I-5-4-43.Taylor v. Shalala
| Purpose | |
| Background | |
| Guiding Principles | |
| Definition of Individuals Entitled to Taylor Relief | |
| Determination of Persons Entitled to Relief and Preadjudication Actions | |
| Processing and Adjudication | |
| Case Coding | |
| Inquiries | |
| Settlement Agreement Dated April 5, 1994. | |
| TAYLOR COURT CASE FLAG/ALERT | |
| ROUTE SLIP OR CASE FLAG FOR SCREENING | |
| TAYLOR SCREENING SHEET | |
| Route Slip for Routing Court Case Alert and Prior Claim File(s) to ODIO or PSC - OHA No Longer Has Current Claim | |
| Non-Entitlement to Relief Notice | |
| Route Slip for Non-Entitlement to Relief Cases | |
| Text for Notice of Revised Entitlement to Relief Determination | |
| Taylor Court Case Flag for Headquarters Use (DDS Readjudication - retention period expired) | |
| Taylor Court Case Flag for Headquarters Use (DDS Readjudication - retention period has not expired) | |
| ALJ Dismissal to DDS | |
| Notice Transmitting ALJ Order of Dismissal | |
| Taylor Court Case Flag for Headquarters Use (DDS Readjudication) |
ISSUED: November 30, 1994
I. Purpose
This Temporary Instruction (TI) sets forth procedures for implementing the parties' April 5, 1994 joint settlement agreement in the Taylor v. Shalala class action involving the standard for determining disability in surviving spouse claims.
Adjudicators throughout the country must be familiar with this TI because individuals entitled to relief under the Taylor settlement who now reside outside of the states of Ohio and Kentucky must have their cases processed in accordance with the requirements of the settlement agreement.
II. Background
On December 21, 1990, plaintiffs filed a class complaint alleging that the Secretary failed to consider residual functional capacity (RFC) for any gainful activity in determining eligibility for title II disability benefits for widows, widowers, and surviving divorced spouses.[1]
Congress enacted the Omnibus Budget Reconciliation Act of 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.
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 February 17, 1993, in anticipation of the expected satisfactory conclusion of settlement negotiations, the district court dismissed the case without prejudice. The court retained jurisdiction to reinstate the action, if necessary, for cause shown that settlement had not been completed.
On April 5, 1994, the parties concluded settlement negotiations with the execution of a joint settlement agreement setting forth the terms for the implementation of relief (Attachment 1). Pursuant to ¶ 16, the parties provided the district court with an informational copy of the settlement agreement and asked the court to place it in the court file.
III. Guiding Principles
Under Taylor, the Secretary will readjudicate the claims of those persons who: 1) respond to notice informing them of the opportunity for review; and 2) are determined to be entitled to review after screening (see Part V.). The Disability Review Section in the Great Lakes Program Service Center (GLPSC) will screen the claims of individuals potentially entitled to relief, unless there is a current claim pending at the Office of Hearings and Appeals (OHA) (in which case OHA will have screening responsibility). Regardless of the state of the claimant's current residence, the Disability Determination Services (DDSs) in Ohio and Kentucky, in most cases, will perform the agreed-upon readjudications, irrespective of the administrative level at which the claim was last decided.
EXCEPTIONS:
The DDS servicing the claimant's current address will perform the readjudication if a face-to-face review is necessary; i.e., terminal illness (TERI) cases. The Great Lakes Program Service Center has review jurisdiction if there is railroad involvement in the Taylor claim.
OHA will screen cases and perform readjudications under limited circumstances (see Part V.B.).
Cases readjudicated by the DDSs will be processed at the reconsideration level regardless of the final level at which the claim was previously decided. Individuals entitled to relief 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 Taylor 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 5-3-15, 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.
IV. Definition of Individuals Entitled to Taylor Relief
For purposes of implementing the terms of the settlement agreement, individuals entitled to relief under Taylor will include any individual who:
filed for or received title II benefits as a disabled widow, widower or surviving divorced spouse (DWB);
was issued a less than fully favorable (i.e. later onset, closed period, or denied) administrative determination or decision between January 1, 1991, and June 4, 1991, inclusive, that became the final decision of the Secretary, that was based on whether the individual's impairment met or equalled a listed impairment and did not consider the individual's RFC for gainful activity (see Part V.B.2.b., 2d note, for further explanation of the final decision concept);
was not issued a final determination or decision by the Secretary or a court which considered the individual's RFC for gainful work for the entire period at issue in the Taylor claim(s) in denying any other title II or title XVI disability claim;
was residing in Ohio or Kentucky at the time the final administrative decision was issued; and
did not have the Secretary's final decision in the potential Taylor claim reviewed and decided by a Federal court.
EXCEPTIONS:
An individual is not entitled to relief under Taylor if he or she
(1) filed a claim for disability benefits under titles II or XVI, either concurrently with, or after, any DWB claim(s) which was denied between January 1, 1991, and June 4, 1991, inclusive, and received a final administrative denial or a final adverse judgment from a Federal district or appellate court on the disability claim at steps one, two, four or five of the sequential evaluation process that covered the entire timeframe at issue in the Taylor claim(s); or
(2) filed a complaint in Federal district court based on an administrative denial of any DWB claim(s) between January 1, 1991, and June 4, 1991, inclusive, and received a final judgment from a Federal district or appellate court; or
(3) first filed a DWB claim on or after January 1, 1991, and that claim did not involve entitlement to DWB for any month(s) before January 1991 (i.e., did not involve an alleged onset date that could result in entitlement prior to January 1991), and was denied administratively on the ground that the claimant did not meet the statutory standard for disability set forth in § 5103 of OBRA 90, that became effective January 1, 1991; or
(4) had a claim for DWB denied on the ground that he or she did not satisfy the disability standard of SSR 91-3p for all relevant periods of time at issue.
V. Determination of Persons Entitled to Relief and Preadjudication Actions
A. Pre-Screening Actions - General
Notification
SSA will send notices to all individuals potentially entitled to relief under Taylor as identified by a computer run. Individuals have 60 days from the date of receipt of the notice to request that SSA readjudicate their claims under the terms of the Taylor settlement agreement. SSA will presume an individual's receipt of the notice five days after mailing, unless the individual establishes that receipt actually occurred later. The Office of Disability and International Operations (ODIO) will retrieve the claim files of late responders and send them, together with the untimely responses, to the servicing Social Security field office (i.e., district or branch office) to develop good cause for the untimely response. Good cause determinations will be based on the standards set forth in 20 CFR § 404.911 and SSR 91-5p. If good cause is established, the field office will forward the claim to the GLPSC for screening.
Alert and Folder Retrieval Process
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 Taylor alert.
In most instances, ODIO will associate the computer-generated alerts with any ODIO-jurisdiction potential Taylor claim file(s) and forward them to the GLPSC for retrieval of any additional claim files and screening (see Part III.).
Alerts Sent to OHA
If GLPSC determines that either a potential Taylor claim or a subsequent claim is pending appeal 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).
GLPSC will send all alerts potentially within OHA jurisdiction and related prior claim files to the Office of Civil Actions (OCA), Division III, at the following address:
Office of Hearings and Appeals
Office of Civil Actions, Division III
One Skyline Tower, Suite 704
5107 Leesburg Pike Falls Church, VA 22041-3200
ATTN: TaylorScreening UnitFolder Reconstruction
In general, ODIO or the GLPSC will coordinate any necessary reconstruction of prior claim files. OHA requests for reconstruction of potential Taylor cases should be rare. However, if it becomes necessary for OHA to request reconstruction, the OHA component (if not OCA, Division III) will return the alert and any accompanying claim file(s) to OCA, Division III. OCA, Division III, will direct any necessary reconstruction requests to the servicing FO with a covering memorandum requesting that the reconstructed folder be forwarded to OHA. OHA will send a copy of the covering memorandum to:
Litigation Staff
Office of the Deputy Commissioner for Programs
3-K-26 Operations Building
6401 Security Boulevard
Baltimore, MD 21235
ATTN: Taylor CoordintorDenials of Entitlement to Relief
The GLPSC or OHA, as appropriate, will hold for 90 days all files of individuals determined not to be entitled to relief under Taylor pending a possible request for review of that determination by the individual or the individual's representative. If the individual or representative make a timely written request (i.e., within 60 days of receipt of notice of non-entitlement to relief) to review the claim file, GLPSC or OHA will forward the files to a mutually agreed upon SSA office for review. SSA has 30 days to make the folder available, and the claimant has 30 days to inspect it. If the claimant is still dissatisfied after reviewing the file or if the claimant chooses to dispute the determination without looking at the claim folder, he or she must notify the Office of the General Counsel (OGC) within 60 days of initially having notified SSA.
B. OHA Screening Actions
Pre-Screening Actions
Current Claim in OHA
As provided in Part V.A.3., if there is a current claim pending at OHA, OCA will receive the alert and related Taylor claim file(s). OCA will determine which OHA component has the current claim and forward for screening as follows.
If the current claim is in a hearing office (HO), OCA will use Attachment 3 to forward the alert and the prior claim file(s) to the HO for screening.
If the current claim is before the Appeals Council, OCA will use Attachment 3 to forward the alert and prior claim file(s) to the appropriate Office of Appellate Operations (OAO) branch for screening.
If the current claim file is in an OAO branch minidocket or Docket and Files Branch (DFB), OCA will request the file, associate it with the alert and prior claim file(s) and perform the screening.
If OCA is unable to locate the current claim file within OHA, OCA will broaden its claim file search and arrange for folder retrieval, transfer of the alert or folder reconstruction, as necessary.
NOTE:
OCA, Division III, is responsible for controlling and reconciling the OHA Taylor alert workload. Because the number of individuals potentially entitled to relief is small, the OHA alert workload will be minimal and a manual accounting should suffice. OCA will maintain a record of all alerts 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 a final alert/screening reconciliation.
Current Claim Pending in Court
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 III, will associate the alert with the claim file(s) (or court transcript) and screen for entitlement to relief under Taylor. See Part V.B.2.b. for special screening instructions when a civil action is involved.
Screening
General Instructions
The OHA screening component will associate the alert and prior claim file(s), if any, with the claim file(s) in its possession and then complete a screening sheet (see Attachment 4) as follows:
NOTE:
If the claim pending at OHA is the only potential Taylor claim, then the individual is not entitled to relief under Taylor (see Part IV.). Complete the screening sheet and follow the instructions in Part V.B.3.a. for processing non-Taylor claims.
Consider all applications denied (including res judicata denials/dismissals) during the Taylor timeframe;
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 Taylor screening purposes.
Follow all instructions on the screening sheet;
Sign and date the original screening sheet, place it in the claim file (on the top right side of the file); and
Forward a copy of the screening sheet to:
Office of Hearings and Appeals Division of Litigation Analysis and Implementation One Skyline Tower, Suite 702 5107 Leesburg Pike Falls Church VA 22041-3200
ATTN: TaylorCoordinator
The Division of Litigation Analysis and Implementation (DLAI) will forward copies of the screening sheet to OCA, Division III, (if not the screening component) and the Litigation Staff at SSA Central Office.
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 III (see address in Part V.A.3.), 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).
NOTE:
Final determinations or decisions made on or after January 1, 1991, on a subsequent claim filed by an individual potentially entitled to Taylor relief may have adjudicated the timeframe at issue in the potential Taylor claim.
Special OCA Screening Instructions if a Civil Action Is Involved
As noted in Part V.B.1.b., OCA, Division III, will screen for individuals entitled to relief under Taylor when a civil action is involved. OCA's determination will dictate the appropriate post-screening action.
NOTE:
A remand by a Federal court under sentence four of § 405(g) of the Social Security Act is a “final” judgment for screening purposes.
If the claim pending in court is the potential Taylor 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 13 to indicate that there is a subsequent claim pending in court, but that the Taylor claim is being forwarded for separate processing.
If the final administrative decision on the claim pending in court was not adjudicated in accordance with the disability evaluation standards reflected in § 5103 of OBRA 90 and SSR 91-3p, or is legally insufficient for other reasons, OCA will initiate voluntary remand proceedings and consolidate the claims.
Post-Screening Actions
Cases of Individuals Not Entitled to Relief Under Taylor
If the screening component determines that the individual is not entitled to relief under Taylor, the component will:
notify the individual, and representative, if any, of non-entitlement to Taylor relief using Attachment 6 (modified as necessary to fit the circumstances and posture of the case when there is a current claim);
NOTE:
Include the date and claim number at the top of Attachment 6.
retain a copy of the notice in the claim file;
An individual who wishes to dispute a determination that they are not entitled to relief under Taylor may do so directly, through their representative of record or through Taylor counsel, as explained in the notice (Attachment 6).
retain the claim file(s) for 90 days pending a possible dispute regarding the individual's entitlement to relief; if the screening component is not OCA, Division III, and the file(s) is not needed for adjudication, forward the file(s) for storage to OCA, Division III, at the address in Part V. A.3. (see Generic Class Action HALLEX Instruction I-1-7-9);
if the individual makes a timely request to review the claim file (i.e., within 60 days from receipt of notice of non-entitlement to relief), DLAI will notify the OHA component housing the claim file to send it to the individual's local SSA office or a mutually agreed upon SSA office using the routing slip in Attachment 7 (see Part V.A.5.). OHA has 30 days to make the file available. Thereafter, the individual will have 30 days to review the file(s).
NOTE:
Photocopy any material contained in the prior file that is relevant to the current claim and place it in the current claim file before shipping the prior file.
if through OGC, SSA resolves the dispute in the claimant's favor: 1) rescreen the case; 2) send the notice of revised entitlement to relief determination (Attachment 8) to the claimant and representative, if any; 3) proceed in accordance with Part VI.; and 4) notify DLAI, at the address in Part V.B.2., of the revised determination by forwarding a copy of the revised screening sheet (DLAI will forward copies of the revised screening sheet to OCA, Division III (if OCA is not the screening component), and to Litigation Staff at SSA Headquarters); and
if after 90 days no review is requested, return the file(s) to the appropriate location.
Cases of Individuals Determined to be Entitled to Relief Under Taylor
If the screening component determines that the individual is entitled to relief under Taylor, it will proceed with processing and adjudication in accordance with the instructions in Part VI.
VI. Processing and Adjudication
A. Cases Reviewed by the DDS
As previously indicated, the DDSs servicing Ohio and Kentucky residents will usually conduct the first Taylor review. An exception may apply when the Taylor claim is a TERI case. An exception will also apply for cases consolidated with claims pending or being held at the OHA level (see Part VI.D.).
The DDS determination will be a reconsideration determination, regardless of the administrative level at which the Taylor claim(s) was previously decided, with full appeal rights (i.e., ALJ hearing, Appeals Council and judicial review).
B. OHA Adjudication of Claims of Individuals Entitled to Relief Under Taylor
The following instructions apply to both consolidation cases in which the ALJ or Appeals Council conducts the Taylor readjudication and to DDS readjudication cases in which the claimant requests a hearing or Appeals Council review. Except as noted herein, HOs and OHA Headquarters will process Taylor claims according to all other current practices and procedures including coding, scheduling, developing evidence, routing, etc.
NOTE:
Type of Review and Period to be Considered
Pursuant to the Taylor settlement agreement, the type of review to be conducted is a “reopening.” The readjudication shall be a de novo reevaluation of the individual's eligibility for benefits based on all evidence in his or her file, including newly obtained evidence relevant to the period of time at issue in the administrative decision(s) through the present or the date of a subsequent allowance.
Disability Evaluation Standards
Adjudicators must use the disability evaluation standards reflected in § 5103 of OBRA 90 and SSR 91-3p for evaluating disability in claims of individuals entitled to relief under Taylor. The disability evaluation standard enacted by § 5103 of OBRA 90 is effective for determining entitlement to monthly benefits payable for January 1991 or later. (See HALLEX TI 5-3-15, 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 evaluating disability and determining entitlement to benefits payable for the pre-1991 period.
Individual Entitled to Relief Is Deceased
If an individual entitled to relief 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 Taylor claim or a subsequent claim file) is located in OHA Headquarters but there is no claim actively pending administrative review, i.e., OHA 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 entitlement to relief under Taylor. (See Part V.B.3., for instructions on processing claims of individuals not entitled to relief under Taylor.)
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 Taylor flag (see Attachment 9) to the outside of the file and forward the claim file(s) to the appropriate DDS for review of the Taylor claim.
If less than 120 days have elapsed, OCA will attach a Taylor case flag (see Attachment 10) to the outside of the file to ensure the case is routed to the appropriate DDS after expiration of the retention period. Pending expiration of the retention period, OCA will also:
return unappealed ALJ decisions and dismissals to DFB, OAO; and
return unappealed Appeals Council denials to the appropriate OAO minidocket.
The respective OAO component will monitor the retention period and, if the claimant does not seek further administrative or judicial review, route the file(s) to the appropriate DDS in a timely manner.
D. Processing and Adjudicating Taylor Claims in Conjunction with Current Claims (Consolidation Procedures)
General
If an individual entitled to relief under Taylor has a current claim pending at any administrative level and consolidation is warranted according to the guidelines below, the appropriate component will consolidate all Taylor claims with the current claim at the level at which the current claim is pending.
Current Claim Pending in the Hearing Office
Hearing Has Been Scheduled or Held, and All Remand Cases
Except as noted below, if an individual entitled to relief under Taylor 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 Taylor case with the appeal on the current claim.
EXCEPTIONS:
The ALJ will not consolidate the claims if:
the current claim and the Taylor claim do not have any issues in common; or
a court remand contains a court-ordered time limit, and it will not be possible to meet the time limit if the claims are consolidated.
If the claims are consolidated, follow Part VI.D.2.c. If the claims are not consolidated, follow Part VI.D.2.d.
Hearing Not Scheduled
Except as noted below, if an individual entitled to relief under Taylor 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 Taylor claim and the current claim. Instead, the ALJ will dismiss the request for hearing on the current claim and forward both the Taylor claim and the current claim to the DDS for further action (see Part VI.D.2.d.).
EXCEPTION:
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 entitled to Taylor relief, the ALJ will consolidate the claims.
If the claims are consolidated, follow Part VI.D.2.c. If the claims are not consolidated, follow Part VI. D.2.d.
Actions If Claims Consolidated
When consolidating a Taylor 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 Taylor claim with the current claim, the ALJ will:
give proper notice of any new issue(s) as required by 20 CFR §§ 404.946(b) and 416.1446(b), if the Taylor 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 Taylor claim raises an additional issue(s), unless the ALJ is prepared to issue a fully favorable decision with respect to the Taylor claim; and
issue one decision that addresses both the issues raised by the current request for hearing and those raised by the Taylor claim (the ALJ's decision will clearly indicate that the ALJ considered the Taylor claim pursuant to the Taylor settlement agreement).
Action If Claims Not Consolidated
If common issues exist but the ALJ decides not to consolidate the Taylor claim with the current claim because the hearing has not yet been scheduled, the ALJ will:
dismiss the request for hearing on the current claim without prejudice, using the language in Attachment 11 and the covering notice in Attachment 12;
send both the Taylor claim and the current claim to the appropriate DDS for consolidation and further action.
If the ALJ decides not to consolidate the Taylor claim with the current 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 Taylor claim for DDS review using Attachment 13; immediately route it to the appropriate DDS for adjudication; retain a copy of Attachment 13 in the current claim file; and
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 Taylor 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 Taylor claim.
Appeals Council Intends to Dismiss, Deny Review or Issue a Denial Decision on the Current Claim -- No Taylor Issue(s) Will Remain Unresolved.
This will usually arise when the current claim duplicates the Taylor review claim, i.e., the current claim raises the issue of disability and covers the period adjudicated in the Taylor 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 Taylor claim.
Appeals Council Intends to Dismiss, Deny Review or Issue a Denial Decision on the Current Claim -- Taylor Issue(s) Will Remain Unresolved.
This will usually arise when the current claim does not duplicate the Taylor claim, e.g., the current claim raises the issue of disability but does not cover the entire period adjudicated in the Taylor claim. For example, the Taylor 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 Taylor case flag (Attachment 13; appropriately modified) to the Taylor claim, immediately forward the Taylor claim to the appropriate DDS for readjudication, and retain a copy of Attachment 13 in the current claim file. OAO will modify Attachment 13 to indicate that the Appeals Council's action on the current claim does not resolve all Taylor issues and that the Taylor 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 Taylor Issue(s) Will Remain Unresolved.
If the Appeals Council intends to issue a fully favorable decision on a current claim, and this decision would be fully favorable with respect to all issues raised by the application that makes the claimant an individual entitled to relief under Taylor, 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 Taylor claim and issue a decision that adjudicates both applications.
The Appeals Council's decision will clearly indicate that the Appeals Council considered the Taylor claim pursuant to the Taylor settlement agreement.
Appeals Council Intends to Issue a Favorable Decision on the Current Claim -- Taylor 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 Taylor 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 appropriate DDS after the Appeals Council's decision is effectuated. OAO staff will include the following language on the transmittal sheet used to forward the case for effectuation: "Taylor court case review needed -- following effectuation, forward the attached combined folders to the appropriate DDS."
Appeals Council Intends to Remand the Current Claim to an ALJ.
If the Appeals Council intends to remand the current claim to an ALJ, it will proceed with its intended action unless one of the exceptions below applies. In its remand order, the Appeals Council will direct the ALJ to consolidate the Taylor claim with the action on the current claim pursuant to the instructions in Part VI.D.2.a.
EXCEPTIONS:
The Appeals Council will not direct the ALJ to consolidate the claim if
the current claim and the Taylor claim do not have any issues in common, or
a court remand contains a court-ordered time limit and it will not be possible to meet the time limit if the claims are consolidated.
If the claims do not share a common issue or a court-ordered time limit makes consolidation impractical, OAO will forward the Taylor claim to the DDS for separate review. The case flag in Attachment 13 should be modified to indicate that the Appeals Council, rather than an Administrative Law Judge, is forwarding the Taylor claim for separate processing.
VII. Case Coding
HO personnel will code prior claims into the Hearing Office Tracking System (HOTS) and the OHA Case Control System (OHA CCS) as “reopenings.” If the prior claim is consolidated with a current claim already pending at the hearing level (see Part VI.D.), 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.D.2.b. apply, the ALJ should dismiss the request for hearing on the current claim, and HO personnel should enter “OTDI” in the “DSP” field.
To provide for HOTS identification of the cases of individuals entitled to relief, HO personnel will code “TA” in the “Class Action” field. No special identification codes will be used in the OHA CCS.
VIII. Inquiries
HO personnel should direct any questions to their Regional Office. Regional Office personnel should contact the Division of Field Practices and Procedures in the Office of the Chief Administrative Law Judge at (703) 305-0022.