I-5-4-55.Adamson v. Chater
|Definition of Class|
|Determination of Class Membership and Preadjudication Actions|
|Processing and Adjudication|
|Reconciliation of Implementation|
|Privacy Act Protective Order filed October 23, 1995; Stipulation; Findings of Fact, Conclusions of Law, and Order of Settlement and Dismissal filed December 19, 1995; and Final Judgment Entered by the United States District Court for the District of Colorado on December 21, 1995.|
|Adamson Court Case Flag/Alert|
|Screening Flag - Within OHA|
|Adamson SCREENING SHEET|
|Screening Flag - Outside OHA|
|Non-Class Membership Notice|
|Route Slip for Non-Class Members Claims|
|Readjudication Flag for OHA Retention Cases|
|ALJ Dismissal to DDS|
|Notice Transmitting ALJ Order of Dismissal|
|Class Member Flag - Readjudication Necessary|
ISSUED: September 27, 1996
This Temporary Instruction (TI) sets forth procedures for implementing the Stipulation approved by the United States District Court for the District of Colorado in its Order of Settlement and Dismissal filed December 19, 1995, in the Adamson v. Chater class action. The court entered final judgment on December 21, 1995 (Attachment 1).
Because the Stipulation affects only individuals who still reside in the Tenth Circuit (Colorado, Kansas, New Mexico, Oklahoma, Utah and Wyoming), adjudicators processing Tenth Circuit cases, either as part of their regular jurisdiction or on a case transfer basis, must be familiar with this TI.
On January 8, 1985, plaintiff Adamson amended his individual complaint, that was filed on October 17, 1984, for the purpose of proceeding as a class action. The plaintiff alleged that the Agency had failed to acquiesce to Tenth Circuit case law regarding the weight that should be given to the reports of treating physicians in disability cases. Following the district court's initial denial of plaintiff's motion for class certification, the Tenth Circuit remanded for further proceedings on the issue. Subsequently, the district court certified a class on March 14, 1989. Thereafter, following extensive discovery and a September 11, 1991 hearing on the parties' objections to the magistrate judge's report and recommendation, the court requested that the parties engage in settlement negotiations. On December 19, 1995, after a fairness hearing on October 13, 1995, the district court gave final approval to the parties' proposed Stipulation.
III. Guiding Principles
Under the Adamson Stipulation, the Secretary will readjudicate the claim(s) of those persons who: 1) respond to personal notice informing them of the opportunity for review; or 2) respond to public notice posted in all SSA field offices (FOs) in the Tenth Circuit, regarding the opportunity for review; and 3) are determined to be class members entitled to relief. In most cases, the Office of Disability and International Operations (ODIO) or the Mid-America Program Service Center (MAMPSC) will screen the claims of those individuals who respond to personal or public notice, and forward class member claims to the Disability Determination Service (DDS) for readjudication. However, the DDS will screen reconstructed cases and cases in which a current claim is pending in the DDS. In addition, if the potential class member claim or another claim is located in OHA when class membership becomes an issue, or if the claimant has a civil action pending, OHA will perform the screening and, under the limited circumstances described in Part VI., will perform the readjudication.
The type of readjudication is a redetermination (see HALLEX I-1-7-04). The class member claim(s) will be adjudicated under current policies and procedures and the claimant will receive normal appeal rights (i.e., Administrative Law Judge (ALJ) hearing, Appeals Council and judicial review).
IV. Definition of Class
The Adamson class members entitled to relief consists of individuals who, under titles II and/or XVI, while residing in the 10th Circuit:
had a claim for disability benefits denied or terminated at the reconsideration level, at steps 4 or 5 of the sequential evaluation  , between October 17, 1984, and July 31, 1991, inclusive, and did not pursue appeal; or
had a claim for disability benefits denied or terminated by an ALJ or the Appeals Council at steps 4 or 5 of the sequential evaluation, between April 10, 1987, and June 27, 1988, inclusive, and did not pursue appeal; or
had a request for review denied by the Appeals Council during the period between April 10, 1987, and June 27, 1988, inclusive, based on a claim for disability benefits denied or terminated by an ALJ at steps 4 or 5 of the sequential evaluation, and did not pursue appeal; and
had a treating physician opinion of record regarding the individual's medical condition that was inconsistent with the decision to deny or terminate benefits.
An individual is not an Adamson class member entitled to relief if he or she
had his or her prior claim(s) readjudicated pursuant to the Luna, Peck, Trujillo or Zebley class actions; or
received a subsequent award of benefits on another claim with respect to the entire time period at issue in the potential class member claim(s); or
received a decision on the merits of a subsequent claim, covering the entire time period at issue in the potential class member claim(s), by the DDS after July 31, 1991, or by OHA before April 10, 1987, or after June 27, 1988.
V. Determination of Class Membership and Preadjudication Actions
A. Pre-Screening Actions - General
Notification of Potential Class Members
SSA sent notices to certain potential class members as identified by computer run. Individuals have 60 days from the date of receipt of the notice to request that SSA readjudicate their claims under the terms of the Adamson Stipulation. Individuals will make their requests by returning a reply form enclosed with the notice. SSA will presume the individual's receipt of notice to be five days after mailing, unless the individual establishes that receipt actually occurred later. If an individual fails to respond within the required 60 days, he or she will be denied relief absent a finding of “good cause” as set forth in 20 CFR §§ 404.911/416.1411.
SSA also disseminated posters to all SSA FOs in the Tenth Circuit, to inform individuals not entitled to personal notice, i.e., those whose disability claims were denied/terminated between October 17, 1984, and April 9, 1987, inclusive, of their right to request review under the terms of the Stipulation. Posters will remain displayed for a period of 120 days, and potential class members must request review not later than 60 days after the poster display period has ended.
Alert and Folder Retrieval Process
ODIO will receive all response forms and requests for review and the information will be entered into the Civil Action Tracking System (CATS). CATS will generate alerts to ODIO. (See Attachment 2 for a sample Adamson alert.)
ODIO will associate the alerts and response forms, and will forward them to the appropriate component for retrieval. ODIO will retrieve title II-only and concurrent title II/XVI folders, except those located in OHA or a DDS (see Part V. A. 3. below). The MAMPSC will retrieve title XVI-only folders, except those located in the Wilkes-Barre Data Operations Center (WBDOC), OHA or a DDS (see Part V. A. 3. below). The WBDOC will retrieve title XVI-only folders and forward them to the MAMPSC for screening.
Alerts Sent to OHA
If ODIO determines that a current claim, i.e., either a potential class member claim or another claim, is pending or stored at OHA, ODIO will forward the alert, along with any other claim file(s) to OHA for screening, consolidation consideration (if appropriate) and possible readjudication. ODIO will also forward the alert to OHA if the potential class member claim or another claim is pending in court. If necessary, ODIO will obtain and forward a copy of the court transcript along with the alert. If ODIO is unable to locate a prior claim file(s) and a current claim is pending or stored at OHA, ODIO will telephone the hearing office (HO) or OHA Headquarters, as appropriate, to determine if the prior claim file(s) is associated with the claim file(s) pending or stored at OHA. (In most cases at the OHA level, the prior claim file(s) will be associated with the current claim.)
If the claim is located in an HO, ODIO will forward the alert and claim file(s), if any, directly to the HO for processing. If the claim is located in OHA Headquarters, ODIO will forward the alert and claim file(s), if any, to the Office of Appellate Operations (OAO) at the following address (case locator code 5007):
Office of Appellate Operations
One Skyline Tower, Suite 701
5107 Leesburg Pike
Falls Church, VA 22041-3200
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 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 (see Part VIII. below).
After a thorough search for an inactive claim file, the search time not to exceed 120 days from the alert date, ODIO or the MAMPSC will initiate reconstruction through the servicing FO. The MAMPSC will also initiate reconstruction for title XVI-only folders that the Wilkes-Barre DOC is unable to retrieve.
Because ODIO or MAMPSC will obtain all potential class member claims within the class member timeframes, or otherwise arrange for their reconstruction, prior to forwarding cases for screening, OHA requests for reconstruction of potential 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 particular claim would not confer class membership and, therefore, make reconstruction unnecessary.
OHA (the HO or the OAO branch) will direct any necessary reconstruction requests to the FO servicing the claimant's address. The request will be made by memorandum and will include the alert and any accompanying claim file(s) (if the claim file(s) is not needed for adjudication purposes) as attachments. The request will also include documentation of the attempts to locate the file. The memorandum will request the FO to send the reconstructed file to OHA after it completes its reconstruction action. HOs and the OAO branches will route any reconstruction requests directly to the FO servicing the claimant's address. The OAO branches will also route copies of the 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:
for Programs and Policy
3-K-26 Operations Building
6401 Security Boulevard
Baltimore, MD 21235
HO personnel and the OAO branch will identify in the reconstruction request the OHA location of any existing claim file(s) being retained for adjudication purposes, and the date(s) of the claim(s) involved.
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 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 taken on the formerly pending claim. For additional information on reconstruction procedures, see the Class Action Implementation instructions in HALLEX I-1-7-05C.
Class Membership Denials
The screening component will hold all non-class member claim files for 90 days pending potential review by class counsel. However, because potential class member claims that are screened in OHA are either associated with pending claims or stored pending appeal, the OHA screening component will return the denied claim to, or hold the denied claim in, its normal location. If an individual wishes to request SSA's further consideration of a class membership denial determination, he or she must do so through class counsel. Class counsel has 60 days from receipt of notice of the class membership denial to notify the Regional Counsel of SSA's Office of the General Counsel, Region VIII, of disagreement. Upon timely request by class counsel (i.e., within 60 days of receipt of the notice of class membership denial) to review claim files, SSA has 30 days from receipt of the request to make the claim file available. Accordingly, Litigation Staff will request the storage component to forward the relevant claim files to the designated FO in each Tenth Circuit state.
The claim file will be available for class counsel's review for a period of 30 days. Upon review of the files, class counsel will have an additional 30 days, if necessary, to contact the Office of the General Counsel (OGC) directly to resolve any remaining class membership disputes. If the parties are unable to resolve any dispute, class counsel may submit the issue to the Adamson court for final resolution, within 30 days of Regional Counsel's written affirmation of the determination of non-eligibility for relief. If class counsel fails to act within the 30 days, SSA's class membership determination will become final and not subject to further review.
B. OHA Screening Actions
Determining Jurisdiction for Screening
As provided in Part V. A. 3. above, if there is a current claim pending or stored at OHA Headquarters, or if a civil action has been filed, the OAO Class Action Coordinator will receive the Adamson alert and related claim file(s). The OAO Class Action Coordinator may also receive alerts (forwarded in error) for cases in which there is no current claim pending or stored at OHA Headquarters. The Coordinator will determine which OHA component has the pending or stored claim and forward for screening as follows.
If the current claim is pending in an HO, the Coordinator will forward the alert and any prior claim file(s) located in OHA Headquarters to the HO for screening, using Attachment 3. (Part V. B. 2. below provides instructions to 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 pending before the Appeals Council, or located in an OAO branch mini-docket or in the OAO Docket and Files Branch (DFB), the Coordinator will forward the alert and any prior claim file(s) to the appropriate OAO branch for screening, using Attachment 3. (Part V. B. 2. below provides instructions to the OAO Branches regarding the action to be taken if they receive an alert package but no longer have a current claim pending.)
If a claim, either the alerted claim or a subsequent or prior claim, is pending in court, the Coordinator will forward the alert and any accompanying claim file(s) or court transcripts to the appropriate OAO Court Case Preparation and Review Branch (CCPRB) for screening, using Attachment 3.
If the Coordinator (or the designee) is unable to locate the current claim file within OHA, the Coordinator (or the designee) will broaden the claim file search and arrange for alert transfer or claim file reconstruction, as necessary.
Do not screen pending cases unless an alert has been received. The presence of an alert is evidence that the claimant has timely responded to notice of potential class membership and that his or her case is ready for review. However, if a claimant with a non-alerted pending case should allege class membership, contact the Adamson coordinator in the Division of Litigation Analysis and Implementation (DLAI) for assistance in determining the claimant's status and responding to the claimant's allegation. DLAI's address is
Division of Litigation Analysis
One Skyline Tower, Suite 702
5107 Leesburg Pike
Falls Church, VA 22041-3255
The DLAI Adamson coordinator's telephone number is (703) 305-0726.
Preparing the Case for Screening
Prior to screening an individual case, the screening component will obtain and place in the claim file appropriate systems information (if not already in file) to determine whether:
there is a current claim pending at any administrative level or in court; or
there are additional claims within the class dates that have not been associated; or
the claimant has received a determination/decision on a subsequent claim that is fully favorable with respect to the entire time period at issue in the potential class member claim and thus provides a basis for determining that the claimant is not a class member eligible for class relief; or
the claimant has received a merits determination/decision during certain timeframes on a subsequent claim that may provide a basis for determining that the claimant is not a class member eligible for class relief.
The screening component will also:
obtain the files for all unassociated claims that fall within the class dates, as well as any inactive claims that postdate the class period (that potentially provide a basis for screen-out or for limiting class relief); and
if necessary, request reconstruction of any potential class member files for claims that cannot be located (see Part V. A. 4. above).
The screening component will associate the alert and any prior claim file(s) with the claim file(s) in its possession and then complete a screening sheet (see Attachment 4) as follows:
Consider all applications denied/ceased during the Adamson timeframes; and
Annote the “Remarks” section if another subsequent claim is pending at any administrative level; and
Follow all instructions on the screening sheet and the screening sheet instructions; and
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 or an HO, 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 sheets into a database and will forward the screening sheets to DLAI.) HO personnel may also forward material by telefax to the Coordinator at (703) 05-0655. (DLAI will retain a copy of each screening sheet received from the Coordinator and will forward copies to Litigation Staff for entry to CATS.)
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 send the alert and prior claim file(s) to the OAO Class Action Coordinator (see address in Part V. A. 3. above) and advise the Coordinator of the action taken on the claim and its destination. The Coordinator will determine the current claim file location and forward the alert and any accompanying prior claim file(s) to that location for screening using Attachment 3 (within OHA) or Attachment 5 (outside OHA).
If an OAO branch receives an alert only, or an alert associated with a prior claim file(s) and no longer has the current claim file, 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 material to the OHA location. If the file(s) is no longer in OHA, the OAO branch will use Attachment 5 to forward the material to the non-OHA location. The OAO branch will also advise the OAO Class Action Coordinator of its actions.
Class Members Not Entitled to Relief
If the screening component determines that the individual is not a class member eligible for relief, the component will:
notify the individual, and representative, if any, of non-eligibility for class relief using Attachment 6 (modified as necessary to fit the circumstances and posture of the case when there is a current claim);
Include the address and telephone number of the servicing Social Security FO at the top of the notice.
retain a copy of the notice in the claim file;
send a copy of the notice to:
Division of Litigation Analysis
3333 South Bannock St.
Englewood, CO 80110; and
if the claim is not currently pending, return it to its OHA storage location.
If class counsel makes a timely request to review the claim file and the file is located in OHA, DLAI will notify the OHA component housing the claim file to send it to the SSA FO for class counsel's review (see Part V. A. 5. above). The component will use the 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.
If the file is needed for adjudication purposes and cannot be immediately released, the OHA component will either forward a copy of the file or provide an explanation to DLAI of the reason for the delay and the expected timeframe within which the file can be released.
If SSA through OGC, Region VIII, resolves the dispute in the claimant's favor:
OGC will notify the claimant or representative, if any, and class counsel, and will alert Litigation Staff to prepare a revised screening sheet;
OHA-jurisdiction cases will proceed in accordance with Part VI. below;
Litigation Staff will notify DLAI of the revised determination by forwarding a copy of the revised screening sheet to DLAI; and
DLAI will coordinate with the OAO Class Action Coordinator as necessary.
If class counsel fails to review the claim file, it will be assumed that review is no longer desired, and SSA's determination of non-eligibility for class relief will become final and not subject to further review.
Class Members Entitled to Relief
There is no class member notice. If the screening component determines that the individual is a class member entitled to relief, it will proceed based on the instructions in Part VI. below unless a claim is pending in court. If a claim is pending in court, the CCPRB will immediately contact OGC, which will determine the action to be taken. This is true whether the claim is the potential class member claim or another claim.
VI. Processing and Adjudication
A. Cases Reviewed by the DDS
The DDS will usually conduct the Adamson review. An exception will apply for cases consolidated at the OHA level (see Part VI. D.). The DDS determination will be a reconsideration determination, regardless of the administrative level at which the class member claim(s) was previously decided, with full appeal rights (i.e., ALJ hearing, Appeals Council and judicial review). (See Part VI. B. below.) However, the following processing and adjudication procedures will apply when OHA has responsibility for screening, i.e., when a potential class member claim or another claim is pending or stored in OHA, and when the claimant is a class member.
B. OHA Adjudication of Class Member Claims
The following instructions apply to consolidation cases in which the ALJ or Appeals Council conducts the Adamson readjudication and to DDS readjudication cases in which the claimant requests a hearing or Appeals Council review. Except as noted herein, HOs and OHA Headquarters will process Adamson class member cases according to all other current practices and procedures including coding, developing evidence, routing, etc.
Type of Review and Period to Be Considered
Pursuant to the Adamson stipulation, the type of review to be conducted is a redetermination. The redetermination shall be a de novo evaluation of the class member's eligibility for benefits based on all evidence in his or her file including newly obtained evidence relevant to the period that was at issue in the administrative determination or decision(s) that formed the basis for Adamson class membership. (Under the Stipulation, claimants may submit additional medical evidence that relates to the relevant period of time.)
If the redetermination results in a favorable decision, the adjudicator will determine whether the individual's disability has been continuous through the date of the redetermination or to the date of the most recent allowance.
If the evidence establishes that disability began only at some point after the administrative determination(s) that forms the basis for Adamson class membership, the class member must file a new application to establish eligibility. The OHA decision should advise the claimant of the opportunity to file a new claim, but should not make a formal finding with respect to disability after the date of the review period.
Disability Evaluation Standards
Adjudicators must use the disability evaluation standards contained in the statute, regulations and Rulings.
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.
C. Claim at OHA But No Current Action Pending
If a claim file (either a class member or another disability claim) 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. (The OAO Class Action Coordinator will coordinate the necessary actions, as explained in Part V.). (See Part V. B. 3. a., above, for non-class member processing instructions.)
If the 120-day retention period for holding a claim file after an ALJ decision or Appeals Council action has expired, OAO will attach an Adamson class member flag (see Attachment 8), to the outside of the file and forward the claim file(s) to the DDS for review of the Adamson class member claim.
If less than 120 days have elapsed, OAO will attach an Adamson class member flag (see Attachment 8) to the outside of the file to ensure that the case is routed to the 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 DDS in a timely manner.
D. Processing and Adjudicating Class Member Claims in Conjunction with Current Claims (Consolidation Procedures)
Claims subject to consolidation should be consolidated only to the extent practicable. Thus, if consolidation would unreasonably delay a decision on the current claim, consolidation is not required.
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 Adamson class member claims with the current claim at the level at which the current claim is pending. Because the receipt of a determination or decision during certain timeframes on a subsequent claim that covered the entire time period at issue in the Adamson claim is a basis for screen-out, there should be few class member claims associated with current claims at the OHA level. Examples would be when the current claim involves a later onset date or, for Appeals Council purposes, when the ALJ dismissed the request for hearing on the current claim.
Current Claim Pending in the Hearing Office
Hearing Has Been Scheduled or Held, and All Remand Cases
Except as noted below, if an Adamson 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, including court remands, the ALJ will consolidate the Adamson case with the appeal on the current claim.
The ALJ will not consolidate the claims if
the current claim and the Adamson 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. D. 2. c. below. If the claims are not consolidated, follow Part VI. D. 2. d. below.
Hearing Not Scheduled
Except as noted below, if an Adamson class member has a request for hearing pending on a current claim and the HO has not yet scheduled a hearing, the ALJ will not consolidate the Adamson claim and the current claim at the OHA level. Instead, the ALJ will dismiss the request for hearing on the current claim and forward both the Adamson claim and the current claim to the DDS for further action (see Part VI. D. 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 favorable with respect to all the issues raised by the application that makes the claimant an Adamson class member, the ALJ will consolidate the claims.
If the claims are consolidated, follow Part VI. D. 2. c. below. If the claims are not consolidated, follow Part VI. D. 2. d. below.
Actions If Claims Consolidated
When consolidating an Adamson claim with any subsequent claim, and the two claims involve overlapping periods at issue, the issue is whether the claimant was disabled at any time from the earliest alleged onset date through the present or to the date of the most recent allowance (or through the claimant's date last insured, if applicable and earlier). Accordingly, in effect, consolidation will result in a reopening of the Adamson claim through the time period at issue in the current claim.
However, if the period to be adjudicated in the current claim does not overlap the period to be adjudicated in the Adamson claim, the two claims should be considered separately. Nevertheless, if the claimant is found to be disabled within the timeframe of the Adamson claim, the claim will be reopened through the date at issue in the current claim. If the ALJ decides to consolidate the current claim with the Adamson claim(s), the HO will:
offer the claimant a supplemental hearing if the ALJ has already held a hearing and the Adamson claim raises an additional issue(s), unless the ALJ is prepared to issue a fully favorable decision with respect to the Adamson claim;
issue one decision that addresses both the issues raised by the current request for hearing and those raised by the Adamson claim (the ALJ's decision will clearly indicate that the ALJ considered the Adamson claim pursuant to the Adamson stipulation);
forward a copy of the decision directly to DLAI at the address in Part V. B. 1. a. above.
Action if Claims Not Consolidated
If common issues exist but the ALJ decides not to consolidate the current claim with the Adamson claim because the hearing has not yet been scheduled, the ALJ will:
dismiss the request for hearing on the current claim without prejudice, using the language in Attachment 9 and the covering notice in Attachment 10; and
send both the Adamson claim and the current claim to the DDS for consolidation and further action.
If the ALJ decides not to consolidate the current claim with the Adamson 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 Adamson claim for DDS review using Attachment 11; immediately route it to the DDS for readjudication (photocopies of any relevant material from either file should be made and placed in the other file before shipping) and retain a copy of Attachment 11 in the current claim file;
take the necessary action to complete the record and issue a decision on the current claim.
Current Claim Pending at the Appeals Council
The action the Appeals Council takes on the current claim determines the disposition of the Adamson 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 Adamson claim.
Appeals Council Intends to Dismiss, Deny Review or Issue a Denial Decision on the Current Claim
In this instance, the Appeals Council will proceed with its intended action on the current claim. OAO staff will attach an Adamson case flag (Attachment 11; appropriately modified) to the Adamson claim, immediately forward the Adamson claim to the DDS for adjudication, and retain a copy of Attachment 11 in the current claim file. OAO staff will include copies of the ALJ's or Appeals Council's decision or order or notice of denial of request for review on the current claim and the exhibit list used for the ALJ's or Appeals Council's decision.
Appeals Council Intends to Issue a Favorable Decision on the Current Claim -- No Adamson 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 an Adamson class member, the Appeals Council should proceed with its intended action. In this instance, the Appeals Council will consolidate the claims, reopen the final determination or decision on the Adamson claim and issue a decision that adjudicates both applications. The Appeals Council's decision will clearly indicate that the Appeals Council considered the Adamson claim. OAO staff will forward a copy of the decision, for coordination with DLAI, to the OAO Class Action Coordinator at the address in Part V. A. 3. above.
Appeals Council Intends to Issue a Favorable Decision on the Current Claim -- Adamson Issue(s) Will Remain Unresolved
If the Appeals Council intends to issue a fully favorable decision on a current claim and this decision would not be fully favorable with respect to all issues raised by the Adamson claim, the Appeals Council will proceed with its intended action. In this situation, the Appeals Council will request the effectuating component to forward the claim files to the 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: "Adamson court case review needed -- following effectuation forward the attached combined folders to the DDS."
Appeals Council Intends to Remand the Current Claim to an Administrative Law Judge
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 Adamson claim with the action on the current claim pursuant to the instructions in Part VI. D. 2. a. above.
The Appeals Council will not direct the ALJ to consolidate the claim if
the current claim and the Adamson 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 Adamson class member claim to the DDS, for separate review. The case flag in Attachment 11 should be modified to indicate that the Appeals Council, rather than the ALJ, is forwarding the Adamson class member claim for separate processing.
VII. Case Coding
In all situations, to identify class member cases in the Hearing Office Tracking System (HOTS), HO personnel will code “AD” in the “Class Action” field. Additionally, in the OHA Case Control System, HO personnel will code “A” in the “SPC” field.
If the Adamson claim is consolidated with a current claim already pending at the hearing level, HO personnel will 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.” HO personnel will code dismissal cases as “OTDI” in the “DSP” field. HOTS users will need to bypass the automated case routing capability and manually route dismissal cases through the special case disposition/routing function. Only the systems administrator can access this function. The individual will need to enter the DDS address and destination code.
VIII. Reconciliation of Implementation
At an appropriate time, the Litigation Staff at SSA Central Office 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 (i.e., a record of alerts processed by OAO), and a record of cases screened and consolidated by OHA (as reported by HOs and OAO to the Coordinator after screening and/or consolidation). See HALLEX I-1-712 with respect to reporting requirements.
HO personnel should direct any questions concerning this instruction 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. OHA Headquarters personnel should contact DLAI at 305-0708.