I-1-7-11.Screening and Notice Process

1. Pre-Screening Actions

Before screening an individual case, the screening component will take the actions listed below.

1. Determine whether a subsequent claim is pending at any administrative level or in court.

2. Determine whether there are additional claims within the class dates that have not been associated.

3. Obtain the file(s), for any:

   • unassociated claim(s) that fall within the class dates, and

   • inactive claims that postdate the class period (that potentially provide a basis for the screening decision).

4. If necessary, request reconstruction of any additional potential class member claim files.

2. General Screening Principles

Absent a specific provision in the court order or settlement agreement, the following screening principles apply:

• A claimant who received a partially favorable decision will not be screened out from class relief if all other class membership criteria are met.

• If the determination or decision on a claim filed subsequent to the claim being screened applied the standard or criteria mandated by the court order or settlement agreement and adjudicated the entire time period at issue in the claim being screened, the claimant will be screened out from class relief. (To assess this, the screener must carefully review the required standard or criteria, and compare the evidence and determination or decision on the subsequent claim with the evidence in the potential class member claim.)

• The term “final decision of the Commissioner” includes ALJ or Appeals Council dismissals or Appeals Council denials of requests for review, unless otherwise defined in the individual class action.

• The receipt of a determination or decision on a subsequent claim that is fully favorable with respect to the time period at issue in the potential class member claim provides a basis for determining that the claimant is not a class member eligible for class relief only if the individual has received all benefits (i.e., payments or eligibility for Medicare) to which the individual could be entitled based on the potential class member claim.

• A lost claim that would otherwise be reconstructed for screening and review purposes will be screened out if available systems data or other information establishes that the claim would not be subject to class relief (e.g., the Supplemental Security Record (SSR) shows that the date the claim was adjudicated is outside the class timeframe); the screener must attach pertinent documentation to the screening sheet and must annotate the screening sheet with the basis for screening out the claim (e.g., the SSR).

3. Post-Screening Actions

• The OAO screener will place the original screening sheet in the claim file and, for reporting purposes, forward two copies to the OHA Class Action Coordinator at the address in I-1-7-11 A. The Coordinator will enter the information from the screening sheet into a database and will retain a copy of each screening sheet and forward a copy to the Office of Program Law (OPL) in the Office of the General Counsel.

• The HO screener will place the original screening sheet in the claim file and forward, for reporting purposes, two copies directly to the OHA Class Action Coordinator at the address shown in I-1-7-11 A.

The OHA Class Action Coordinator will update the screening information to CATS, retain a copy of each screening sheet and forward a copy to OPL.

• If the HO or OAO screener determines that a subsequent claim is pending at another adjudicative level, the screener will annotate this information on the screening sheet for the adjudicator's use in considering consolidation (see I-1-7-13 concerning consolidation and I-1-7-13 H. concerning notification to OPL if a subsequent or prior case is pending judicial review) or other action, and will expedite the case.

• If the HO or OAO screener determined that the claimant is entitled to class relief, and there is an appeal pending judicial review on a claim filed either before or after the class claim, the screener must notify OPL because class membership may influence the action on the court case. OAO or the HO will alert the appropriate OAO Court Case Preparation and Review Branch (CCPRB) to the situation. The CCPRB will contact OPL directly and will notify the component of any action to be taken. (See I-1-7-13 H. for additional instruction to notify OPL about a screen-in if a court case is pending and overlapping periods are at issue.)

  EXCEPTION:

  If an OAO screener determines that a claimant with an inactive OHA- jurisdiction class claim has a subsequent (current) claim pending in an HO, the screener will notify the HO Director (or designee) that the screener is transmitting the class claim.

• If the screener determined, on screening an OHA-jurisdiction class claim case, that a non-OHA component has jurisdiction for readjudication, or the screener receives a CDR alert from a non-OHA component, the screener will, send any required notice and then forward the case to the non-OHA component. Screeners in OAO and HOs will notify the OHA Class Action Coordinator, either orally or in writing, of the change in jurisdiction for coordination with OPL in OGC.

4. Special Post-Screening Actions

1. Notice of Class Relief

Many cases under the jurisdiction of DDSs' do not provide claimants with a separate notice of a favorable class membership determination. Occasionally an OHA component may screen a DDS-jurisdiction case for the purpose of consolidating at the OHA level (e.g., OHA plans to issue a favorable decision that is also fully favorable with respect to the class member claim). In this situation, OHA will give notice in the body of the decision that all class relief has been provided.

For OHA-jurisdiction cases, there may be a time lag between the date of screening for eligibility for class relief and the date that OHA processes the case (e.g., the date that a claim is scheduled for hearing). Therefore, at the OHA level, the screening component may give notice of eligibility for class relief at the time of screening. (Such notice may sometimes be given in connection with notice of action on a current claim.)

2. Notice of Non-Class Membership or Notice That Individual Is Not Eligible for Class Relief

All individuals denied class membership or class relief will receive notice of the denial and any ensuing right to review of the denial. The notice will be tailored to the particulars of the class action and the individual claim.

3. General Notice Guidelines

When providing notice, the OHA screening component will:

• Use OHA letterhead paper.

• Send the original to the claimant or if the claimant is deceased, to the potential substitute party or eligible individual. If not known, send the notice in the deceased claimant's name in care of the “Next of Kin.”

• Send copies to the representative (if any); class counsel (if required); and to OPL (if required in the particular case).

• Place a copy of the notice in the claim file.

On release of the notice, the screening component (if it is not the adjudicating component), will forward the file(s) to the adjudicating component or to the designated location for those not entitled to class relief. (The location will be identified in the applicable TI.)