Source: http://www.ssa.gov/OP_Home/hallex/I-05/I-5-4-35.html
Timestamp: 2013-12-04 17:34:56
Document Index: 51080353

Matched Legal Cases: ['§ 223', '§ 5103', '§ 5103', '§ 423', '§ 5103', '§ 5103', '§ 5103', '§ 404', '§ 5103', '§423', '§ 404', '§ 423', '§ 404', '§ 552', '§ 404', '§ 404', '§ 404', '§ 405', '§ 405', '§ 404']

HALLEX I-5-4-35
I-5-4-35.Martel v. Sullivan
Settlement Agreement Filed October 21, 1992, and Approved by the Court on October 26, 1992 Attachment 2
Martel COURT CASE FLAG/ALERT
Martel Screening Sheet and Screening Sheet Instructions
Martel Non-Class Membership Notice
Martel Class Member Flag for Headquarters Use (DDS Readjudication -- Retention Period Expired)
Martel Class Member Flag for Headquarters Use (DDS Readjudication -- Retention Period has not Expired)
Martel Class Member Flag for HO Use (DDS Readjudication)
ISSUED: November 15, 1993
This Temporary Instruction (TI) sets forth procedures for implementing the parties' October 21, 1992 Settlement Agreement, approved by the United States District Court for the District of Connecticut on October 26, 1992, in the Martel v. Sullivan class action involving the standard for determining disability in surviving spouse claims. Adjudicators throughout the country must be familiar with this TI because Martel class members who now reside outside of Connecticut must have their cases processed in accordance with the requirements of the settlement agreement. II. Background
On April 3, 1989, plaintiff filed a complaint challenging the Secretary's listings-only policy of evaluating disability with respect to the title II claims of widows, widowers and surviving divorced spouses.¹ On October 8, 1989, plaintiff filed an amended complaint seeking class status and relief. Congress enacted the Omnibus Budget Reconciliation Actof 1990 (OBRA 90) (Pub. L. 101-508) on November 5, 1990. Section 5103 of OBRA 90 amended § 223 of the Social Security Act to repeal the special definition of disability applicable in widows' claims and conform the definition of disability for widows to that for all other title II claimants and title XVI adult claimants. The amendment became effective for entitlement to monthly benefits payable for January 1991, or later, based on applications filed or pending on January 1, 1991, or filed later. The U.S. District Court for the District of Connecticut certified a statewide class on May 14, 1991 (see Part IV. below, for class definition). On May 22, 1991, the Commissioner of Social Security published Social Security Ruling (SSR) 91-3p to provide a uniform, nationwide standard for the evaluation of disability in widows' claims for the pre-1991 period. Because the merits of plaintiffs' challenge were resolved by the enactment of § 5103 of OBRA 90 and the publication of SSR 91-3p, the parties agreed to settle the remaining class relief issues. On October 26, 1992, the district court approved the parties' October 21, 1992 Settlement Agreement setting forth the terms for the implementation of relief to class members (Attachment 1).
Under Martel, the Secretary 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). The Disability Review Section in the Northeastern Program Service Center (NEPSC) will screen folders for class membership, unless there is a current claim pending at OHA. Regardless of the state of the claimant's current residence, the Connecticut Disability Determination Service (CDDS) will, in most cases, perform the agreed upon readjudications, irrespective of the administrative level at which the claim was last decided.
Cases readjudicated by the CDDS will be processed at the reconsideration level regardless of the final level at which the claim was previously decided. Class members who receive adverse readjudication determinations will have full appeal rights(i.e., Administrative Law Judge (ALJ) hearing, Appeals Council and judicial review).
Adjudicators must use the disability evaluation standards reflected in § 5103 of OBRA 90 (42 U.S.C. § 423(d)(2) (1992)) and SSR 91-3p for evaluating disability in Martel class member claims. The disability evaluation standard enacted by § 5103 of OBRA 90 is effective for entitlement to monthly benefits payable for January 1991 or later.² (See HALLEX TI 5-315, issued February 11, 1991, for further instructions on processing disabled widows' claims under the provisions of § 5103 of OBRA 90.) The disability evaluation standard announced in SSR 91-3p must be used for the evaluation of disability and entitlement to benefits payable for the pre-1991 period.
For purposes of implementing the terms of the settlement agreement, the Martel class is divided into two subclasses. The first consists of all Connecticut residents who:
were issued a less than fully favorable (i.e., later onset, closed period, denied or terminated) final administrative determination or decision, based on medical reasons, between May 1, 1983, and August 12, 1989, inclusive; and
timely filed a request for reconsideration of the initial determination or reapplied for disabled widow's benefits between the date of the initial determination and May 22, 1991, inclusive.
The second subclass consists of all Connecticut residents who:
were issued a less than fully favorable (i.e., later onset, closed period, denied or terminated) final administrative determination or decision, based on medical reasons, between August 13, 1989, and May 22, 1991, inclusive.
(1) the individual received an adverse decision on a worker's claim for disability benefits under title II or title XVI (adult) at steps 4 or 5 of the sequential evaluation and that decision covered the timeframe at issue in all of the potential Martel claims; or
(2) the individual received a favorable determination or decision after May 21, 1991, on a subsequent claim that raised the issue of disability and covered the timeframe at issue in the potential Martel claim, i.e., the onset date alleged in connection with the subsequent claim was on or before the onset date alleged in connection with the potential Martel claim. This exception applies only if the individual has received all benefits to which he or she could be entitled based on the potential class member claim.
On April 23, 1993, 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 Martel settlement agreement. Notices returned as undeliverable will be mailed a second time if SSA obtains an updated address.
All response forms will be returned to ODIO and the information will be entered into the Civil Actions Tracking System (CATS). CATS will generate alerts to ODIO. See Attachment 2 for a sample Martel alert.
Office of Hearings and Appeals Office of Civil Actions, Division IOne Skyline Tower, Suite 6015107 Leesburg PikeFalls Church, VA 22041-3200ATTN: Martel Screening Unit
In general, ODIO or NEPSC will coordinate any necessary reconstruction of prior claim files.
The NEPSC or OHA will hold all non-class member claim files pending review by class counsel. Upon timely request by class counsel, NEPSC or OHA will forward claim files to the Willimantic, Connecticut District Office located at:
SSA District Office 54 North StreetWillimantic, Connecticut 06226
Upon review of the files, class counsel will contact the Office of the General Counsel (OGC) directly to resolve any remaining class membership disputes.
As provided in Part V.A.3. above, if there is a current claim pending at OHA, OCA will receive the alert and related Martel claim file(s). OCA will determine which OHA component has the current claim and forward for screening as follows:
OCA, Division I is responsible for controlling and reconciling the class alert workload of potential class member claims shipped to OHA for association with a current claim. Because this is a relatively small class, the OHA alert workload will be minimal and a manual accounting should suffice. OCA should maintain a record of all alert packages transferred to other locations (to include the pertinent information about destinations), and a copy of all screening sheets. This information will be necessary to do the final class membership reconciliation.
If OCA receives an alert for a claimant who has a civil action pending, either on the alerted case or on a subsequent or prior claim, OCA, Division I will associate the alert with the claim file(s) (or court transcript) and screen for Martel class membership. See Part V.B.2.b. below for special screening instructions when a civil action is involved.
If the claim pending at OHA is the only potential class member claim, then the individual is not a class member (see Part IV. above). Complete the screening sheet and follow the instructions in Part V.B.3.a. below for processing non-class member claims.
Consider all applications denied (including res judicata denials/dismissals) during the Martel timeframe;
Office of Hearings and AppealsDivision of Litigation Analysis andImplementationOne Skyline Tower, Suite 7025107 Leesburg PikeFalls Church, VA 22041-3200ATTN: Martel Coordinator
The Division of Litigation Analysis and Implementation will forward copies of the screening sheet to OCA Division I and the Litigation Staff at SSA Headquarters.
If the HO or OAO branch 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 the alert and the prior claim file(s) to OCA Division I (see address in Part V.A.3. above) and advise OCA of what action was taken on the current claim. OCA will determine the claim file location and forward the alert and any accompanying prior claim file(s) to that location (see Attachment 5).
As noted in Part V.B.1.b. above, OCA will screen for Martel class membership when a civil action is involved. OCA's class membership determination will dictate the appropriate post-screening action.
If the claim pending in court is the potential Martel class member claim, OCA will immediately notify OGC so that OGC can notify the claimant of the option to have the case remanded for readjudication.
If the claim pending in court is a subsequent claim, and the final administrative decision on the claim was adjudicated in accordance with the disability evaluation standards reflected in § 5103 of OBRA 90 and SSR 91-3p, OCA will modify the case flag in Attachment 12 to indicate that there is a subsequent claim pending in court, but that the Martel class member claim is being forwarded for separate processing.
Sheldon A. Mossberg, Esq.670 Main StreetWillimantic, Connecticut 06226
retain the claim file(s) for 90 days pending possible class membership dispute;
if class counsel makes a timely review request, send the non-class member claim file to the Willimantic, Connecticut District Office using the pre-addressed route slip in Attachment 7;
if after 90 days no review is requested,return the file(s) to the appropriate location.
The CDDS, or any other DDS servicing Connecticut residents, will usually conduct the first Martel review. An exception may apply where the class member claim is a cessation or TERI case. An exception will also apply for cases consolidated at the OHA level (see Part VI.E. below). 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). Except as otherwise noted in this instruction, ALJs should process and adjudicate requests for hearing on Martel DDS review cases in the same manner as for any other case.
If the Martel claim involves a cessation, the usual reinstatement provisions apply. Following an adverse DDS readjudication determination, a class member may elect to have disability benefits reinstated pending appeal. In general, the servicing Social Security field office has responsibility for processing benefit reinstatements.
If a class member contacts OHA requesting benefit reinstatement, OHA will:
contact the servicing field office by telephone and advise them of the pending Martel claim that may be eligible for benefit reinstatement;
The following instruction applies to both consolidation cases in which the ALJ or Appeals Council conducts the Martel 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 Martel class member cases according to all other current practices and procedures including coding, scheduling, developing evidence, routing, etc.
Pursuant to the Martel settlement agreement, 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 Martel claim through the present (or through the date the claimant last met the prescribed period requirements if earlier).
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, OCA will associate the alert with the file and screen for class membership. (See Part V.B.3., 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, OCA will attach a Martel class member flag (see Attachment 8) to the outside of the file and forward the claim file(s) to the CDDS for review of the Martel class member claim.
If less than 120 days have elapsed, OCA will attach a Martel class member flag (see Attachment 9) to the outside of the file to ensure the case is routed to the CDDS, or other appropriate DDS, after expiration of the retention period. Pending expiration of the retention period, OCA will also:
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 CDDS in a timely manner.
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 Martel class member claims with the current claim at the level at which the current claim is pending.
Except as noted below, if a Martel 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 Martel case with the appeal on the current claim.
the current claim and the Martel claim do not have any issues in common, or
Except as noted below, if a Martel 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 Martel claim and the current claim. Instead, the ALJ will dismiss the request for hearing on the current claim and forward both the Martel 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 Martel class member, the ALJ will consolidate the claims.
When consolidating a Martel claim with any subsequent claim, the issue is whether the claimant was disabled at any time from the earliest alleged onset date through the present (or through the date the claimant last met the prescribed period requirements, if earlier).
If the ALJ decides to consolidate the current claim with the Martel 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 Martel 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 Martel claim raises an additional issue(s), unless the ALJ is prepared to issue a fully favorable decision with respect to the Martel claim;
issue one decision that addresses both the issues raised by the current request for hearing and those raised by the Martel claim (the ALJ's decision will clearly indicate that the ALJ considered the Martel claim pursuant to the Martel settlement agreement).
If common issues exist but the ALJ decides not to consolidate the current claim with the Martel claim because the hearing has not yet been scheduled, the HO will:
send both the Martel claim and the current claim to the CDDS for consolidation and further action.
If the ALJ decides not to consolidate the current claim with the Martel 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 Martel claim for DDS review using Attachment 12; immediately route it to the CDDS for adjudication; and retain a copy of Attachment 12 in the current claim file; and
The action the Appeals Council takes on the current claim determines the disposition of the Martel 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 Martel claim.
Appeals Council Intends to Dismiss, Deny Review or Issue a Denial Decision on the Current Claim -- No Martel Issue(s) Will Remain Unresolved.
This will usually arise when the current claim duplicates the Martel review claim, i.e., the current claim raises the issue of disability and covers the period adjudicated in the Martel claim, and the current claim has been adjudicated in accordance with the provisions of § 5103 of OBRA 90 and SSR 91-3p. 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 Martel claim.
Appeals Council Intends to Dismiss, Deny Review or Issue a Denial Decision on the Current Claim -- Martel Issue(s) Will Remain Unresolved.
This will usually arise when the current claim does not duplicate the Martel claim, e.g., the current claim raises the issue of disability but does not cover the entire period adjudicated in the Martel claim. For example, the Martel 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.
OAO staff will attach a Martel case flag (Attachment 12; appropriately modified) to the Martel claim, immediately forward the Martel claim to the CDDS for adjudication, and retain a copy of Attachment 12 in the current claim file. OAO will modify Attachment 12 to indicate that the Appeals Council's action on the current claim does not resolve all Martel issues and that the Martel class member claim is being forwarded for separate processing. 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 Martel 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 Martel class member, the Appeals Council will proceed with its intended action. In this instance, the Appeals Council will consolidate the claims, reopen the final determination or decision on the Martel claim and issue a decision that adjudicates both applications. The Appeals Council's decision will clearly indicate that the Appeals Council considered the Martel claim pursuant to the Martel settlement agreement.
Appeals Council Intends to Issue a Favorable Decision on the Current Claim -- Martel 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 Martel 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 CDDS 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: "Martel court case review needed -- following effectuation forward the attached combined folders to Division of Vocational Rehabilitation, Bureau of Disability Determination, 600 Asylum Avenue, 2nd Floor, Hartford, Connecticut 06105."
If the Appeals Council intends to remand the current claim to an Administrative Law Judge, 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 Martel claim with the action on the current claim pursuant to the instructions in Part VI.E.2.a. above.
If the claims do not share a common issue or a court-ordered time limit makes consolidation impractical, OAO will forward the Martel class member claim to the CDDS, or other appropriate DDS, for separate review. The case flag in Attachment 12 must be modified to indicate that the Appeals Council, rather than an Administrative Law Judge, is forwarding the Martel class member claim for separate processing.
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.E. 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.” If the conditions described in Part VI.E.2.b. above apply and, the ALJ dismisses the request for hearing on the current claim, HO personnel should enter OTDI in the DSP field.
To identify class member cases in HOTS, HO personnel will code “MR” in the “Class Action” field. No special identification codes will be used in the OHA CCS.
HO personnel should direct any questions to their Regional Office. Regional Office personnel may contact the Division of Field Practices and Procedures in the Office of the Chief Administrative Law Judge at (703) 305-0022.
Attachment 1. Settlement Agreement Filed October 21, 1992, and Approved by the Court on October 26, 1992 UNITED STATES DISTRICT COURTFOR THEDISTRICT OF CONNECTICUT
JOAN J. MARTEL, et al.,Plaintiffs, CIVIL NO. H-89-196(AMN)
[Filed October 21, 1992]
WHEREAS the Court issued an order on May 14, 1991 certifying a plaintiff class, and WHEREAS the parties have agreed to resolve all of the outstanding disputes in this case without further litigation,
THEREFORE, the parties to this action, by their undersigned counsel, hereby agree to a settlement of plaintiff's claims in this litigation in accordance with the following terms and conditions:
all Connecticut residents who applied for or were receiving disabled widows', widowers' or surviving divorced spouses' benefits (“DWB”), who received final unfavorable administrative decisions from May 1, 1983 through August 12, 1989, resulting in a denial or termination of such benefits under 42 U.S.C. §423 (d)(2)(B), and who filed a timely request at the reconsideration level of administrative review, 20 C.F.R. § 404.907 (1991), or higher, 20 C.F.R. 404.929, 904.967(1991), or reapplied for DWB benefits from the date of the initial determination through May 22, 1991, and all Connecticut residents who applied for or were receiving DWB, and who received final unfavorable administrative decisions at any level of administrative review from August 13, 1989 through May 22, 1991, resulting in a denial or termination of such benefits under 42 U.S.C. § 423 (d)(2), without consideration of their actual ability to perform any gainful activity.
However, the class shall exclude the DWB claims of those individuals who filed concurrent applications for DWB and for disability benefits under Title II or XVI claims were denied or terminated at either step 4 or 5 of the sequential evaluation process, 20 C.F.R. §§ 404.1520 (e) and 416.920 (e), and the decision covered the entire period of time covered by the DWB claim.
In readjudicating claims pursuant to this Agreement, SSA shall apply the standard set forth in Social Security Ruling (SSR) 91-3p, which was effective on May 22, 1991, to DWB claims for benefits payable for any month prior to January 1991, except that SSA will not use any residual functional capacity assessment from any previous Title II or Title XVI determination as the basis for a denial of benefits. For purposes of determining entitlement to DWB for months after December 1990, Section 5103 of the Omnibus Budget Reconciliation Act (OBRA) of 1990 (also known as Public Law 101-508) shall be the standard.
SSA shall, by means of its data processing systems, identify the names, Social Security Numbers and last known addresses of potential class members, in accordance with the criteria set forth in ¶1. This process of identification shall be within 90 days of the Court's approval and entry of this Agreement.
Within 120 days of the Court's approval and entry of this Agreement, SSA will issue Instructions for its effectuation, including the notice referred to ¶ 5 and the proper standard for evaluating the eligibility of claim members for disability benefits, to all adjudicators responsible for conducting adjudications hereunder.
During the 120 day period mentioned above and prior to its expiration, SSA will provide plaintiffs' counsel with a draft copy of the proposed notice for review and allow plaintiffs 10 days after receipt to comment on the notice.
The notice will instruct potential class members that they may be entitled to have their DWB claims readjudicated and will further inform such individuals that they must return the enclosed pre-addressed and postage prepaid envelope and “Court Case Review Request Form”, within 60 days from the date of receipt of the notice, in the event that such redetermination is desired. A short statement will also be included in the notice indicating that if the named claimant is deceased, benefits may still be payable and SSA should be contacted for further assistance. The notice will contain the name and telephone number of designated class counsel and will advise the individual that legal assistance is available.
Plaintiffs' counsel will also furnish SSA, for inclusion in the notice, short tag statements in Spanish, Italian, Polish, and French stating that the individual may be entitled to additional benefits and to contact SSA for further assistance. Such statements are to be furnished at the same time the notice comments are provided to SSA.
Following the expiration of the 10 day period for plaintiffs' comments, if any, on the proposed notice, SSA will prepare and send it for final printing. The authority to approve the language of the final notice shall rest with SSA.
Within 60 days of the issuance of the instructions described in ¶ 4, SSA shall send a notice by first class mail to each potential class member identified in ¶ 3, at his or her last known address.
SSA shall attempt to obtain updated addresses for potential class members whose notices are mailed pursuant to the receding paragraph and returned as undeliverable, by requesting the state of Connecticut to ask its Department of Income Maintenance, Department of Human Resources, and State Department on Aging or their successor agency to march their records to provide current addresses through a computerized match with public assistance, food stamp, or other relevant records.
SSA requests for computer matches with the State agencies' data systems will be subject to the requirements of the Privacy Act, as amended by the Computer Matching and Privacy Protection Act, 5 U.S.C. § 552a. Furthermore, SSA shall not be required to institute legal proceedings to gain access to State data system records to reimburse or compensate the State of Connecticut for this matching operation.
SSA will thereafter mail a second notice by first-class mail to all potential class members for whom the computerized match produces an updated address and will have no further obligation to locate those individuals whose current addresses have not been obtained despite the efforts undertaken pursuant to this Agreement.
No later than 45 days after mailing the second notice, SSA shall provide plaintiffs' counsel with a list of the names of all undeliverable notices for those individuals whom it is still unable to locate. The list shall be organized in alphabetical order by last name and contain the address(es) to which each class member's notice was mailed. An updated list of undeliverable notices shall be provided to plaintiffs every 120 days thereafter.
SSA shall provide informational posters alerting the public to this settlement to all Social Security Field Offices serving Connecticut. SSA shall also mail posters to those health agencies, hospitals, and non-profit organizations for which Plaintiffs provide mailing labels. In addition, SSA shall provide public service announcements to radio stations in Connecticut advising of this settlement, but will be under no obligation to ensure that the stations run such announcements.
If a person who receives a notice pursuant to ¶ 5 or ¶ 6(b) requests a review of his claim by responding more than 6 days after receiving such notice, the Secretary shall determine whether that person has “good cause” for the late request, as defined in 20 C.F.R. § 404.911 and SSR 91-5p. SSA will send to class counsel a copy of any determination where “good cause” cannot be found to excuse a potential class members' failure to respond timely to me notice. Class counsel may seek to resolve the question of “good cause” by negotiations with the Office of the General Counsel.
The claims folders of those individuals who timely respond to the Notice described in either ¶ 5 or ¶ 6(b) will be screened for class membership. If SSA determines, that an individual is not a class member, a notice will be sent to the individual, with a copy to class counsel, with an explanation of the reason for denial of class membership. The notice will contain the name and telephone number of designated class counsel and will advise the individual that he or she may call class counsel for assistance in requesting review of the denial of class membership.
Clams counsel may, within 60 days of the date of the non-class membership determination notice, in turn notify in writing an individual to be designated in the Office of the General Counsel, Department of Health and Human Services, Boston, MA 02203 that review of the individual's claims file or other records relied upon by SSA in making the non-class membership determination is desired.
Within 30 days of the receipt of counsel's written request to review such records indicated above, SSA will make available that individuals records at a designated SSA field office location in Connecticut and will notify class counsel in writing. Such records will be available for review by class counsel for a period of 30 days.
At the expiration of 30 days, if class counsel has still not reviewed the records, it shall be assumed that review is no longer desired, and SSA's non-class membership determination shall become final and not subject to further review.
If class counsel's review of the relevant SSA records establishes that there is a dispute as to whether the individual is a clam member entitled to relief, class counsel will notify the Office of the General Counsel, Department of Health and Human Services, Boston, MA by telephone or in writing, within 30 days of such review. Both parties will then attempt to resolve the dispute, and the Office of the General Counsel will issue a final response within 30 days.
In the event the parties are still unable to resolve the dispute, class counsel may submit any unresolved dispute to the Court for final resolution, by proper motion made within 30 days of the date of written reaffirmation, by the Office of the General Counsel, of the prior non-class membership determination, and the defendant shall have the opportunity to respond thereto consistent with federal and local court rules.
Failure of class counsel to request a judicial determination within the aforesaid 30 day period shall render SSA's non-class membership determination final and not subject to further review.
Except as noted in ¶ ¶ 13 and 14 of this Agreement, all claims entitled to readjudication under the terms of this settlement shall be reopened and readjudicated at the reconsideration level, with determinations being appealable to an Administrative Law Judge upon request made pursuant to the procedures set forth at 20 C.F.R. § 404.933. Appeal of an Administrative Law Judge's decision will be to the Appeals Council, upon request made pursuant to the procedures set forth at 20 C.F.R. § 404.968. Class members will retain rights to judicial review as provided in 42 U.S.C. § 405(g).
In conducting the readjudications required by this settlement, SSA adjudicators will apply all applicable law and regulations.
At the option of SSA, class members with subsequent disability claims active and simultaneously pending at any administrative level of review at the time the class claim is being evaluated may have all claims covered by this Agreement consolidated with the current claim.
Class members having individual actions pending in federal court with respect to the unfavorable administrative decision resulting in class membership may elect either to seek a remand of their claim(s) for review by an Administrative Law Judge or to have the action proceed in federal court pursuant to, and subject to the limitations contained in, 42 U.S.C. § 405(g). Nothing in this Agreement shall be construed to avoid or preclude the res judicata effect of a final court decision where a class member decides to proceed with his or her individuals action in federal court.
On readjudication, SSA shall develop the record in accordance with SSA policy, e.g., 20 C.F.R. §§ 404.1512 to 404.1518. Class members may submit new evidence pertaining to the readjudication of their claim.
The resort by class counsel to the dispute resolution or written objection procedures set forth in ¶ 9 and ¶ 10 of this Agreement shall serve to stay SSA's duty to comply with any time limitations otherwise set forth herein. The stay shall be continued until resolution of such dispute or objection, at which time SSA shall have the benefit of the unexpired remainder of the time limitation or 10 additional days, whichever is longer, subject to the Court's expansion or modification thereof.
The Secretary agrees that plaintiffs are the prevailing party in this action for purposes of an award of attorney's fees pursuant to the Equal Access To Justice Act. The amount of such fees, including an appropriate cost-of-living increase, will be determined by the court following approval of the Agreement and the filing of a timely fee application.
This Settlement is entered into by agreement of the parties, as a means of avoiding further litigation. The terms of this Agreement shall not be cited as precedent in any other case. This Agreement is not an admission by the Secretary that he has in the past violated or failed to comply with any federal law, rule of regulation dealing with any matter within the scope of the allegations contained in the complaint or otherwise raised by the plaintiffs.
This Agreement resolves all claims, by individuals who satisfy the conditions of paragraph 1, regarding the standard used to determine eligibility for DWB as more particularly set forth in the pleadings filed in the above entitled action.
The claims of all individuals who were included in the class originally certified by the court, but who are not entitled to readjudication pursuant to ¶ 1 of this Agreement, will be dismissed without prejudice.
Sheldon A. Mossberg33 Church StreetP.O. Box 224Williamantic, CT 06226#Ct06540
Joanne LewisConnecticut Legal Services, Inc.69 Walnut StreetNew Britain, CT 06051#Ct06541
John P. SpilkaConnecticut Legal Services, Inc.P.O. Box 1208New London, CT 06320#Ct06158
Attorneys for PlaintiffsAlbert S. DabruwskiUnited States AttorneyDeirdre A. Martini AssistantU.S. Attorney915 Lafayette BoulevardBridgeport, CT 06604Attorney for Defendant
Attachment 2. Martel COURT CASE FLAG/ALERT
FUN NAME  SSN OR HUN RESP DTE TOE
FOLDER LOCATION INFORMATION TITLE CFL CFL DATE ACN PAYEE
DHHS, SSA NORTHEASTERN PROGRAM SERVICE CENTER ONE JAMAICA CENTER PLAZA JAMAICA, NEW YORK 11432-38030
OFFICE OF HEARINGS AND APPEALS OFFICE OF CIVIL ACTIONS, DIVISION I ONE SKYLINE TOWER, SUITE 601 5107 LEESBURG PIKE FALLS CHURCH, VA 22041-3200
ATTN: Martel SCREENING UNIT
Martel Class Action Case
Claimant's Name: __________________________
This claimant may be a Martel class member. The attached folder location information indicates that a current claim file is pending in your office. Accordingly, we are forwarding the attached alert [and prior claim file(s)] for association, screening for class membership, consolidation consideration and possible readjudication. Please refer to HALLEX Temporary Instruction 5-435 for additional information and instructions.
TO: _____________________________________________________________________________________________________________________________________________________________________
Attachment 4. Martel Screening Sheet and Screening Sheet Instructions
CLASS ACTION CODE: M R
6. Did the responder reside in the State of Connecticut at any time from May 1, 1983 through May 22, 1991, inclusive?
7. Was a less than fully favorable denial/termination issued on this claim for some reason other than the claimant's medical condition (e.g., SGA)?
8.a. Was a less than fully favorable determination/decision issued on this claim at the reconsideration level or higher by the Connecticut DDS, OHA, or any office servicing the State of Connecticut, from May 1, 1983, through August 12, 1989, inclusive, and did this become the final decision of the Secretary? (Note: Although not the “final decision of the Secretary,” an Appeals Council denial of a request for review is the last action of the Secretary, and the date of such a denial controls for class membership screening purposes.)
b. If the claimant did not appeal a less than fully favorable determination made at the initial level of administrative review and made within the timeframes given in a. above, did the claimant reapply for DWB benefits between the date of the initial determination and May 22, 1991, inclusive?
9. Was a less than fully favorable denial/termination issued on this claim at any administrative level from August 13, 1989, through May 22, 1991, inclusive, without consideration of claimant's actual ability to perform any gainful activity?
10. Did the claimant receive a subsequent fully favorable determination/decision which covered the timeframe at issue in the potential Martel claim?
11. Was a claim for title XVI or title II worker's disability benefits covering the timeframe at issue in the potential Martel claim, concurrently denied/ceased at steps 4 or 5 of the sequential evaluation process?
12. The responder is not a Martel class member eligible for class relief.
Check the NONMEMBER block in item 4 and enter the screenout code as follows:
Enter 07 if question 7 was answered “YES”
MARTEL SCREENING SHEET INSTRUCTIONS
Fill in wage earner's SSN, beneficiary identification code, widow(er)'s or surviving divorced spouse's name, and current date.
Do not fill in the member/non-member blocks and screenout code until the screening is completed.
Screen for type of claim and residency. If either question is answered “No”, enter the appropriate screenout code in item 4 as directed in item 12 on the screening sheet and check the non-member block.
To answer this question look for non-medical denial codes in item 22 of the SSA-831-U3 or SSA-833-U3, or on the SSA-3687-U2 or the SSA-3428-U2. The non-medical denial codes are: N1, N2, L1, L2, M7, M8. (For a complete list of DWB denial codes see DI 26510.045.) For cases previously decided at the OHA level, the answer can be found in the Administrative Law Judge or Appeals Council decision. If the answer to question 7 is “Yes”, enter the appropriate screenout code in item 4 as directed in item 12 on the screening sheet and check the non-member block.
Screen for date of decision, not date of application. Individuals are class members if they received a denial, cessation or a less than fully favorable decision (e.g., later onset, closed period, payment of benefits beginning 1/1/91 under OBRA despite an earlier onset) at the reconsideration level or higher which became the final decision of the Secretary, or if they reapplied for DWB benefits prior to May 23, 1991. (Note: Although not the “final decision of the Secretary,” an Appeals Council denial of a request for review is the last action of the Secretary, and the date of such a denial controls for class membership screening purposes.) If the answer to 8a or 8b is “Yes”, proceed to question 10. If the answer to 8a is “No”, go to part b. If the answer to 8b is “No”, go to question 9.
Review the file to determine whether the claimant received a decision at any administrative level between August 13, 1989, and May 22, 1991, inclusive, which did not consider the claimant's ability to perform any gainful activity (i.e., was not denied at step 4 or 5 of the sequential evaluation process.) If the answer to question 9 is “No”, enter the appropriate screenout code in item 4 as directed in item 12 on the screening sheet. Be sure to check the non-member block in item 4 of the screening sheet.
This class relief exception applies only if the individual has received all benefits to which he or she could be entitled based on the potential class member claim. Review the file to determine whether benefits were subsequently allowed or continued beginning with the earliest alleged onset date, cessation date, or control date within the timeframes for class membership (May 1, 1983, through May 22, 1991, inclusive) and that all benefits have been paid. The allowance or continuance could have been either on the same claim or on a subsequent application. If the answer to question 10 is “Yes”, enter the appropriate screenout code in item 4 as directed in item 12 on the screening sheet and check the non-member block found in item 4.
Check file(s) and queries (e.g., ACT, SSID) to determine whether claimant received a denial/cessation decision on a concurrent claim for SSI, or worker's disability which covered the timeframe at issue in the potential Martel claim. If so, review the file(s) to determine whether the claimant's residual functional capacity (RFC) was assessed. The following codes in block 22 of the SSA-831-U3, SSA-832-U3, and SSA-833-U3 indicate denial/cessation on the basis that claimant retained the RFC to perform SGA. Title II denials: H1, H2, J1, J2 and sometimes E3. Title XVI denials: N31, N32, N42, N43. For cases previously decided at the OHA level, review the Administrative Law Judge or Appeals Council decision to determine if the claimant's RFC was assessed. If the answer to question 11 is “Yes”, enter the appropriate screenout code in item 4 as directed in item 12 on the screening sheet and check the non-member block in item 4 of the screening sheet.
Be sure to check the appropriate block on the non-class member notice.
Martel Court Case Coordinator
P.O. Box 17729Baltimore, Maryland 21235
Follow procedures in DI 42574.001B.2. for class member cases.
OHA screeners, see TI 5-435 for instructions.
Processing Non-class Member Cases
Follow procedures in POMS DI 42574.001B.3. for non-class member cases.
Martel CASE
OHA received the attached alert [and prior claim file(s)] for screening and no longer has the current claim file. Our records show that you now have possession of the current claim. Accordingly, we are forwarding the alert and any accompanying prior claim file(s) for association with the current claim. After associating the alert with the current claim, please forward to the Northeastern Program Service Center for screening and possible readjudication. SEE POMS DI 42574.005 OR DI 12574.005
Attachment 6. Martel Non-Class Membership Notice
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 Martel class for the reason given below. This means that we will not review your claim.
A copy of this letter will be mailed to the attorney representing the Martel class. If you think we are wrong, you should call class counsel right away at the telephone number shown below. You have 60 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 name and address of the attorney is:
Sheldon A. Mossberg, Esq. 670 Main Street P.O. Box 165 Willimantic, CT 06226 Telephone 1-800-772-5586
You are not a Martel class member because:
You did not reside in the State of Connecticut at any time between May 1, 1983 through May 22, 1991, inclusive.
You did not receive a final medical decision denying or terminating disability benefits at the reconsideration level or above between May 1, 1983 and August 12, 1989, inclusive.
You did not file a timely request for an administrative review of the unfavorable decision, or reapply for disabled widow(er)'s or surviving divorced spouse's benefits, before May 23, 1991.
Your claim was not denied or ceased at any administrative level between August 13, 1989 and May 22, 1991, inclusive, without consideration of your actual ability to perform any gainful activity.
We already changed our earlier decision and found that you were disabled. You have received all benefits due.
You received a decision denying or terminating disability benefits on a concurrent claim, which was based on a consideration of your residual functional capacity and covered the timeframe at issue in the potential Martel claim.
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 Martel class member.
If you have questions you should write, call or visit any Social Security office. Most questions can be answered by telephone. If you call or visit a Social Security office, please have this letter with you. It will help us answer your questions.
cc: Sheldon A. Mossberg, Esq.
2. 54 North Street
3. Willimantic, Connecticut 06226
We have determined that this claimant is not a Martel class member. (See screening sheet and copy of non-class membership notice in the attached claim file(s).) SEE POMS DI 12574.010
Attachment 8. Martel Class Member Flag for Headquarters Use (DDS Readjudication -- Retention Period Expired)
This claimant is a Martel class member. Accordingly, we are forwarding the attached claim file(s) to the Connecticut DDS for readjudication.
Division of Vocational Rehabilitation Bureau of Disability Determination 600 Asylum Avenue, 2nd Floor Hartford, Connecticut 06105. (Destination code: S08)
Attachment 9. Martel Class Member Flag for Headquarters Use (DDS Readjudication -- Retention Period has not Expired)
This claimant is a Martel class member. After expiration of the retention period, forward claim file(s) to the Connecticut 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 Martel claim file(s) without delay to the Connecticut DDS for readjudication.
In accordance with the Settlement Agreement negotiated by the parties and approved by the United States District Court for the District of Connecticut in the case of Martel v. Sullivan,Civil No. H-89-196 (D. Conn. October 26, 1992), the claimant has requested readjudication of the final (determination/decision) on the prior application(s) filed on ______________. The claimant has been identified as a Martel class member and is entitled to have the final administrative denial of the prior application(s) reviewed under the terms of the Settlement Agreement. Because the claimant's current claim shares certain issues in common 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 Connecticut Disability Determination Service which will conduct the Martel readjudication.
Enclosed is an order of the Administrative Law Judge dismissing your request for hearing and returning your case to the Connecticut 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 Martel class member claim back to the Connecticut Disability Determination Service for further processing. The enclosed order explains why. The Next Action on Your Claim
The Connecticut Disability Determination Service will contact you to tell you what you need to do. If you do not hear from the Connecticut Disability Determination Service within 30 days, contact your local Social Security office. Do You Have Any Questions?
Attachment 12. Martel Class Member Flag for HO Use (DDS Readjudication)
Martel Class Action CaseREADJUDICATION NECESSARY
This claimant is a Martel class member. The attached Martel claim file was forwarded to this hearing office for possible consolidation with a current claim. _______
600 Asylum Avenue, 2nd Floor
Hartford, Connecticut 06105. (Destination code: S08)