I-5-4-61.Goodnight v. Apfel
| Purpose | |
| Background | |
| Guiding Principles | |
| Definition of Class | |
| Determination of Class Membership and Preadjudication Actions | |
| Processing and Adjudication | |
| Case Coding | |
| Reconciliation of Implementation | |
| Inquiries | |
| Final Order Approving Settlement; Entered by the United States District Court for the District of Utah on July 30, 1998. | |
| - Sample Goodnight COURT CASE FLAG/ALERT | |
| - Reconstruction Flag | |
| - Screening Flag -- Inside OHA | |
| - GOODNIGHT SCREENING SHEET | |
| - Screening Flag -- to DDS | |
| - Screening Flag -- Outside OHA | |
| - Notice of Non-Class Membership | |
| - Readjudication Flag for OHA Retention Cases | |
| - Readjudication Flag for Non-Consolidation Cases |
ISSUED: July 19, 1999
I. Purpose
This Temporary Instruction (TI) sets forth procedures for implementing the Final Order entered by the United States District Court for the District of Utah on July 30, 1998, approving the parties' settlement agreement in the Goodnight v. Apfel class action. The Goodnight class action was principally oriented toward alleged deficiencies in Utah Disability Determination Services (DDS) actions and procedures.
Adjudicators throughout the country must be familiar with this TI because of case transfers and because Goodnight class members who now reside outside of Utah must have their cases processed in accordance with the requirements of the Final Order and settlement agreement.
II. Background
On March 27, 1992, the named plaintiffs filed a class action law suit against the Secretary of Health and Human Services and three Utah DDS officials. Plaintiffs alleged that the defendants have established a system of policies, practices, procedures and standards to illegally deny initial claims for title II and title XVI disability benefits. Specifically, plaintiffs alleged that the Utah DDS failed to: 1) obtain medical assessments; 2) develop a complete previous 12-month history; 3) properly apply step three of the sequential evaluation process; 4) consider the effect of a combination of impairments; 5) properly determine the duration of impairment; 6) properly apply the medical-vocational guidelines for individuals of advanced age; 7) obtain residual functional capacity assessments from physicians; and 8) give proper notice of unfavorable determinations.
On October 27, 1993, the district court denied the Federal and State defendants' motions to dismiss and granted plaintiffs' motion for class certification. Plaintiffs then proceeded with discovery and identified two Utah DDS medical advisers who were signing decisional documents prepared by disability examiners without having reviewed the claim files between 1991 and 1993. Following restrictions on funding to the Legal Services Corporation, plaintiffs' counsel removed themselves from the case and plaintiffs secured representation from a private practitioner.
On October 30, 1996, plaintiffs filed a motion for partial summary judgment and the Federal and State defendants filed oppositions to plaintiffs' motion. On January 28, 1997, the court held a hearing on the parties' cross-motions for summary judgment. On April 14, 1997, the court issued a memorandum decision and order which denied plaintiffs' motion for partial summary judgment and denied in part and granted in part defendants' cross-motion for partial summary judgment. The court held that a Program Operations Manual System (POMS) instruction which permits disability examiners to assist in completion of residual functional capacity (RFC) assessment forms was consistent with the Social Security Act and regulations and not subject to the notice and comment provisions of the Administrative Procedure Act. However, the court found that an issue of material fact existed as to whether defendants violated plaintiffs' civil rights by processing certain claims without an independent physician's assessment.
Following the Supreme Court's decision in Blessing v. Firestone, 117 S. Ct. 1353 (1997), the defendant filed a brief for the purpose of prompting the court to reconsider its prior denial of its motion to dismiss plaintiffs' claim under 42 U.S.C. § 1983 against the State defendants. (In Blessing, the Supreme Court held that a plaintiff cannot bring an action under § 1983 and sue a State defendant for its systematic failure to apply the Federal regulations and laws of a Federally funded program.) On March 10, 1998, the court denied defendant's motion to reconsider.
On June 9, 1998, the parties filed notice of a proposed settlement agreement, and, on June 10, 1998, the court gave its preliminary approval of the settlement agreement. On June 26, 1998, July 3, 1998 and July 10, 1998, notice of the public hearing regarding the settlement proposal appeared in four Utah newspapers. On July 29, 1998, following the conclusion of the fairness hearing, the court approved the parties' jointly negotiated settlement proposal, and, on July 30, 1998, the court entered the order (see Attachment 1).
III. Guiding Principles
Under the Goodnight settlement, the Utah DDS (and the Commissioner) will readjudicate the claims of those persons who: 1) respond to notice informing them of the opportunity for review (see Part V. A. 1. below); and 2) are determined, after screening, to be class members entitled to relief (see Part V. B. 3. below). Regardless of the state of the claimant's current residence, the Utah DDS will, in most cases, perform the agreed-upon readjudications. OHA will screen cases and perform readjudications under limited circumstances (see Parts V. and VI. below).
The type of readjudication will be a “redetermination.” A redetermination consists of 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(s) that forms the basis for the claimant's class membership. If the redetermination results in a favorable decision, the adjudicator must also determine whether the class member's disability and eligibility has been continuous through the date of the readjudication, i.e., through the current date or the date of the most recent allowance. The adjudicator will also assess disability through the current date if a class member claim is consolidated with a common-issue current claim.
Cases readjudicated by the Utah DDS will be processed at the reconsideration level regardless of the final level at which the claim was previously decided. The class member claim(s) will be adjudicated under current policies and procedures.
IV. Definition of Class
Except as noted below, the Goodnight class members eligible to request relief are those persons:
who had a claim for title II and/or title XVI disability benefits denied at steps two, four or five of the sequential evaluation process by the Utah DDS at the initial or reconsideration levels between January 1, 1991, and February 20, 1994, inclusive; and
whose determinations for disability benefits were based in whole or in part on a mental impairment as indicated in primary or secondary diagnostic blocks 16A or 16B on Form SSA-831-U3/C3 (the Disability Determination and Transmittal); or
whose Form SSA-831-U3/C3 was signed by Utah DDS employees Doctor Manya Atiya or Doctor Rebecca Dalisay.
EXCEPTIONS:
A person is not a Goodnight class member eligible to request relief if he or she:
received a subsequent award of benefits with respect to the same period of time at issue in the class claim (Although the period at issue in the class claim can be prior to January 1, 1991, the adjudication of the claim only had to occur between January 1, 1991 and February 20, 1994, inclusive); or
appealed the denial of his or her class claim to an Administrative Law Judge (ALJ), the Appeals Council (AC) or to Federal court; or
received a subsequent disability determination after February 20, 1994, that adjudicated the same time period covered by the class claim; or
has in his or her claim file a Psychiatric Review Technique Form (PRTF) and Mental Residual Functional Capacity (MRFC) form each completed in its entirety by a Utah DDS psychiatrist or psychologist employed by the Utah DDS between January 1, 1991, and February 20, 1994, inclusive; or
failed, without good cause, to timely request a redetermination by responding to the notice requirements.
V. Determination of Class Membership and Preadjudication Actions
A. Pre-Screening Actions - General
Identification, Notification and Routing
In April 1999, SSA by means of its data processing systems identified the names, social security numbers (SSNs) and last known addresses of potentially eligible Goodnight class members and sent these individuals notices. On June 3, 1999, because of problems with the mailing, SSA sent a second notice to all potential class members except those who responded to the first mailing and whose earlier notice was returned as undeliverable. Potential class members have 90 days from the receipt of the notice to return a reply form to the Office of Central Operations (OCO)(formerly known as the Office of Disability and International Operations) requesting that SSA readjudicate their claims under the terms of the Goodnight settlement order.
Undeliverable notices returned to OCO will be used to update the Civil Action Tracking System (CATS). Litigation Staff will then attempt to obtain updated addresses by providing the Utah DDS with a computer tape of those otentially eligible class members whose notices were returned as undeliverable. The Utah DDS will then attempt to provide Litigation Staff with a computer tape of updated addresses. Within 60 days of receiving the updated addresses from the Utah DDS, Litigation Staff will make a good faith effort to resend the notice by first class mail. If the second notice is returned as undeliverable, Litigation Staff will then provide the Utah DDS with a computer tape of those second mailed notices that were returned as undeliverable. Within 120 days of receiving the computer tape of undeliverable notices from the Utah DDS, plaintiffs' representative may attempt to provide notice to those potentially eligible class members whose second notice was returned as undeliverable.
Following issuance of the POMS instructions, SSA will also display posters in all of its Utah field offices (FOs) for a period of 180 days from posting. Absent a finding of good cause, potential class members will have 90 days after the poster display period has ended in which to respond. However, individuals who receive a mailed notice will not be eligible to have the time period extended within which they must respond to the mailed notice by responding to the poster notice.
Individuals can also request review in person by visiting any FO. If the individual has the Goodnight reply form, the FO will instruct the potential class member to return the reply form to OCO in the postage-paid, pre-addressed envelope. If the claimant lost or never received one or is requesting review based on the poster display, the FO will assist the claimant in completing an SSA-795 (Statement of Claimant). The SSA-795 should state that the claimant is requesting review of his or her disability claim based on the Goodnight court case and include the claimant's name, SSN, current address and telephone number. The claimant or representative payee should sign the SSA-795.
Individuals can also request review by contacting any FO by telephone or in writing. If the individual contacts the FO by telephone and the individual has the reply form, the FO should instruct the individual to return it to OCO. If the potential class member lost or never received a reply form, the FO should complete an SSA-5002 (Report of Contact). The report of contact should state that the claimant requested a review of his disability claim based on the Goodnight court case and include his or her name, SSN, current address and telephone number.
Any written requests for review and completed SSA-795 and SSA-5002 forms should be forwarded to the Regional Office, Center for Disability, Federal Building, 1961 Stout Street, Room 834, Denver, CO 80294, Attention: Goodnight Coordinator.
Alert and Folder Retrieval Process
OCO will enter the reply form information into the CATS, and CATS will generate court case folder alerts (see Attachment 2 for a sample Goodnight Court Case Flag/Alert). The alerts and appropriate systems queries will be used to locate and retrieve the Goodnight claim file(s).
OCO will associate the computer-generated alerts and query package (which consists of a CATS alert cover sheet, SSIRD, AR-25, MBR FACT, OHAQ, DDBQ, DDSQ and SEQY queries) and forward them to the appropriate component for folder retrieval. OCO will be responsible for retrieving OCO jurisdiction title II only and concurrent title II and title XVI potential class member claims. The PSCs will be responsible for retrieving PSC jurisdiction title II only and concurrent title II and title XVI potential class member claims. The Wilkes-Barre Folder Servicing Operations (FSO) and the FOs will be responsible for retrieving title XVI claims. OCO, the PSCs, the FSO and the FOs will forward retrieved claim files to the Utah DDS for class membership screening.
Alerts Sent to OHA
If OCO, the PSCs, the FSO or the FOs 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).
If a claim is located in an OHA hearing office (HO), OCO, the PSCs, the FSO or the FOs will forward the alert and query package and claim file(s), if any, directly to the HO for processing. If the claim is pending or stored at OHA Headquarters, OCO, the PSCs, the FSO or the FOs will forward the alert and query package and claim file(s), 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 CoordinatorNOTE:
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 should maintain a record of all alerts received and the location, if any, to which they are transferred. SSA needs this information to do the final class membership reconciliation.
Folder Reconstruction
In general, OCO, the PSCs, or FOs will coordinate any necessary reconstruction of prior claim files. OHA requests for reconstruction of potential Goodnight 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. OHA (the HO or the OAO branch) will direct any necessary reconstruction requests to the servicing FO. 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 will route any reconstruction requests directly to the servicing FOs. The OAO branch will also route reconstruction requests directly to the servicing FO and will send a copy of the request 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:
Office of Program Benefits
Litigation Staff
3-K-26 Operations Building
6401 Security Boulevard
Baltimore, MD 21235-6401Attn: Goodnight Coordinator
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 folder, the HO or OAO, as appropriate, will forward the class action material, including the alert, if still in its possession, unneeded claim files, if any, and a copy of the reconstruction request directly to the servicing FO using Attachment 3. The HO or OAO will send a copy of the covering attachment to the OAO Class Action Coordinator, along with a copy of the action taken on the pending claim. For additional information on reconstruction procedures, see Generic Class Action Implementation instructions in HALLEX I-1-7-5 C.
Occasionally, the situation may arise where OHA is in possession of a Goodnight alert, and is ready to take action on a pending, non-Goodnight claim, but the Goodnight file has not been located and reconstruction appears necessary but has not yet been requested. In this situation, OHA will not delay its action on the pending claim. OHA will proceed with its action on the pending claim and concurrently send the Goodnight alert and a reconstruction request to the servicing FO using Attachment 3, modified to fit the circumstances of the case.
B. OHA Screening Actions
Determining Jurisdiction for Screening
Current Claim Pending or Stored in OHA
As provided in Part V. A. 3. above, if there is a current claim pending or stored at OHA Headquarters, the OAO Class Action Coordinator will receive the alert and related Goodnight 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 forward the alert and any prior claim file(s) to the HO for screening using Attachment 4. (Part V. B. 3. a. 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 is 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 4. (Part V. B. 3. a. 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 the Coordinator (or designee) is unable to locate the current claim file within OHA, the Coordinator (or designee) will broaden the claim file search and arrange for alert transfer or folder reconstruction, as necessary.
NOTE:
Do not screen pending cases unless an alert has been received. The presence of an alert is evidence that the claimant has 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 Goodnight coordinator in the Division of Litigation Analysis and Implementation (DLAI) for assistance in determining the claimant's status. DLAI's address is
Division of Litigation Analysis
and Implementation
Office of Hearings and Appeals
One Skyline Tower, Suite 1605
5107 Leesburg Pike
Falls Church, VA 22041-3255ATTN: Goodnight Coordinator
Telephone Number: (703) 605-8278
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 a subsequent or prior claim, the Coordinator will forward the alert and any accompanying claim file(s) to the appropriate OAO Court Case Preparation and Review Branch (CCPRB) for screening, using Attachment 4. See Part V. B. 3. b. below for special screening instructions when a civil action is involved.
Pre-Screening Procedures
Prior to screening an individual case, the screening component will obtain appropriate systems information to determine whether:
there is a subsequent claim pending at any other administrative level or in court;
there are additional claims within the class dates which have not been associated;
the claimant has received a determination/decision on a subsequent claim with respect to the time period at issue in the potential class member claim, thus providing a basis for determining that the claimant is not a class member eligible for relief.
The screening component will also:
obtain the files for all unassociated claims that fall within the class dates, as well as the files for any inactive claims that postdate the class period (which potentially provide a basis for screen-out or for limiting class relief); and
if necessary, request reconstruction of any potential class member claim files that cannot be located, unless available systems data or other information provides satisfactory proof that the particular claim would not confer class membership.
Screening
General Instructions
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 5) as follows.
Consider all applications denied during the Goodnight timeframe;
Follow all instructions on the screening sheet and the screening sheet instructions (Attachment 5);
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 sheet into a database and will forward the screening sheet to DLAI.) HO personnel may also forward material by telefax to DLAI at (703) 605-8251. (DLAI will retain a copy of each screening sheet, share a copy with the OAO Class Action Coordinator and forward a copy to Litigation Staff.)
NOTE:
If the case contains a PRTF and MRFC form each completed in its entirety by a Utah DDS psychiatrist or psychologist employed by the Utah DDS between January 1, 1991 and February 20, 1994, inclusive, and it is possible that the case will be screened out using screenout code “11,” do not proceed with any further screening. Instead, send the claim file to the Utah DDS using Attachment 6. Do not send the claimant a notice of denial of class membership. Any notice to be sent to the claimant concerning class membership status will be taken by the DDS following the results of a “double screening.”
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 any 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 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 claim file(s) to the responsible OAO branch for screening, using Attachment 4. If the file(s) is no longer in OHA, the Coordinator will use Attachment 7 to send the alert and any accompanying claim file(s) to the non-OHA location.
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 (and it is not located in mini-dockets or 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 4 to forward the material to the OHA location. If the file(s) is no longer in OHA, the OAO branch will use Attachment 7 to forward the material to the non-OHA location. The OAO branch will also advise the OAO Class Action Coordinator of its actions.
Special OAO Screening Instructions if a Civil Action Is Involved
As noted in Part V. B. 1. b. above, the CCPRB will screen for Goodnight class membership/eligibility for relief when a civil action is involved. The CCPRB's class membership/eligibility for relief determination will dictate the appropriate post-screening action.
If the claimant is a class member eligible for relief, the CCPRB will immediately notify the Regional OGC so that the Regional OGC can take appropriate action. The Regional OGC will advise the CCPRB of the action to be taken.
If the claimant is not a class member eligible for relief, the CCPRB will follow the instructions in 4. a. below.
Post-Screening Actions
Screened Out Cases
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 that determination using Attachment 8 (modified as necessary to fit the circumstances and posture of the case when there is a current claim); and
retain a copy of the notice in the claim file;
send a copy of the notice to:
Brent V. Manning
Manning Curtis Bradshaw & Bednar, LLC
370 E. South Temple, Suite 200
Salt Lake City, UT 84111The Utah DDS or OHA, as appropriate, will hold for 65 days all claim files of individuals to whom SSA sends notice of non-class membership or ineligibility for relief pending a dispute by class counsel. Upon timely request by class counsel, send the claim the claim file(s) to:
Utah Disability Determination Services
P.O. Box 144032
Salt Lake, City UT 84114-4032Attn: Goodnight Coordinator
If after 65 days no review is requested, return the file(s) to the appropriate storage location if not otherwise needed.
Cases Determined to be Class Members
If the screening component determines that the individual is a class member eligible for relief, it will proceed with processing and adjudication in accordance with the instructions in Part VI. below.
NOTE:
Class membership will be presumed in reconstructed Goodnight cases if the queries indicate a medical denial between January 1, 1991 and February 20, 1994, inclusive.
VI. Processing and Adjudication
A. Cases Reviewed by the DDS
The Utah DDS will usually conduct the Goodnight 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 and the claimant will be entitled to appeal rights (i.e., ALJ hearing, Appeals Council and judicial review.) 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 (see Part D. below) in which the ALJ or Appeals Council conducts the Goodnight readjudication and to DDS readjudication cases in which the claimant requests, and is eligible for, a hearing or Appeals Council review. Except as noted herein, HOs and OHA Headquarters will process Goodnight 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 Goodnight Order, the type of review to be conducted is a redetermination. The redetermination consists of 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 forms the basis for Goodnight class membership. Because any new evidence must relate to the time period that was at issue in the administrative determination(s) forming the basis for the claimant's class membership, ordering consultative examinations should be done only rarely.
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 Goodnight class membership, the class member must file a new application to establish eligibility.
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, e.g., Headquarters is holding the file awaiting potential receipt of a request for review or notification that a civil action has been filed, OAO branches 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. 4., above, for non-class member processing instructions.)
Whether the 120-day retention period for holding a claim file after an ALJ decision or Appeals Council action has expired or not, OAO will attach a Goodnight class member flag (see Attachment 9), to the outside of the file and immediately forward the original or photocopies (if less than 120 days) of the claim file(s) pertaining to the Goodnight claim(s) to the Utah DDS for review of the Goodnight class member claim.
D. Processing and Adjudicating Class Member Claims in Conjunction with Current Claims (Consolidation Procedures)
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 Goodnight class member claims with the current claim at the level at which the current claim is pending.
Current Claim Pending in the Hearing Office
Except as noted below, if a Goodnight class member has a request for hearing pending on a current claim, and in all remand cases, including court remands, the ALJ will consolidate the Goodnight case with the appeal on the current claim.
EXCEPTIONS:
The ALJ will not consolidate the claims if
the current claim and the Goodnight 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, or
a consolidation will unreasonably delay action on either the current claim or the Goodnight claim.
If the claims are consolidated, follow Part VI. E. 2. a. below. If the claims are not consolidated, follow Part VI. E. 2. b. below.
Actions if Claims Consolidated
When consolidating a Goodnight claim with any current claim, and when 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 or the date the claimant last met prescribed period requirements, if applicable and earlier). Accordingly, consolidation will result in a reopening of the Goodnight 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 Goodnight claim, the two claims should be considered separately.
Nevertheless, if the claimant is found to be disabled within the timeframe of the Goodnight claim, the claim will be reopened through the date at issue in the current claim. If the current claim and the Goodnight claim are consolidated, 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 Goodnight 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 Goodnight claim raises an additional issue(s), unless the ALJ is prepared to issue a fully favorable decision with respect to the Goodnight claim; and;
issue one decision that addresses both the issues raised by the current request for hearing and those raised by the Goodnight claim (the ALJ's decision will clearly indicate that the ALJ considered the Goodnight claim pursuant to the Goodnight order);
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 the ALJ decides not to consolidate the current claim with the Goodnight claim because: 1) the claims do not have any issues in common, or 2) there is a court-ordered time limit, or 3) consolidation would unreasonably delay action on either the current claim or the Goodnight claim, the ALJ will:
flag the Goodnight claim for DDS review using Attachment 10; immediately route it to the Utah 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 10 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 Goodnight 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 Goodnight 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 a Goodnight case flag (Attachment 10; appropriately modified) to the Goodnight claim, immediately forward the Goodnight claim to the Utah DDS for adjudication, and retain a copy of Attachment 10 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 Unresolved Claim — No Goodnight 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 Goodnight 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 Goodnight claim and issue a decision that adjudicates both applications. 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 — Goodnight 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 Goodnight claim, the Appeals Council will proceed with its intended action. OAO staff will flag the Goodnight claim for DDS review using Attachment 9 and immediately route it to the Utah DDS for redjudication (OAO staff will make photocopies of any relevant material from either file and place in the other file before shipping) and will retain a copy of Attachment 9 in the current claim file.
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 Goodnight claim with the action on the current claim pursuant to the instructions in Part VI. E. 2. above.
EXCEPTIONS:
The Appeals Council will not direct the ALJ to consolidate the claim if
the current claim and the Goodnight 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, or
consolidation would unreasonably delay action on either the current claim or the Goodnight claim.
If any of the above-listed exceptions apply, OAO will immediately forward the Goodnight class member claim to the Utah DDS, for separate review. The case flag in Attachment 10 should be modified to indicate that the Appeals Council, rather than the ALJ, is forwarding the Goodnight class member claim for separate processing.
VII. Case Coding
HO personnel will code prior claims into the Hearing Office Tracking System (HOTS) as “reopenings.” If the prior claim is consolidated with a current claim already pending at the hearing level (see Part VI. D. above), 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,” i.e., “20.” If the conditions described in Part VI. E. 2. b. above apply, the ALJ should dismiss the request for hearing on the current claim and HO personnel should enter “OTDI” in the “DSP” field.
To identify class member cases in HOTS, HO personnel will code “GN” 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 (i.e., a record of alerts processed by OHA, and a record of cases screened and consolidated by OHA), as reported by HOs and OAO.
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) 605-8530. OHA headquarters personnel should contact the Division of Litigation Analysis and Implementation at 605-8278.