when a prior claim
is being reconstructed for screening purposes, unless the prior claim is
needed for the adjudication of the pending claim. If OHA completes action
on the pending claim prior to the receipt of the reconstructed file, the
HO or OAO, as appropriate, will forward the class action material,
including the alert, unneeded claim files, if any, and the reconstruction
request to the OAO Class Action Coordinator, along with a copy of the
action on the pending claim (see V.B.2.a. below). For additional
information on reconstruction procedures, see the Generic Class Action
Implementation Instructions, Hallex
I-1-7-5 C.
5. Class
Membership Denials
The Chicago, Illinois district office, located at 175 West Jackson
Boulevard, will hold all non-class member claim folders pending review by
class counsel. Upon review of the folders, class counsel will contact the
Office of the General Counsel (OGC) directly to resolve class membership
disputes.
B. OHA
Actions
1. Pre-Screening
Actions
a. Current
Claim in OHA
As provided in Part V.A.3. above, if there is a current claim pending or
stored at OHA, the OAO Class Action Coordinator will receive the alert and
related Johnson claim file(s). The OAO Class Action Coordinator will
determine OHA jurisdiction for screening and forward as follows.
If the current claim is in an HO, the Coordinator will use Attachment 3 to
forward the alert and the prior claim file(s) to the HO for screening.
(Part V.B.2.a. below provides instructions to the HOs regarding the action
to be taken if they receive an alert package but no longer have a current
claim pending.)
If the current claim is before the Appeals Council, or is located in an
OAO branch mini-docket or in the OAO Docket and Files Branch, the
Coordinator will use Attachment 3 to forward the alert and prior claim
file(s) to the appropriate OAO branch for screening. (Part V.B.2.a. below
provides instructions to the OAO branches regarding the action to be taken
if they receive an alert package from the OAO Class Action Coordinator
but no longer have a current claim pending.)
If the Coordinator (or designee) is unable to locate the current claim
file within OHA, the Coordinator (or designee) will broaden its claim file
search and arrange for alert transfer or file reconstruction, as
necessary.
b. Current
Claim Pending in Court
If the OAO Class Action Coordinator receives an alert for a claimant who
has a civil action pending, either on the alerted case or on another
claim, the Coordinator will forward the alert and any accompanying claim
file(s) to the appropriate Court Case Preparation and Review Branch
(CCPRB) for screening using Attachment 3. See Part V.B.2.b. below for
special screening instructions when a civil action is involved.
2. Screening
a. General
Instructions
The screening component will associate the alert, if any, and any prior
claim file(s) with the claim file(s) in its possession and then complete
the screening sheet (see Attachment 4) as follows:
consider all applications denied (including res judicata
denials/dismissals) during the Johnson timeframe;
follow all instructions on the screening sheet;
sign and date the original screening sheet, place it in the claim file(on
the top right side of the file); and,
if the screening component is an OHA Headquarters component, forward a
copy of the screening sheet to the OAO Class Action Coordinator at the
address in Part V.A.3. above. (The Coordinator will enter information from
the screening sheet into a database and forward a copy of the screening
sheet to the Division of Litigation Analysis and Implementation (DLAI). If
the screening component is an HO, forward a copy of the screening sheet
directly to DLAI at the following address:
Office of Hearings and Appeals
Division of Litigation Analysis
and
Implementation
One Skyline Tower, Suite 702
5107 Leesburg
Pike
Falls Church, VA 22041-3255
HO personnel may also forward material by telefax to DLAI at (703)
305-0655. (DLAI will retain a copy of each screening sheet and forward a
copy to the OAO Class Action Coordinator and to Litigation Staff.)
If the HO receives an alert only, or an alert associated with a prior
claim file(s) for screening and no longer has the current claim file, it
will return or forward the alert and the prior claim file(s) to the OAO
Class Action Coordinator (see address in Part V.A.3. above) and advise the
Coordinator of what action was taken on the current claim and its
destination. The Coordinator will determine the current claim file
location and, if it is located in OHA Headquarters, will forward the alert
and any accompanying prior claim file(s) to the responsible OAO branch
for screening, using Attachment 3. If the file(s) is no longer in OHA,
the Coordinator will use Attachment 5 to send the alert and any
accompanying prior claim file(s) to the non-OHA location and request that
the file(s) be forwarded to the Illinois DDS for screening.
If the OAO branch receives an alert only, or an alert associated with a
prior claim file(s), and the branch no longer has the current claim file
(and it is not located in an OAO branch mini-docket or in the OAO DFB), it
will determine the location of the current claim file. If the current
claim file is located within OHA, the OAO branch will use Attachment 3 to
forward the alert and any accompanying prior claim file(s) to the current
OHA location. If the file(s) is no longer in OHA, the OAO branch will use
Attachment 5 to forward the alert and any accompanying prior claim file(s)
to the non-OHA location and request that the file(s) be forwarded to the
Illinois DDS for screening. The OAO branch will also advise the OAO Class
Action Coordinator of its actions.
Final determinations or decisions made after May 1, 1985, on a claim filed
by a potential Johnson class member may adjudicate the same timeframe
covered by the Johnson claim. Instead of applying the doctrine of
administrative res judicata to the Johnson claim, these claims should be
denied class membership.
b. Special
OAO Screening Instructions if a Civil Action Is Involved
As noted in Part V.B.1. above, the CCPRB will screen for Johnson class
membership when a civil action is involved. The CCPRB's class membership
determination will dictate the appropriate post-screening action.
If the current claim pending in court was adjudicated in accordance with
SSR
85-28 and resolved all Johnson issues, the claimant is not a Johnson
class member. The CCPRB will follow the instructions in Part V.B.3.a.
below for processing non-class member claims.
If the current claim pending in court was adjudicated in accordance with
SSR
85-28, but a Johnson issue remains unresolved, e.g., there is a prior
(inactive) Johnson claim and the current claim does not include the
entire period covered by the Johnson claim, the CCPRB will forward the
Johnson claim to the Illinois DDS for separate review. The CCPRB will
modify the case flag in Attachment 9 to indicate that the pending court
case does not resolve all Johnson issues and that the Johnson class
member claim is being forwarded for separate processing. The CCPRB will
notify the OAO Class Action Coordinator of this action.
If the final administrative decision on the claim pending in court was not
adjudicated in accordance with
SSR
85-28 or is legally insufficient for other reasons, the CCPRB will
initiate voluntary remand proceedings and consolidate the claims.
The CCPRB will immediately notify OGC if the pending court case is a
Johnson class member claim so that OGC can notify the claimant of the
option to have the case remanded for readjudication.
3. Post-Screening
Actions
a. Non-Class
Member Cases
If the screening component determines that the individual is not a class
member, the component will:
notify the individual, and representative, if any, of non-class membership
using Attachment 6 (modified as necessary to fit the facts and posture of
the case when there is a current claim);
retain a copy of the notice in the claim file;
send a copy of the notice to:
John Bouman, Attorney
Poverty Law Project
National Clearinghouse for
Legal Services
205 West Monroe, 2nd Floor
Chicago, Illinois
60606
Attn: Johnson
send the non-class member claim file(s) to the Chicago, Illinois district
office using the pre-addressed route slip in Attachment 7.
Photocopy any material contained in the prior file that is relevant to the
current claim and place it in the current claim file before shipping the
prior file.
An individual who wishes to appeal a determination of non-class membership
may do so only through class counsel, as explained in the notice
(Attachment 6).
b. Cases
Determined to Be Class Members
If the screening component determines that the individual is a class
member, it will proceed with processing and adjudication in accordance
with the instructions in Part VI below.
VI. Processing and Adjudication
A. Cases
Reviewed by the DDS
The Illinois DDS will conduct the first Johnson
review except for cases consolidated at the OHA level (see Part VI.D.
below). The DDS determination will be a reconsideration determination,
regardless of the administrative level at which the class member's
claim(s) was previously decided, with full appeal rights (i.e., ALJ
hearing, Appeals Council and judicial review). Except as otherwise noted
in this instruction, ALJs should process and adjudicate requests for
hearing on Johnson DDS review cases in the same
manner as for any other case.
B. Payment
Reinstatement for Cessation Cases
If the Johnson claim involves a title II or title XVI cessation, the class
member may elect to have disability benefits reinstated pending
readjudication. In general, the servicing Social Security field office has
responsibility for:
contacting the class member who may have reinstatement rights;
completing the election forms;
verifying non-disability factors; and
making a good faith effort to reinstate benefits within 45 days after
retrieval or reconstruction of the Johnson claim
file.
For OHA jurisdiction cases, the screening component will:
(1) identify Johnson claims involving title II or
title XVI cessations;
(2) immediately notify the servicing field offices by telephone of the
pending Johnson claims that may be eligible for
benefit reinstatement and document the file accordingly; and
(3) provide the servicing field office with identifying information and
any other information requested.
C. OHA
Adjudication of Class Member Claims
The following instruction applies to both consolidation cases in which the
ALJ or Appeals Council conducts the Johnson
readjudication and to DDS readjudication cases in which the claimant
requests a hearing or Appeals Council review. Except as noted herein, HOs
and Headquarters will process Johnson class
member cases according to all other current practices and procedures
including coding, scheduling, developing evidence, routing, etc.
1. Type
of Review and Period to Be Considered
Pursuant to the Johnson order, regardless of
whether the claim under review is an initial claim or cessation case, the
type of review to be conducted is a reopening. The claim of each class
member must be fully reopened to determine whether the claimant was
disabled at any time from the onset date alleged in the
Johnson claim through the present (or, in title
II cases in which the claimant is no longer insured, through the date
last insured).
2. Step
Two of the Sequential Evaluation
Johnson does not require any change in OHA's
current adjudicatory policies or practices with respect to step two of the
sequential evaluation. Effective with enactment of the 1984 Amendments to
the Social Security Act, OHA's adjudicators have considered the combined
effects of individual “not severe” impairments in evaluating
disability claims at step two. ALJs and the Appeals Council may, if
appropriate, continue to deny or cease the disability claims of Illinois
residents in accordance with
20 CFR
§§ 404.1520(c),
404.1521,
416.920(c) and
416.921, as
well as
SSR
85-28. The then Acting Associate Commissioner's memorandum, dated
February 21, 1991 (Attachment 8), regarding the proper standard for
adjudicating claims at step two, remains in effect.
3. Class
Member Is Deceased
If a class member is deceased, the usual survivor and substitute party
provisions and existing procedures for determining distribution of any
potential underpayment apply.
D. Claim
at OHA But No Current Action Pending
If a claim file (either a class member or a subsequent claim file) is
located in OHA Headquarters but there is no claim actively pending
administrative review, i.e., Headquarters is holding the file awaiting
potential receipt of a request for review or notification that a civil
action has been filed, OAO will associate the alert with the file and
screen for class membership.
If the 120-day retention period for holding a claim file after an ALJ
decision or Appeals Council action has expired, OAO will attach a
Johnson class member flag (see Attachment 9) to
the outside of the file and send the claim file(s) to the Illinois DDS
for review of the Johnson class member claim.
If less than 120 days has elapsed, OAO will attach a
Johnson class member flag to the outside of the
folder (see Attachment 9) to ensure the case is routed to the Illinois DDS
after expiration of the retention period. Pending expiration of the
retention period, OAO will also:
return unappealed ALJ decisions and dismissals to DFB, OAO; and
return unappealed Appeals Council denials to the appropriate OAO
minidocket.
The respective OAO component will monitor the retention period and, if the
claimant does not seek further administrative or judicial review, route
the file(s) to the Illinois DDS in a timely manner.
E. Processing
and Adjudicating Class Member Claims in Conjunction with Current Claims
(Consolidation Procedures)
1. General
If a class member has a current claim pending at any administrative level
and consolidation is warranted according to the guidelines below, the
appropriate component will consolidate all
Johnson class member claims with the current
claim at the level at which the current claim is pending.
2. Current
Claim Pending in the Hearing Office
a. Hearing
Has Been Scheduled or Held, and All Remand Cases
Except as noted below, if a Johnson class member has a request for hearing
pending on a current claim, and the ALJ has either scheduled or held a
hearing, and in all remand cases, the ALJ will consolidate the
Johnson case with the appeal on the current
claim.
The ALJ will not consolidate the claims if:
the current claim and the Johnson claim do not
have any issues in common, or
a court remand contains a court-ordered time limit and it will not be
possible to meet the time limit if the claims are consolidated.
If the claims are consolidated, follow Part VI.E.2.c. below. If the claims
are not consolidated, follow Part VI.E.2.d. below.
b. Hearing
Not Scheduled
Except as noted below, if a Johnson class member
has an initial request for hearing pending on a current claim and the HO
has not yet scheduled a hearing, the ALJ will not consolidate the
Johnson claim and the current claim. Instead, the
ALJ will dismiss the request for hearing on the current claim and forward
both the Johnson claim and the current claim to
the DDS for further action (see Part VI.E.2.d. below).
If the hearing has not been scheduled because the claimant waived the
right to an in-person hearing, and the ALJ is prepared to issue a fully
favorable decision on the current claim, and this decision would also be
fully favorable with respect to all the issues raised by the application
that makes the claimant a Johnson class member,
the ALJ will consolidate the claims.
If the claims are consolidated, follow Part VI.E.2.c. below. If the claims
are not consolidated, follow Part VI.E.2.d. below.
c. Actions
if Claims Are Consolidated
Because the Johnson court order requires the
Secretary to reopen fully the claims of class members, the issue in title
II Johnson claims is whether the claimant was
disabled at any time from the onset date alleged in the
Johnson claim through the present (or, if the
person is no longer insured, through the date the claimant last met the
insured status requirements). If a title II
Johnson claim involves an earlier alleged onset
date than the current claim, the Johnson court order requires the ALJ to
consider the additional issue of whether the claimant became disabled at
any time between the two alleged onset dates. Similarly, consolidation of
a title XVI claim will always raise the issue of whether a claimant
became disabled between the dates the claims were filed.
If the ALJ decides to consolidate the current claim with the
Johnson claim(s), the HO will:
give proper notice of any new issue(s) as required by
20 CFR
§§ 404.946(b) and
416.1446(b),
if the Johnson claim raises any additional
issue(s) not raised by the current claim;
offer the claimant a supplemental hearing if the ALJ has already held a
hearing and the Johnson claim raises an
additional issue(s), unless the ALJ is prepared to issue a fully
favorable decision with respect to the Johnson
claim;
issue one decision that addresses both the issues raised by the current
request for hearing and those raised by the
Johnson claim (the ALJ's decision will clearly
indicate that the ALJ considered the Johnson
claim pursuant to the Johnson court order);
and
send copies of the consolidated hearing decision to both:
Office of Hearings and Appeals
Division of Litigation Analysis
and
Implementation
One Skyline Tower, Suite 702
5107 Leesburg
Pike
Falls Church, VA 22041-3255
ATTN:
Johnson Coordinator
and
Litigation Staff
Office of Policy and Planning
P.O. Box
17729
Baltimore, Maryland 21235
ATTN:
Johnson Coordinator
d. Action
if Claims Not Consolidated
If common issues exist but the ALJ decides not to consolidate the current
claim with the Johnson claim because the hearing
has not yet been scheduled, the HO will:
dismiss, without prejudice, the request for hearing on the current claim,
using the language in Attachment 11 and the covering notice in Attachment
12;
send both the Johnson claim and the current claim
to the Illinois DDS for consolidation and further action.
If the ALJ decides not to consolidate the current claim with the
Johnson claim because: 1) the claims do not have
any issues in common, or 2) there is a court-ordered time limit, the ALJ
will:
flag the Johnson claim for DDS review using
Attachment 10, immediately route it to the Illinois DDS for adjudication
and retain a copy of Attachment 10 in the current claim file; and
take the necessary action to complete the record and issue a decision on
the current claim.
3. Current
Claim Pending at the Appeals Council
The action the Appeals Council takes on the current claim dictates the
disposition of the Johnson claim. Therefore, OAO
must keep the claim files together until the Appeals Council completes its
action on the current claim. The following sections identify possible
Appeals Council actions on the current claim and the corresponding action
on the Johnson claim.
a. Appeals
Council Intends to Dismiss, Deny Review or Issue a Denial Decision on the
Current Claim -- No Johnson Issue(s) Will Remain
Unresolved.
This will usually occur when the current claim duplicates the
Johnson review claim, i.e., the
Johnson claim raises an issue of disability for a
period covered by the current claim, and the current claim has been
adjudicated in accordance with the provisions of
SSR
85-28 and the current severity regulations, i.e.,
20 CFR
§§ 404.1520(c),
404.1521,
404.1523,
416.920(c),
416.921 and/or
416.923. In this
instance, the Appeals Council will consolidate the claims and proceed
with its intended action.
The Appeals Council's order, decision or notice of action will clearly
indicate that the ALJ's or Appeals Council's action resolved or resolves
both the current claim and the Johnson claim.
b. Appeals
Council Intends to Dismiss, Deny Review or Issue a Denial Decision on the
Current Claim — Johnson Issue(s) Will
Remain Unresolved.
This will usually occur when the current claim does not duplicate the
Johnson claim, e.g., the current claim raises the
issue of disability but does not cover the entire period adjudicated in
the Johnson claim . For example, the
Johnson claim raises the issue of disability for
a period prior to the period adjudicated in the current claim. In this
instance, the Appeals Council will proceed with its intended action on the
current claim in accordance with the provisions of
SSR
85-28.
OAO staff will attach a Johnson case flag
(Attachment 9) to the Johnson claim, immediately
route it to the Illinois DDS for adjudication, and retain a copy of
Attachment 9 in the current claim file. OAO will modify Attachment 9 to
indicated that the Appeals Council action on the current claim does not
resolve all Johnson issues and that the
Johnson class member claim is being forwarded for
separate processing. OAO staff will include copies of the ALJ or Appeals
Council decision or order on the current claim and the exhibit list used
for the ALJ or Appeals Council decision.
c. Appeals
Council Intends to Issue a Favorable Decision on the Current Claim -- No
Johnson Issue(s) Will Remain Unresolved.
If the Appeals Council intends to issue a fully favorable decision on a
current claim, and this decision would be fully favorable with respect to
all issues raised by the application that makes the claimant a
Johnson class member, the Appeals Council will
proceed with its intended action. The Appeals Council will consolidate the
claims, reopen the final determination or decision on the
Johnson claim and issue a decision that
adjudicates both applications. The Appeals Council's decision will
clearly indicate that the Appeals Council considered the
Johnson claim pursuant to the
Johnson court order. For class action reporting
purposes, the Appeals Council will send copies of its decision to the
Johnson coordinators listed in Part VI.E.2.c.
above.
d. Appeals
Council Intends to Issue a Favorable Decision on the Current Claim --
Johnson Issue(s) Will Remain Unresolved.
If the Appeals Council intends to issue a favorable decision on a current
claim and this decision would not be fully favorable with respect to all
issues raised by the Johnson claim, the Appeals
Council will proceed with its intended action. In this instance, the
Appeals Council will request the effectuating component to forward the
claim files to the Illinois DDS after the Appeals Council's decision is
effectuated. OAO staff will include the following language on the
transmittal sheet used to forward the case for effectuation:
“Johnson court case review needed —
following effectuation forward the attached combined files to Department
of Rehabilitation Services, Bureau of Disability Determination Services,
100 N. First Street, Springfield, Illinois 62702.”
e. Appeals
Council Intends to Remand the Current Claim to an ALJ.
If the Appeals Council intends to remand the current claim to an ALJ, it
will proceed with its intended action unless one of the exceptions below
applies. In its remand order, the Appeals Council will direct the ALJ to
consolidate the Johnson claim with the action on
the current claim pursuant to the instructions in Part VI.E.2.a.
above.
The Appeals Council will not direct the ALJ to consolidate the claim
if:
the current claim and the Johnson claim do not
have any issues in common, or
a court remand contains a court-ordered time limit and it will not be
possible to meet the time limit if the claims are consolidated.
If the claims do not share a common issue or a court-ordered time limit
makes consolidation impractical, OAO will forward the
Johnson class member claim to the Illinois DDS
for separate review.
The case flag in Attachment 10 should be modified to indicate that the
Appeals Council, rather than an ALJ, is forwarding the
Johnson class member claim for separate
processing.
F. Copy
Requirements
For all cases in which OHA is the first level of review for the
Johnson claim (i.e., the Appeals Council or an
ALJ consolidates the Johnson claim with action
on a current claim or a class member only claim is pending at OHA), HO,
OAO or OCA personnel, as appropriate, must send a copy of any OHA
decision to the Johnson coordinators at the
addresses listed in Part VI.E.2.c. above.
VII. Case Coding
HO personnel will code prior claims into the Hearing Office Tracking
System (HOTS) and the OHA Case Control System (OHA CCS) as
“reopenings.” If the prior claim is consolidated with a
current claim already pending at the hearing level (see Part VI above), HO
personnel should not code the prior claim as a separate hearing request.
Instead, HO personnel will change the hearing type on the current claim to
a “reopening.” To identify class member cases in HOTS, HO
personnel will code “JN” in the “Class Action”
field. No special identification codes will be used in the OHA CCS.
VIII. Reconciliation of Implementation
At an appropriate time, Litigation Staff will request SSA components to
reconcile their screening activity and disposition of class member claims
with information available on CATS. Within OHA, the OAO Class Action
Coordinator is responsible for maintaining a personal computer-based
record of OHA implementation activity (e.g., a record of alerts processed
by OHA, and a record of cases screened and consolidated by OHA), as
reported by HOs and OAO to the Coordinator. See Part V.B.2.a. and HALLEX
I-1-7-12 with respect
to their reporting requirements
IX. Inquiries
HO personnel should direct any questions to their Regional Office.
Regional Office personnel should contact the Division of Field Practices
and Procedures in the Office of the Chief Administrative Law Judge at
(703) 305-0022.
Attachments:
Final Judgment Order Dated April 3, 1991
Johnson Court Case Flag/Alert
Route Slip or Case Flag For Screening
Johnson Screening Sheet
Route Slip for Routing Class Member Alert (and Prior Claim Folder(s)) to
ODIO or PSC -- OHA No Longer Has Current Claim
Johnson Non-Class Membership Notice
Route Slip for Non-Class Membership Cases
Acting Associate Commissioner's Memorandum Dated February 21, 1991,
Entitled “The Standard for Evaluating 'Not Severe'
Impairments”
Johnson Class Member Flag for Headquarters Use (DDS Readjudication)
Johnson Class Member Flag for HO Use (DDS Readjudication)
ALJ Dismissal Order to DDS
Cover Notice for ALJ Dismissal Order
[Date Filed 04/3/1991]
IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF
ILLINOIS
FINAL JUDGEMENT ORDER
This case comes before the Court on remand from a unanimous en banc
decision of the court of appeals. Johnson v.
Sullivan, 922 F.2d 346 (7th Cir. 1990), directing, inter alia,
“[t]he implementation of relief for those who qualify . . .
[to] begin and begin immediately.” Id. at 357. In
conformity with the court of appeals' directions, it is hereby ORDERED,
ADJUDGED, AND DECREED that:
As used herein, the following terms have the meanings indicated:
“Class Members” means the class of persons defined as:
All persons in Illinois who are filing or have filed applications for
disability benefits under Title II and/or Title XVI of the Social Security
Act whose benefits (on or after February 26, 1979) have been or are being
denied pursuant to the practices applied under
20 C.F.R. §
§ 404.1520(c) and
.1522 (1983),
416.920(c) and
.922 (1983),
and Social Security Rulings cum ed. 82-55, 82-56 (1982), if such
persons had claims for those benefits pending at any level of the
administrative process (at the initial claims level, on reconsideration,
before an Administrative Law Judge, or before the Appeals Council) on or
after June 12, 1983, or had fully exhausted their administrative remedies
pursuant to 20 C.F.R Part 404, Subpart J, or Part 416, Subpart N, prior to
June 12, 1983.
All recipients of disability benefits under Title II and/or Title XVI of
the Social Security Act who (on or after February 26, 1979) have made
claims for continued benefits (through participation in a Continuing
Disability Interview), and whose benefits have been or are being
terminated pursuant to the practices specified in paragraph 1(a) (i), if
such recipients had claims for such continued benefits or claims that
their benefits should not have been terminated pending at any level of the
administrative process (at the initial claims stage, at the
reconsideration stage, before an Administrative Law Judge, or before the
Appeals Council) on or after June 12, 1983 or had fully exhausted their
administrative remedies pursuant to 20 C.F.R. Part 404, Subpart J, or Part
416, Subpart N, prior to June 12, 1983.
“Secretary” or “defendant” means the defendant
Secretary of Health and Human Services.
“SSA” means the Social Security Administration.
“BDDS” means the Illinois Bureau of Disability Determination
Services.
“DDS” means any state disability determination service unit
(other than BDDS) having jurisdiction over the redetermination of a class
member's claim under 3 infra, or other state or federal entitiles
designated by SSA to have such jurisdiction.
“disability benefits” means benefits paid under Title II
and/or XVI of the Social Security Act, to persons who were or are eligible
for them, because they were or are disabled within the meaning of the
Act.
“SSA administrative decision” means any decision on a claim
when rendered by an SSA administrative unit or decision maker, including
BDDS (or any DDS), an Administrative Law Judge (ALJ), or the Appeals
Council.
“redermination class members” mean:
class members (as defined in paragraph 1 (a) supra) who claimed to be or
were suffering from multiple “nonsevere” or
“severe” impairments and:
whose de novo applications for disability benefits were denied at the
severity step of the sequential evaluation process by any SSA
administrative decision between August 20, 1980 and May 1, 1985 inclusive,
or;
whose previously awarded disability benefits where terminated at the
severity step of the sequential evaluation process by any SSA
administrative decision between August 20, 1980 and May 1, 1985 inclusive,
or;
whose claims for disability benefits were denied or terminated at the
severity step of the sequential evaluation process by the BDDS between
February 26, 1979 and August 19, 1980 inclusive, if they were listed by
the BDDS under listing code 922.
Under the definition in paragraph 1(h) (i) no person otherwise a
redetermination class member shall be deemed not such a class member
because: he appealed any denial or termination of a claim (within the
administrative appeals process, or to the federal courts); or the time for
such an administrative appeal lapsed on or after June 12, 1983 and such
an appeal was not taken; or the time for taking a judicial appeal under
42 U.S.C. § 405(g) lapsed and an appeal was not taken; or based on a
later application, he was found eligible for disability benefits for a
period of time later than that with respect to which his benefits were
initially denied or terminated; or he failed to allege multiple
impairments but the evidence establishes the existence of more than one
impairment; or he received a judicial decision on his claim.
Under the definition in paragraph 1(h) (i), a person who would otherwise
be a redetermination class member because a particular claim was denied or
terminated at the severity step of the sequential evaluation process is
not such a member if:
the last SSA administrative denial or termination he received respecting
that particular claim was based on any step of the sequential evaluation
process other than the severity step; or
he received an SSA administrative decision on a subsequent claim for
disability benefits that reopened an earlier severity denial or
termination of that claim, which decision determined entitlement to
benefits for a period beginning no later than the first date with respect
to which his eligibility would otherwise be redetermined under this order,
and either the last SSA administrative denial on the subsequent claim was
based on any step of the sequential evaluation process other than the
severity step, or the last administrative denial on the subsequent claim
was based on the severity step of the sequential evaluation process, but
the denial came after May 1, 1985.
“responding claimants” means the persons on whose behalf the
election forms described in paragraph 3(a) and (b) infra are returned to
SSA.
“claims” when used in connection with “redetermination
class members” means such class members' applications for
disability benefits under Titles II and/or XVI of the Social Security Act,
or their claims for continuing disability benefits under Titles II and/or
XVI of the Act, or any request for disability benefits to which they may
be entitled under this order.
“redetermination” or “redetermine” when used in
connection with “claims” and/or “redetermination class
members” means:
for a redetermination class member whose Title XVI application was denied
or whose Title XVI benefits were terminated, a new determination by BDDS
(or an appropriate DDS) on the class member's claim, the new determination
to establish eligibility vel non for disability benefits for the entire
period from the date of the class member's Title XVI application (that was
denied) or from the date of the termination Title XVI benefits, to the
date the new determination decision is made (and thereafter until
eligibility ends). “Redetermination” also includes the
issuance of a written decision explaining the result of the determination
to the individual claimant (whose claim has been redetermined) and to his
designated representative (if any);
for a redetermination class member whose Title II application was denied
or whose Title II benefits were terminated, a new determination by BDDS
(or an appropriate DDS) on the class member's claim, the new determination
to establish eligibility vel non for disability benefits for the entire
period from the seventeenth month prior to the date of the Title II
application or from the date of termination of Title II benefits (or date
of alleged onset, which is later, to the date the redetermination decision
is made (and thereafter until eligibility ends).
“Redetermination” also includes the issuance of a written
decision explaining the result of the determination to the individual
claimant (whose claim has been redetermined) and to his designated
representative (if any);
“retroactive benefits” when used to refer to the payment of
disability benefits to “redetermination class members” means
the payment of disability benefits to such persons for all periods from
February 26, 1979 inclusive to the date of the redetermination decision,
provided that they are eligible for them, as determined by the
redeterminations required by paragraphs 3, 4 and 9 of this order,
“sequential evaluation process” means the process for
determining eligibility for disability benefits described in
20 C.F.R.
§§ 404.1520 and
416.920, and the
“severity step” is the step of that process described at
20 C.F.R
§§ 404.1520(c) and
416.920(c);
“combination criteria” means the following statutory
eligibility criteria:
In determining whether an individual's physical or mental impairments are
of sufficient medical severity that such impairment or impairments could
be the basis of eligibility ... [for disability benefits], the
Secretary shall consider the combined effect of all of the individual's
impairments without regard to whether any such impairments, if considered
separately, would be of such severity. If the Secretary does find a
medically severe combination of impairments, the combined impact of the
impairment shall be considered throughout the disability determination
process.
42 U.S.C. § 423(d)(2)(C);
Within 30 days of the entry of this Order, the Secretary, through the use
of SSA's automated data base, shall complete identification of the persons
who may be redetermination class members (and verify the list of such
persons).
SSA administrative decisions made prior to May 2, 1985 upon the claims of
responding claimants determined to be redetermination class members are
vacated, and the Secretary shall make redeterminations (reopening if
necessary) of the claims of all such responding claimants who are
determined to be redetermination class members. In making these
redeterminations, and on appeals from adverse redeterminations (see
paragraph 9 infra), the sequential evaluation process, including the Act's
combination criteria, shall be employed. The Secretary shall be entitled
to verify that redetermination class members meet all the nondisability
related eligibility criteria for payment of disability benefits. The
procedure governing the conduct of such redeterminations (including the
procedure for notifying claimants of such redetermination decisions and
appeal rights, and for paying benefits owed) shall be as follows:
No later than sixty (60) days after the entry of this order, the Secretary
shall send to each person who has been identified as a redetermination
class member whose de novo application for disability benefits was denied
the notice attached hereto as Exh. A-1. (Such notices shall be sent by
first class mail, postage prepaid, and to such class member's last known
address). With the Exh. A-1 notice, defendant shall provide Exh. A-2,
which, as printed, shall be an election form by which the election
described in Exh. A-1 notice may be made. The election form shall either
be accompanied by a pre-addressed postage pre-paid envelope in which the
election form can be returned to SSA, or it will itself be returned to
SSA, or it will itself be returnable to SSA as a postage prepaid postcard.
The pre-addressed envelope or postcard, which is used, shall be
pre-addressed to a single location (as opposed to various SSA local
offices).
Not later than sixty (60) days after the entry of this order, the
Secretary shall send to each person who has been identified as a
redetermination class member whose previously awarded disability benefits
were terminated, the notice attached hereto as Exh. B-1. (Such notices
shall be sent by first class mail, postage prepaid, and to such class
member's last known address). With the Exh. B-1 notice, defendant shall
provide Exhibit B-2, which, as printed, shall be an election form by which
the election described in Exh. B-1 notice may be made. The election form
shall either be accompanied by a pre-addressed postage prepaid envelope in
which the election form can be returned to SSA, or it will itself be
returnable to SSA as a postage prepaid postcard. The pre-addressed
envelope or postcard, whichever is used, shall be pre-addressed to a
single location (as opposed to various local SSA offices).
Redetermination class members who return a completed Exh. B-2 election
form may elect to have their benefits reinstated (as described in the
Exh.B-1 notice), following completion of one of the applicable forms
attached as Group Exh. C hereto. (SSA will contact the redetermination
class member respecting completion of this form as soon as possible after
that class member's claims file is retrieved or reconstructed, but in no
event later than thirty (30) days after his claims file is retrieved or
reconstructued). However, if a redetermination class member reports, or
SSA becomes aware of, current work activity, SSA will secure a statement
from him regarding his work activity, the amount of monthly wages, and any
other pertinent information pertaining to his employment. Except as
provided in section 1619 of the Social Security Act, 42 U.S.C. §
1382h, reinstated (interim) benefits shall not be payable for any month
for which earnings are at or beyond the substantial gainful activity
level. If interim benefits are not payable for that reason, then
defendant shall notify the individual denied such benefits of that fact,
and the reason for the denial. Defendant will also inform that individual
that if he has any questions, he may contact a social security office, or
plaintiffs' counsel (whose names, address, and phone number will be
provided).
The Secretary shall make all good faith efforts to reinstate benefits to a
redetermination class member within forty-five (45) days after the claims
file of such a class member is retrieved (provided that he is determined
to be entitled to such benefits), or, if such a class member's claims file
is lost, the Secretary shall make all good faith efforts to reinstate
benefits to him within forty-five (45) days of the expiration of the
four-month period specified in paragraph 3(d) infra. Benefits shall be
reinstated in an amount equal to the amount reinstated class members would
then be receiving, including subsequent cost-of-living increases, had
their benefits never been terminated, and effective with the date that SSA
received the Exh. B-2 election form from the redetermination class
member. The payment of such reinstated benefits shall continue from month
to month until there has been an ALJ determination that the individual
whose benefits have been reinstated is not currently eligible for
benefits, or until there has been an earlier SSA administrative decision
that the individual is not currently eligible for benefits, and that
decision became final because the individual did not appeal.
Persons sent notices pursuant to subparagraphs (a) and (b) who do not
respond to the notices within sixty (60) days of the day they receive
them, as provided therein, shall be given the opportunity to show good
cause for such failure to respond pursuant to
20 C.F.R.
§§ 404.909,
404.911,
416.1409,
416.1411.
On a schedule to be determined by SSA (that shall be consistent with
achieving compliance with the requirements of paragraph 3(e)(ii) infra)
SSA shall generate computer alerts showing the processing center having
jurisdiction over the claim of redetermination class members, and shall
arrange for retrieval of the claims files of such class members. The first
computer alerts generated shall call for the claim files of all
responding claimants whose benefits have been terminated. Defendants
shall begin reconstructing the claim file of any redetermination class
member whose file cannot be located within four (4) months after a
computer alert has been generated for the claim file of that individual.
Redetermination class members whose files are being reconstructed shall
be notified of that fact, and shall, consistent with applicable
regulations, submit documentary evidence to SSA that will assist
defendant in reconstructing the file and that might support their
claim.
Defendant, by BDDS (or the DDS to which a responding class member's case
file has been sent), shall:
screen all files to determine if the responding class member is a
redetermination class member. Defendant shall mail (by first class mail
postage prepaid) to any individual whom he determines is not a
redetermination class member a notice, the form of which is attached
hereto as Exh. D. A copy of the completed notice will be sent to
plaintiffs' counsel. Within forty-five (45) days of plaintiffs' attorneys'
subsequent request, or within some other mutually agreed upon time, the
Secretary shall make available that individual's claims file to
plaintiffs' counsel at some mutually agreed upon location or locations. If
plaintiffs' attorneys' review of the file thereafter establishes that
there is a dispute between the parties as to whether an individual is a
redetermination class member, counsel for plaintiffs and defendant (or
their designees) shall seek to resolve such dispute by negotiation;
provided, however, that both plaintiffs and defendant shall each designate
one or more persons to represent them in the negotiations, which
individual(s) shall have final authority to settle such disputes. Either
party may submit any unresolved dispute to the court for resolution, by a
duly noticed motion;
Redetermine the claims of all responding claimants who have been
determined to be redetermination class members, based on the evidence in
their claims files; provided, however, that in making such
redeterminations the Secretary is obliged to develop and redetermination
class members shall provide evidence respecting such class members' claims
in accordance with the requirements of:
20 C.F.R.
§§ 404.1512,
404.1514,
404.1517,
404.1614;
20 C.F.R.
§§ 416.912,
416.914,
416.917,
416.1014, and
include such evidence in the case file. Defendant, by the BDDS and any DDS
making redeterminations, shall make a good faith effort to complete the
redetermination of all redetermination class members entitled to
redetermination of their eligibility under this order within two years
after the date the notice required by subparagraphs (a) and (b) are first
mailed, and shall further make a good faith effort to complete such
redeterminations at an average rate of at least eight hundred (800) a
month for a two-year period beginning with the first full calendar month
sixty (60) days after such notices are first mailed; provided, however,
that if the Secretary is required to complete more than 21,000
redeterminations under this order, then he shall notify plaintiffs'
counsel of that fact in writing promptly after he ascertains it. Counsel
for the parties shall thereafter attempt to agree upon what additional
time, if any, beyond the two-year period the Secretary shall be allowed to
complete all the redeterminations he must complete. If no agreement can
be reached after a one hundred twenty (120) day period of negotiation,
during which time either party may take discovery, then either party may,
by motion, submit the matter to the court for its resolution.
While any DDS is permitted to conduct redeterminations pursuant to this
order, at least seven hundred (700) of the total number of
redeterminations conducted pursuant to this order each month, or a
majority of the total redeterminations conducted pursuant to this order
each month, whichever is less, must be done by the BDDS.
If an individual is a redetermination class member by virtue of a claim
for disability benefits with respect to which there is a pending action in
federal court, he may elect to have his case remanded to the BDDS or to
the DDS of the state in which he resides for a redetermination identical
to the ones required for other redetermination class members, subject to
the approval of the court. Defendant shall notify such class members of
the opportunity they have to make such an election, and provide a written
form by which such an election may be made. If such an election is made,
defendant shall move the court to, or agree to, a remand of the case.
Defendant shall make a good faith effort to complete the redetermination
of a redetermination class member whose case has been remanded from a
federal court within four (4) months of the date that defendant receives a
copy of the remand order.
Redetermination class members whose eligibility for benefits is
redetermined by BDDS (or a DDS) pursuant to subparagraphs (a)-(f), and who
are determined eligible for retroactive benefits, shall be paid such
benefits for all periods for which they are determined eligible for them,
pursuant to paragraph 6 infra.
Notwithstanding the requirements of paragraph 3 supra, the Secretary is
not required to send notices to or redetermine the eligibility of any
redetermination class member who is dead and who:
does not have (as of the date he is determined to be a redetermination
class member) a “living with eligible spouse” or
“eligible parent,” as described in
20 C.F.R. §
416.542(b); and
between February 26, 1979 and May 1, 1985 inclusive, made application for
disability benefits only under Title XVI (as opposed to Title II) of the
Social Security Act, or was a recipient of disability benefits only under
Title XVI (as opposed to Title II). Redeterminations must be made for all
other responding claimants who are determined to be redetermination class
members, even if such class members are dead.
Any overpayment that results from the ultimate determination of the claim
of a redetermination class member whose benefits were reinstated under
paragraph 3(b) shall be subject to waiver consideration under 42 U.S.C.
§ 423(g)(2)(B). No payment to a redetermination class member shall be
considered an overpayment, however, unless SSA has determined that the
individual allegedly overpaid was ineligible for disability benefits for
the months with respect to which the alleged overpayments were made.
The Secretary shall grant retroactive disability benefits to all
redetermination class members for all periods that such persons (upon the
redetermination of their eligibility under paragraphs 3, 4, and 9) are
found eligible for them. The Secretary shall make all good faith efforts
to pay such retroactive benefits within sixty (60) days after the
determination of eligibility is made in the individual claimant's case. If
the Secretary determines that the redetermination class member to whom
retroactive benefits would be paid is dead, then payment of such benefits
shall be made in accordance with the underpayment requirements of
20 C.F.R.
§§ 404.503,
416.542.
With respect to the notices required by paragraph 3(a) and (b) that are
returned to the Secretary as undelivered, he shall immediately remail them
by first class mail. For those notices returned a second time as
undeliverable, the Secretary shall identify the individuals to whom those
notices were sent, and then use procedures set forth in SSA Program
Operations Manual Systems (“POMS”) procedures to determine
the current whereabouts of that class member. Before employing such POMS
procedures, defendant shall attempt to establish a procedure for securing
from Illinois Department of Public Aid the last known address (if any)
that agency may have for that individual. If that address is a later
address for the redetermination class member than that initially utilized
by the Secretary, then he shall use that later address in seeking to
direct such notice. If, after taking the steps required under this
paragraph, the Secretary determines the whereabouts of a redetermination
class member whose paragraph 3 notice was returned as undelivered, he
shall send him a new notice comparable to the first notice. The time
within which a redetermination class member sent such a second notice
shall be required to make an election shall, however, run from the date
this new notice is sent to him.
The Secretary shall ensure that a blank copy of the form of any SSA
notices related to this case that SSA plans to send or give to
redetermination class members, shall be received by plaintiffs' counsel at
least twenty-one (21) days prior to the date notices will be sent or
given, unless plaintiffs' counsel waives the twenty-one (21) day period in
writing. Provision of these notices to plaintiffs' counsel is intended to
afford them the opportunity to comment upon such notices, before they are
printed.
The Secretary, by BDDS or by the DDS making the redetermination, shall
notify redetermination class members (and their designated
representatives, if any) of favorable and unfavorable decisions made by
the BDDS or DDS in their cases, pursuant to paragraph 3 supra. Such
notices shall: contain an explanation of the reasons for the decision if
less than completely favorable, and appeal rights; inform the
redetermination class members that they may submit additional evidence, on
appeal, in support of their claim; inform them that if they wish further
information they may contact a local social security office, their own
representative, or the attorneys for the class (whose names, address, and
phone number shall be given); inform them that the attorneys for the class
may be able to represent them without charge in prosecuting their appeal;
inform them that they have sixty (60) days from the date the notice is
sent to them to request an Administrative Law Judge hearing. Individuals
sent such notices shall have full rights to seek timely administrative and
judicial review of the redetermination decision made pursuant to
paragraph 3, 4, and 9 herein, under 20 C.F.R. Part 404, Subpart J. and
Part 416, Subpart N, and 42 U.S.C. §§ 405(g), 1383(c).
Nothing in this order shall be construed as precluding defendant from
employing the quality assurance review procedures set forth in 42 U.S.C.
§ 421(c)(3) in any class member's case, to the extent defendant deems
that appropriate. Nothing in this order shall be construed as precluding
class members from obtaining greater relief on alternative grounds.
Nothing in this order shall be construed as precluding class members who
choose to proceed with their individual court cases from seeking relief in
those cases.
The Secretary shall:
within thirty (30) days of the entry of this order, issue a teletype to
all SSA offices (including BDDS and any appropriate DDS) having
responsibilities under this order, which teletype shall provide relevant
information relating to the terms of this order needed by SA offices;
Within one hundred fifty (150) days from the entry of this order, issue
directives and instructions designed to ensure full compliance with
it.
The Secretary shall:
provide plaintiffs' attorneys with copies of all teletypes, instructions,
directives, transmittals, agency letters, and like documents issued by SSA
to describe this order to SSA field offices (including Regional Offices,
District Offices, Quality Assurances offices, BDDS or any state DDS with
responsibilities under this order), or to effect compliance with this
order, just as soon as those documents are issued;
serve upon plaintiffs' attorneys a statement that the mailing of the
notices required by paragraph 3(a) and (b) supra has been completed. The
statement shall also specify the total number of such notices mailed. The
statement shall be served within one (1) week after the mailing has been
completed;
serve upon plaintiffs' attorneys, within ninety (90) days after the
mailing of the notices required by paragraph 3(a) and (b) supra has been
completed, a statement attesting to the number of such notices returned a
second time as undelivered, and the number of responding claimants;
serve upon plaintiffs' attorneys a report for each six-month period
beginning with the first full month after the date of entry of this order
and ending when all relief hereunder has been provided, stating, for that
six-month period:
the number of responding claimants given notice that they have been
screened out of the class, pursuant to paragraph 3(e)(i) supra;
the number of responding claimants whose benefits have been reinstated
pursuant to paragraph 3(b) supra;
the number of responding claimants determined eligible for benefits upon
redetermination (for part or all of the redetermination period), and the
number determined ineligible upon redetermination (for part or all of the
redetermination period), and the number of such claimants determined
ineligible whose benefits had previously been reinstated pursuant to
paragraph 3(b) supra;
the number of redetermination class members the Secretary has determined
he cannot locate, pursuant to paragraph 7 supra.
The reports required by this subparagraph shall be filed and served not
later than thirty (30) days after the close of the six-month period with
respect to which the individual report is prepared.
The Secretary may petition the court at any time for relief from any one
or more of the provisions of paragraph 12 supra. Such relief shall be
granted upon a showing made by the Secretary and a determination of the
court that the implementation of this order is proceeding smoothly and
that the information called for in the particular provision or provisions
from which the Secretary seeks relief is no longer required to determined
that the Secretary is fully and expeditiously complying with the
provisions of this order.
This order constitutes a final judgment order. The issue of plaintiffs'
entitlement to attorneys' fees and costs is reserved. Plaintiffs'
entitlement to attorneys' fees and costs is reserved. Plaintiffs shall
file an appropriate petition for fees within the time permitted by the
Equal Access to Justice Act, 28 U.S.C. § 2412. Plaintiffs may file a
bill of costs when they file their petition for fees, their time to file
the bill being thereby extended.
Nothing in this order, and no agreement as to form that this order
reflects, shall be construed to limit any party's right to pursue, in the
appropriate court, a stay of the order or an injunction pending appeal or
an appeal.
This court shall retain continuing jurisdiction over this case to enforce
the terms of this order, or to entertain motions seeking to modify its
terms.
IT IS SO ORDERED:
TITLE:
CATEGORY:
REVIEW OFFICE PSC
MFT DOC
ALERT DATE
BOAN OR PANNAME
CAN
OR
HUN RESP
DTETOE
FOLDER LOCATION INFORMATION
TITLE CFL CFL
DATE ACN PAYEE
ADDRESS
REVIEWING OFFICE ADDRESS:
Department of Rehabilitation
Services
Bureau of Disability Determination
Services
100 N. First Street
Springfield, IL 62702
ATTN: Johnson Screening
Unit
IF CLAIM IS PENDING OR STORED IN OHA, THEN SHIP
TO:
Office of Hearings and Appeals
Office of Appellate Operations
(OAO)
One Skyline Tower, Suite 701
5107 Leesburg Pike
Falls Church, VA 22041-3200
ATTN: OAO Class Action Coordinator
(Case locator code 5007)
Johnson Class Action Case
SCREENING NECESSARY
Claimant's Name: __________________________________
SSN: __________________________________
This claimant may be a Johnson class member. The attached folder location
information indicates that a current claim folder is pending in your
office. Accordingly, we are forwarding the attached alert [and prior
claim folder(s)] for association, screening for class membership,
consolidation consideration and possible readjudication.
Please refer to HALLEX Temporary Instruction 5-411 for additional
information and instructions.
TO: ______________________________
______________________________
______________________________
______________________________
REMARKS
JOHNSON CASE
Claimant: ___________________________
SSN: ________________________________
OHA received the attached alert [and prior claim folder(s)] for
screening and no longer has the current claim folder. Our records show
that you now have possession of the current claim. Accordingly, we are
forwarding the alert and any accompanying prior claim folder(s) for
association with the current claim. After associating the alert with the
current claim, please forward to the Illinois DDS for screening and
possible readjudication. SEE POMS DI 42531.005 OR DI 12531.10
Attachment
DO NOT use this form as a RECORD of approvals, concurrences, disposals,
clearances, and similar actions.
OPTIONAL FORM 41 (Rev. 7-76)
*U.S.GPO:1985-0-461-274/20020 Prescribed by GSA
FPMR (41 CFR) 101-11.206
You asked Social Security to look again at your claim for disability
benefits. We have looked at your case. You are not a member of the Johnson
class for the reason given below. This means that we will not review your
claim.
A copy of this letter is being sent to attorneys for the class. If you
think we are wrong, you should write class counsel right away at the
address shown below. You have 45 days from the date you receive this
notice to let class counsel know you disagree with our reason as to why
you are not a class member, so do not wait. They will answer your
questions about class membership without charge. The names, address and
telephone number of these attorneys are:
John Bouman, Attorney
Poverty Law Project
National Clearinghouse
for Legal Services
205 West Monroe, 2nd Floor
Chicago, Illinois
60606
Attention: Johnson
REASON FOR UNFAVORABLE DECISION
You are not a Johnson class member because:
We Are Not Deciding If You Are Disabled
It is important for you to know that we are not making a decision about
whether you are disabled. We are deciding only that you are not a Johnson
class member.
If You Are Disabled Now
If you think you are disabled now, you should fill out a new application
at any Social Security office.
If You Have Any Questions
If you have questions, you should call, write or visit any Social Security
office. Most questions can be answered by telephone. If you visit a
Social Security office, please bring this letter with you. It will help
us answer your questions.
Esta es una notificacion importante que le dice usted puede tener derecho
a una compensacion monetaria debido a incapacidad. Si usted no entiende
esta notificacion, por favor haga que esta sea traducida immediatamente.
cc:
Poverty Law Project
National Clearinghouse for Legal Services
205
West Monroe, 2nd Floor
Chicago, Illinois 60606
REMARKS
JOHNSON CASE
Claimant: ___________________________
SSN: ________________________________
We have determined that this claimant is not a Johnson class member. (See
screening sheet and copy of non-class membership notice in the attached
claim folder(s).) SEE POMS DI 12531.005 and 32531.005
DO NOT use this form as a RECORD of approvals, concurrences, disposals,
clearances, and similar actions.
OPTIONAL FORM 41 (Rev. 7-76)
*U.S.GPO:1985-0-461-274/20020 Prescribed by GSA
FPMR (41 CFR) 101-11.206
During the past few months, the Office of the General Counsel (OGC) has
requested voluntary remand in a number of cases, denied by the Secretary
at step two of the sequential evaluation, on the grounds that the
decisions have not been fully consistent with SSA policy and the Supreme
Court's opinion in Bowen v. Yuckert, 482 U.S. 137
(1987).
Despite the Yuckert decision, extensive
litigation, both in individual cases and in significant class actions,
continues on the issue of how the Agency applies the step two standard
expressed in
Social
Security Ruling (SSR) 85-28. Because the courts continue to give step
two denials close scrutiny, I am asking all adjudicators and decision
writers to carefully review
SSR
85-28 to ensure that they are applying the proper standard for
adjudicating claims at step two.
In accordance with
SSR
85-28, a step two denial is appropriate only in very limited
situations. The evidence must establish that the claimant's impairment, or
combination of impairments, is so slight that it does not have more than
a minimal effect on the individual's ability to perform basic work
activities. When the medical evidence is inconclusive and does not clearly
establish the effect of a claimant's impairment(s), or when the evidence
shows more than a minimal effect, the claim may not be denied at step
two.
Decisions denying claims at step two must include a comprehensive analysis
of all the evidence of record and a decisional rationale consistent with
SSR
85-28. Even when the medical evidence of record clearly fails to
establish that the claimant has more than a slight mental or physical
abnormality, the decision must clearly show that the adjudicator
evaluated all the evidence and must articulate the reasons for finding
that the impairment(s) is not severe. Furthermore, when the claimant has
a medically determinable impairment(s) which might reasonably be expected
to cause pain or other symptoms, the decision must include an evaluation
of the claimant's subjective complaints using the factors outlined in
SSR
88-13 or its equivalent, i.e.,
SSR
90-1p for Fourth Circuit cases.
If hearing office personnel have questions or need copies of applicable
instructions, they should contact the appropriate Regional Office.
Regional Office personnel should direct their questions to the Division of
Field Practices and Procedures, Office of the Chief Administrative Law
Judge.
Johnson Class Action Case
READJUDICATION NECESSARY
Claimant's Name: __________________________________
SSN: __________________________________
This claimant is a Johnson class member. After
expiration of the retention period, forward claim folder(s) to the
Illinois DDS for readjudication.
If the claimant has filed a civil action and elected to remain in court
for review of the current claim, forward the Johnson claim folder(s)
without delay to the Illinois DDS for readjudication.
Send folders to:
Department of Rehabilitation Services
Department of Disability
Determination Services
100 N. First Street
Springfield, Illinois
62702
(Destination code: S16)
Johnson Class Action Case
READJUDICATION NECESSARY
Claimant's Name: __________________________________
SSN: __________________________________
This claimant is a Johnson class member. The attached Johnson claim folder
was forwarded to this hearing office for possible consolidation with a
current claim.
Accordingly, we are forwarding the attached alert and prior claim
folder(s) to your location for any necessary Johnson readjudication
action.
We are sending the alert and prior folder(s) to:
Department of Rehabilitation Services
Department of Disability
Determination Services
100 N. First Street
Springfield, Illinois
62702
(Destination code: S16)
SOCIAL SECURITY ADMINISTRATION
OFFICE OF HEARINGS AND APPEALS
ORDER OF DISMISSAL
This case is before the Administrative Law Judge pursuant to a request for
hearing filed on _________________ with respect to the application(s)
filed on _________________.
In accordance with an order of the United States District Court for the
Northern District of Illinois in the case of Johnson,
et al. v. Sullivan, No. 83 C 4110 (N.D. Illinois April 3, 1991), the
claimant has requested reopening and revision of the final
(determination/decision) on the prior application(s) filed on
______________. The claimant has been identified as a
Johnson class member and is entitled to have the
final administrative denial of the prior application(s) reviewed under the
terms of the Johnson final judgment order.
Because the claimant's current claim shares certain common issues with
the prior claim, the undersigned hereby dismisses without prejudice the
request for hearing.
The claimant's current application(s) will be associated with the prior
claim(s) and forwarded to the Illinois Disability Determination Service
which will conduct the Johnson readjudication.
The disability determination service will notify the claimant of its new
determination and, if unfavorable, give notice of the claimant's right to
file a new request for hearing.
NOTICE OF DISMISSAL
Claimant's Name
Address
City, State Zip
Enclosed is an order of the Administrative Law Judge dismissing your
request for hearing and returning your case to the Illinois Disability
Determination Service which makes disability determinations for the Social
Security Administration. Please read this notice and Order of Dismissal
carefully.
What This Order Means
The Administrative Law Judge has sent your current claim and your Johnson
class member claim back to the Illinois Disability Determination Service
for further processing. The enclosed order explains why.
The Next Action on Your Claim
The Illinois Disability Determination Service will contact you to tell you
what you need to do. If you do not hear from the Illinois Disability
Determination Service within 30 days, contact your local Social Security
office.
Do You Have Any Questions?
If you have any questions, contact your local Social Security office. If
you visit your local Social Security office, please bring this notice and
the Administrative Law Judge's order with you.
Enclosure
cc: (Name and address of representative, if any)
(Social Security Office (City, State))