I-5-4-45.Cuffee v. Shalala

Attachment 1. Stipulation and Consent Order Entered by the Court on December 2, 1993

WELTON CUFFEE et al., v. DONNA E. SHALALA et. al.

Plaintiffs,

Defendants.

The parties to this action are plaintiffs Welton Cuffee, Josephine Wolbert,and Nellie Roberts, individually and on behalf of all others similarly situated. Defendants are Donna E. Shalala, in her official capacity as the Secretary of the Department of Health and Human Services; Robert Bartman, in his official capacity as Commissioner of Education, State of Missouri: Frank Jost, in his official capacity as the former Coordinator of the Section of Disability Determinations; and Elizabeth Washburn in her official capacity as the Administrator of the Missouri Disability Determination Services (Missouri DDS).

Plaintiffs' Fourth Amended Complaint was filed on November 24, 1992. On June 3, 1993, the Court issued a decision on plaintiffs' partial motion for summary judgment and on June 14, 1993, the Court denied defendants' motion to dismiss and partial motion for summary judgment.

In order to amicably resolve all of the disputes in this case without the expense of further litigation, the parties, by their undersigned counsel, therefore agree to a complete settlement of all of plaintiffs' claims in this action in accordance with the following terms and conditions:

Class Definition

In an order dated June 24, 1991, the Court certified two state-wide classes. These classes are revised to include:

all Missouri residents who applied for (a) Disability Insurance Benefits (DIB) under Title II of the Social Security Act, 42 U. S. C. §§ 401-433 (b) Supplemental Security Income (SSI) under Title XVI of the Social Security Act, 42 U.S.C. §§ 1382-1383d; or (c) both DIB and SSI benefits; and whose application was denied on or between the dates of January 22, 1987, and November 14, 1991.

The class does not include any individual not currently eligible for DIB and/or SSI benefits who had a closed period of eligibility at any time between the dates of January 22, 1987, and November 14, 1991.

Retroactive Relief

1. The class members who shall be entitled to relief under the terms of this Stipulation and Consent Order, are:

   1. All Missouri residents who:

      1. apply for (a) DIB; (b) SSI; or (c) both DIB and SSI benefits, from the effective date of this Order through April 30, 1995,

      2. receive a medical allowance on their application, and who

      3. received a final medical denial by the Missouri DDS on an application for DIB and/or SSI benefits and the denial is dated on or between January 22, 1987, and November 14, 1991;

   2. Any Missouri resident who has a claim for DIB and/or SSI benefits pending at any administrative level or in Federal Court on the effective date of this Stipulation and Consent Order, who subsequently receives a medical allowance on that claim, and who meets the requirement of paragraph 1(a)(3) of the Stipulation and Consent Order.

   3. Any Missouri resident currently entitled to DIB and/or SSI benefits on the effective date of this Stipulation and Consent Order, who meets the requirements in paragraph 1(a) (3) and paragraph four.

   4. A class member who applies for DIB and whose claim is denied on the basis of res judicata at any administrative level, will be entitled to a redetermination under the procedures outlined in paragraph three, if the requirements of paragraph 1(a) (1) and (a) (3) are met.

2. Defendants will not redetermine the class claim of any class member otherwise entitled to relief under this Order who:

   1. appealed the medical denial dated on or between January 22, 1987, and November 14, 1991, and

      1. received an administrative denial (other than a dismissal) from an administrative law judge, which became final because the individual did not seek Appeals Council review, or became final because the Appeals Council denied review of the decision of the administrative law judge, or became final on the Appeals Council's issuance of its own decision on review of the decision of the administrative law judge; or

      2. had their claim reviewed pursuant to Boyd v. Bowen, No. 83--0352-CV-W-3 (W.D. Mo. September 26, 1989); Polaski v. Heckler, 739 F.2d 1320 (8th Cir. 1984); Peck v. Sullivan, No. 88-173-D-1 (S.D. Iowa, November 15, 1990); or Zebley v. Sullivan, 493 U.S. 521, 110 S. Ct. 885, 896 (1990).

3. When a class member entitled to relief in accordance with paragraph 1(a) or (b) receives a medical allowance based on such application, the Social Security Administration (SSA) shall send the class member a request for review form which asks whether the class member wants a redetermination of his or her final medical denial from the Missouri DDS dated on or between January 22, 1987, and November 14, 1991. The request for review form will be accompanied by a postage-paid, pre-addressed envelope. To receive the redetermination, class members must return the request for review form within sixty (60) days of the date on which they receive the form. If a class member does not timely request review in accordance with this paragraph, subject to good cause, the prior denial will not be redetermined. SSA may presume that a class member received the request for review five (5) days after mailing, unless the class member establishes that he or she actually received the request for review at a later date, in which case the sixty (60) days to request redetermination shall be counted from the date of actual receipt.

4. For class members described in paragraph 1(c) to obtain a redetermination under this Stipulation and Consent Order, he or she must notify an SSA Field Office, in writing, in person, or by telephone, that he or she had a final medical denial issued by the Missouri DDS dated on or between January 22, 1987, and November 14, 1991. The individual must notify an SSA Field Office by April 30, 1995.

5. All claims entitled to redetermination under the terms of this Stipulation and Consent Order shall be redetermined at the reconsideration level of administrative review.

6. If a class member has more than one claim subject to redetermination pursuant to this Stipulation and Consent Order, SSA may, at its option, consolidate all such claims and redetermine them at the reconsideration level of review.

7. SSA shall decide whether an individual who requests redetermination under any provision herein is entitled to relief under the criteria of paragraph one or is not entitled to relief because of the exclusions in paragraph two based upon SSA's data processing systems and/or documentation submitted by the individual showing that he or she meets the criteria of those paragraphs.

8. If SSA decides that an individual who has requested redetermination under paragraphs 1(a), (b), or (d), is not entitled to a redetermination of his or her final medical denial based upon the exclusions set forth in paragraph two, SSA shall send a notice of its decision to the individual, the individual's representative of record, if known, and to class counsel. The notice shall specify the reason(s) for SSA's decision not to redetermine the prior denial and will indicate that the individual should contact class counsel if he or she wishes to contest the decision and the time in which the decision must be contested.

9. If SSA determines that an individual who has requested redetermination pursuant to paragraph 1(c) did not have a final medical denial within the specified time period under paragraph 1(a)(3), or is not entitled to a redetermination based upon the exclusions in paragraph two, SSA will send a notice of its decision to the individual and class counsel. The notice shall specify the reason(s) for SSA's decision not to redetermine the prior denial and will indicate that the individual should contact class counsel if he or she wishes to contest the decision and the time in which the decision must be contested.

10. If class counsel disagrees with a decision made by SSA under paragraph eight or nine, he or she shall, within sixty (60) days of receipt of the notice described in paragraph eight or nine, notify the Chief Counsel, Office of the General Counsel (OGC), Department of Health and Human Services, 601 E. 12th Street, Kansas City, Missouri 64106, in writing of the disagreement and specify the reasons for the disagreement. SSA, through OGC, shall respond to the notification of disagreement within sixty (60) days. If class counsel fails to contest a decision made under paragraph eight or nine within the specified time, the decision shall take immediate effect and shall not be subject to further review.

11. Class counsel may request inspection of the claims file, data or documents relied upon by SSA in making a decision under paragraph eight or nine of this Stipulation and Consent Order, but must do so in writing. To protect the privileged information contained in the claims file, class counsel may not use or disclose any information obtained from the claims file except for the purpose of pursuing the individual's claim pursuant to this Stipulation and Consent Order or as otherwise authorized by the claimant. Class counsel and SSA shall arrange for a mutually agreeable time and place for inspection of the data, documents and claims file.

12. OGC and class counsel shall negotiate in good faith to resolve any disputes concerning whether the individual is entitled to a redetermination. If, after negotiation, counsel cannot resolve the issue, OGC will send class counsel written confirmation that the prior claim will not be redetermined. Class counsel may, by motion, submit the unresolved matter to this Court for resolution. Such motion must be filed not later than sixty (60) days after class counsel's receipt of the written confirmation sent by OGC.

13. This Stipulation and Consent Order shall not be construed as limiting the preexisting rights of any class member to apply for benefits, request administrative or judicial review, or request reopening of a decision pursuant to 20 C.F.R. §§ 404.988 and 416.1488.

14. Notice of this Stipulation and Consent Order shall be made through poster notices prepared by SSA and reviewed by class counsel and publicly displayed in all SSA field offices and OHA offices in the State of Missouri until May 1, 1995. Class counsel may publicize the contents of the Stipulation and Consent Order by any other means.

15. Individuals whose claims are redetermined pursuant to this Stipulation and Consent Order shall retain all rights to seek further administrative and judicial review in accordance with 42 U.S.C. § 405(g) and 20 C.F.R. Part 404, Subpart J and Part 416, Subpart N.

16. SSA shall promulgate instructions to all personnel charged with implementing this Stipulation and Consent Order and shall provide class counsel and the Court with a copy of the instructions prior to their distribution. Class counsel will also be provided copies of the notices referred to in this Stipulation prior to distribution.

17. By May 1, 1994, and every six months thereafter, ending with November 1, 1995, SSA shall submit a written report to the Court and class counsel which includes the following information:

    1. The number of individuals to whom a request for review is sent pursuant to paragraph three.

    2. The number of individuals who responded to the request for review described in paragraph three.

    3. The number of individuals who requested redetermination pursuant to paragraph four.

       Prospective Relief

18. SSA agrees to provide additional training by its central office to disability counselors, senior counselors, hearing officers, and medical consultants at the Missouri Disability Determination Services (Missouri DDS) as well as quality assurance personnel, both State and Federal, who are involved in reviewing Missouri DDS disability determinations, within 120 days from the effective date of the Order, concerning:

    1. the development and evaluation of subjective symptoms, including pain;

    2. the development and evaluation of medical evidence and reports of treating sources;

    3. the weight to be afforded the opinion of a treating physician; and

    4. the completion of the residual functional capacity assessment form.

       Class counsel or designated representative will be allowed to attend the training sessions.

19. The Missouri DDS agrees to conduct a special study of cases involving pain for six months beginning July 1, 1994.

20. SSA agrees to conduct a consistency review, as described in POMS GN04441.00 et seq., of cases involving pain adjudicated by the Missouri DDS for six months beginning January 1, 1994, and to provide a copy of the report to class counsel.

21. 21. Defendants agree to ask claimants during disability intake the question “Do you have any side effects from the medication(s) you take?”

22. The Missouri DDS agrees to move the question regarding the treating sources' willingness to perform any necessary consultative examination to the first page of the request for medical evidence of record. The Missouri DDS also agrees to add language to the request stating that the amount paid for the consultative examination will be discussed with the treating source if, and when, an examination is requested.

    Standards for Review

23. SSA agrees that the policies and procedures to be applied in the redetermination of claims pursuant to this Stipulation and Consent Order, as well as the adjudication of current claims for DIB and/or SSI benefits, are found in the Social Security Act, Social Security regulations, Social Security Rulings (SSRs), and the Program Operation Manual System (POMS). The relevant policies and procedures for purposes of this Stipulation and Consent Order include, but are not limited to:

    1. The development and evaluation of subjective symptoms, including pain:

       1. 20 C.F.R. §§ 404.1529, 416.929-

       2. POMS DI 22501.001 et seq.

       3. POMS DI 22505.001 et seq.

       4. POMS DI 22505.005

       5. POMS DI 24515.012

       6. POMS DI 24501.020

       7. POMS DI 24501.025

       8. POMS DI 24515.060D, E and F

    2. Obtaining medical evidence of record from treating sources:

       1. 20 C.F.R. §§ 404.1512, 404.1513, 416.912, and 416.913

       2. POMS DI 22505.001-.040

    3. Obtaining consultative examinations:

       1. 20 C.F.R. §§ 404.1517, 404.1519, 416.917, 416.919

       2. POMS DI 22510.001-.030

    4. The weight to be accorded the opinion of treating sources:

       1. 20 C.F.R. §§ 404.1527, 416.927

       2. POMS DI 24515.001-.010

    5. Determination of residual functional capacity and completion of the residual functional capacity assessment form:

       1. 20 C.F.R. §§ 404.1545, 416.945

       2. POMS DI 24510.001-.065

       3. POMS DI 24515.060E and F

       Case Review

24. For a period not to exceed nine months from May 1, 1994, class counsel may inspect the final decisions made by SSA or the Missouri DDS in connection with the redetermination of claims pursuant to this Stipulation and Consent Order. Individual claims files will be made available for inspection at a mutually agreeable time and office of SSA. The claims files may not be removed from the custody of SSA. Claims files must be reviewed within 90 days after class counsel is notified that a claims file is available for inspection. Class counsel shall notify OGC, 601 E. 12th Street, Kansas City, Missouri 64106, of any alleged pattern of misapplication of SSA policy found during review of the claims files. Upon such notification, SSA agrees to review the cases within 60 days and thereafter, OGC and class counsel shall negotiate in good faith to resolve the disputes.

    Attorney Fees

25. The parties agree that the Federal defendant will pay plaintiffs and their attorneys reasonable attorneys fees and expenses under the Equal Access to Justice Act (EAJA), 28 U.S.C. § 2412. The amount of fees and expenses has been agreed to by the parties. Upon approval of this order by the Court, plaintiffs will file a motion for attorneys fees under the EAJA. With that motion, plaintiffs will file a stipulation setting forth the amount of fees and expenses.

    Release of Claims and Liabilities

26. The terms set forth in this Stipulation and Consent Order shall be in full settlement and satisfaction of any and all claims and demands, of whatever nature, that plaintiffs have against the Secretary of the Department of Health and Human Services, and any of her agents or employees, and against the Secretary of the Department of Elementary and Secondary Education, State of Missouri, and any of his agents or employees, based upon and with respect to the incidents, claims or circumstances giving rise to and/or alleged in the pleadings filed herein. Accordingly, and in consideration for the implementation of the provisions of this Stipulation and Consent Order, the parties, on behalf of themselves and any entity or individual on whose behalf they act or have acted, agree to resolve this action and to fully, finally and forever release, discharge and waive any and all claims, demands, liabilities, actions, rights of action and causes of action of any kind or nature whatsoever based on the incidents, claims or circumstances giving rise to and/or alleged in the pleadings filed herein.

27. Counsel for the parties may, at any time, mutually agree to modify this Stipulation. The parties will notify the Court of the modification and it shall become effective thirty (30) days after notification to the Court unless the Court objects to the proposed modification.

28. The terms of the numbered paragraphs of this Stipulation and Consent Order as well as any memoranda or other submissions filed with the Court for approval of this Stipulation and Consent Order, constitute the entire agreement of the parties, and no statement, representation, agreement or understanding, oral or written, which is not contained therein, shall have force or effect, nor does the Stipulation and Consent Order reflect any agreed upon purpose other than the desire of the parties to reach full settlement.

29. This court retains jurisdiction over this action for the enforcement of the provisions of this Stipulation and Consent Order.

30. The relief offered herein is in no way to be construed as an admission of liability or wrongdoing by defendants and is agreed to by defendants solely to settle the case and to avoid the cost of further litigation.

31. Class counsel, by signing below, warrant and guarantee that they are sole counsel to the plaintiff class and that they are duly authorized to stipulate to the settlement of issues in this action on behalf of Welton Cuffee, Josephine Wolbert, Nellie Roberts, and all class members those named plaintiffs represent. Counsel for defendants, by signing below, represent that they are authorized to stipulate to the settlement of issues in this action.

32. This Stipulation and Consent Order shall be effective only upon entry of the order by the Court.

LET THE JUDGMENT BE ENTERED ACCORDINGLY

Dated this 2nd day of December, 1993

/s/

/s/

/s/

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Attachment 2. CUFFEE COURT CASE FLAG/ALERT

 
 
 
 TITLE: CATEGORY:


 
 
 REVIEW
PSC MFT DOC ALERT DATE
 OFFICE
 
 
 BOAN
OR PAN NAME
 
 
 
 CAN OR HUN RESP
DTE TOE
 
 
 
 FOLDER LOCATION
INFORMATION
 TITLE
CFL CFL DATE ACN PAYEE ADDRESS
 
 
 II

XVI
 

SHIP TO ADDRESS:

     [Missouri DDS Office of jurisdiction]

Attachment 3. Screening Flag - Inside OHA

Attachment 4. Cuffee SCREENING SHEET

CUFFEE SCREENING SHEET INSTRUCTIONS

COMPLETE ONLY ONE SCREENING SHEET, EVEN IF THE CLAIMANT RECEIVED MULTIPLE DETERMINATIONS WITHIN THE CLASS DATES. HOWEVER, THE SCREENING SHEET PROVISIONS MUST BE CONSIDERED SEPARATELY FOR EACH CLAIM. A CLASS MEMBER WHO RECEIVED MULTIPLE DETERMINATIONS IS ELIGIBLE FOR READJUDICATION ONLY ON THOSE CLAIMS MEETING ALL CLASS MEMBERSHIP REQUIREMENTS.

Items 1 - 3

Fill in wage earner's SSN, claimant's name, and date of screening.

Item 5

This question involves three thresholds for potential class membership. Screen first for date of application between December 2, 1993 and April 30, 1995, inclusive. For claims filed between these dates, the date of disposition is immaterial.

Next, screen for claims filed prior to December 2, 1993. Claims filed before this date are potential class member claims as long as the claim was still pending as of December 2, 1993, i.e., any determination, decision, Appeals Council action or Federal court disposition was rendered on or after December 2, 1993. (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.) Claims filed on or after May 1, 1995, are not subject to class membership relief.

Finally, determine if the individual was entitled to or eligible for disability benefits as of December 2, 1993, based on a previous medical allowance, regardless of whether the individual is actually in payment status, e.g., benefits may have been suspended because the claimant exceeds income and resource requirements.

Item 6

If the individual applied for disability benefits between December 2, 1993, and April 30, 1995, inclusive, or had a disability claim pending at any administrative level or in Federal court on December 2, 1993, the individual must have received a medical allowance, either fully or partially favorable, or a res judicata dismissal or denial on the disability claim.

Item 7

The prior claim must have been denied, not ceased, at the initial or reconsideration level on a medical basis. A technical denial on the basis of res judicata is not a medical denial. A closed period received in the Cuffee timeframe will be treated as a medical denial for review purposes. To screen the claim, look for the appropriate regulation basis medical denial codes in item 22 of the Form SSA-831-U3 or on the Form SSA-3687-U2 or the Form SSA-3428-U2. The regulation basis medical denial codes for title II are: E1, E2, E3, E4, F1, F2, G1, G2, H1, H2, J1, J2, K1, K2, L1, L2, M5 or M6. The appropriate regulation basis medical denial codes for title XVI are: N30, N31, N32, N34, N35, N36, N37, N39, N40, N41, N42, N43, N45, N46 or N51. In a Disability Hearing Unit (DHU) case, read the decision to determine the basis for the denial. If the claimant received a reconsideration determination that became final, the reconsideration determination must have been on a non-medical basis for this screen-out code to apply. Use the latest date on the Form SSA-831-U3 or other denial form as the date of denial.

Item 8

Claimants must meet two thresholds for residency. The claimant must have been a resident of the State of Missouri when filing a new claim between December 2, 1993 and April 30, 1995, inclusive. Claimants with pending or effectuated claims must have been a resident as of December 2, 1993, the date of the Stipulation and Consent Order. Additionally, the claimant must have been a resident when s/he received a prior medical denial from the Missouri DDS. Screen for residency in all claims.

Item 9

If the claimant received an unfavorable substantive decision at the hearing level or above, s/he is not a class member. A dismissal is not a substantive decision. If an Administrative Law Judge decision is not final at the time of screening, i.e., the claim is still within the appeal period or the claimant requested Appeals Council or court review which is pending, the claim cannot be screened out. In this situation, this question would be answered “No.”

Item 10

This class relief exception applies only if the individual has received all benefits to which s/he could be entitled based on the potential class member claim. Review the file to determine whether benefits were subsequently (e.g., since November 14, 1991) allowed or continued (in closed period cases) from the earliest alleged onset date, cessation date or control date of a claim decided within the timeframes for class membership. The allowance or continuance could have been either on the same claim or on a subsequent application.

Note: If full retroactive benefits were not awarded because of subsequent application filing date limitations, route the case to a claims authorizer in the PC or ODIO, if Title II, or the appropriate FO, if Title XVI, for the preparation of an amended award in accordance with DI 42537.010 C.6.

Item 11

Check the inactive file(s) for screening sheets or any other information indicating that the claimant may have had a claim that was reviewed pursuant to the Peck v. Sullivan, Zebley v. Sullivan, Polaski v. Heckler or Boyd v. Bowen class actions. The Peck v. Sullivan, Zebley v. Sullivan, Polaski v. Heckler or Boyd v. Bowen class actions, all cover the issues and the time period involved in the terms of the Cuffee Stipulation. If the responder received a review of his/her previous denial under the terms of one or more of these class actions, the responder is not entitled to another review under the terms of the Cuffee Stipulation.

Instructions if Claimant is Determined to be a Class Member

1. Check the “Member” block in item 4. a. of the screening sheet.

2. Sign and date the screening sheet. Enter the name of the screening component.

3. Show the dates of all applications screened and the dates of the final administrative action on each.

4. Retain the original screening sheet in the folder.

5. OHA Headquarters components will send a copy of the screening sheet to the OAO Class Action Coordinator. [The OAO Class Action Coordinator will enter the screening sheet information from the screening sheet into a data base and forward the screening sheet to the Division of Litigation Analysis and Implementation (DLAI).] OHA Hearing Offices (HOs) will send a copy of the screening sheet to:

   Office of Hearings and Appeals
   Division of Litigation Analysis and Implementation 5107 Leesburg Pike Falls Church, VA 22041-3255One Skyline Tower, Suite 702Falls CHurch, VA 22041-3255
   
   ATTN: Cuffee Coordinator

   [DLAI will retain a copy of each screening sheet received from the OAO Class Action Coordinator or an HO and forward a copy to Litigation Staff at SSA Headquarters for entry into the Civil Action Tracking System.]

6. Follow HALLEX I-5-4-45, V. B. 4. b. for screened-in cases.

7. Follow procedures in Part V. B. 4. b. for screened-in cases.

Instructions if Claimant is Determined to be a Non-class Member or a Class Member Not Entitled to Relief

1. Check the “Non-member” block in Item 4. a. of the screening sheet and enter the appropriate screen-out code in item 4. b.

2. Follow items b. - d. above.

3. Prepare the notice in attachment 6. Retain a copy of it in the folder.

4. Follow the procedures in Part V. B. 4. a. for screened-out cases.

Attachment 5. Screening Flag - Outside OHA

REMARKS

CUFFEE CASE

OPTIONAL FORM 41 (Rev. 7-76)

*U.S.GPO:1985-0-461-274/20020 Prescribed by GSA

FPMR (41 CFR) 101-11.206

Attachment 6. Non-Class Membership Notice

We are writing to tell you that we received your request to review your earlier denied claim for disability benefits under the Cuffee v. Shalala court decision. We have looked at your case and have decided that you are not a class member entitled to relief. This means that we will not review our earlier decision that you were not disabled. The reason that you are not a class member entitled to relief under the Cuffee court decision is checked below.

We Are Not Deciding If You Were Disabled

It is important for you to know that we are not making a decision about whether you were disabled at the time of your earlier claim. We are deciding only that you are not a Cuffee class member.

If You Do Not Agree With This Determination

If you want us to review our determination that you are not entitled to relief under the Cuffee case, you must contact the attorneys for the Cuffee case who will answer your questions about entitlement to relief under the Cuffee case. The address and telephone number of the attorneys are listed below. YOU MUST DO THIS WITHIN 60 DAYS OF RECEIVING THIS NOTICE.

If You Have Any Questions

If you have any questions, you may contact your Social Security office. The address and phone number are printed at the top of this letter. If you call or visit an office, please have this letter with you. It will help us answer your questions.

Additionally, if you have someone helping you with your claim you should contact him/her. You may also ask for legal help by contacting a legal aid office in your area or by contacting the lawyers in the Cuffee case:

Si usted no entiende esta carta, llevela a la oficina de Seguro

Social arriba mencionada para que se la expliquen.

cc: Legal Aid of Western Missouri

Attachment 7. Route Slip for Non-class Member Claims

REMARKS

CUFFEE CASE

OPTIONAL FORM 41 (Rev. 7-76)

*U.S.GPO:1985-0-461-274/20020 Prescribed by GSA

FPMR (41 CFR) 101-11.206

Attachment 8. Notice of Revised Class Membership

In an earlier notice that we sent you, we said that you were not a member of the Cuffee class action. After reviewing all of the facts, we have decided that you are a member of the Cuffee class action. Therefore, we will review your class member claim, using the standards set by the court under the Cuffee v. Shalala Stipulation and Consent Order.

We have many requests for review and it may take several months before we look at your claim file. When we start the review, we may contact you for additional evidence or information that you may wish to submit.

If you have any questions, you may contact any Social Security office. If you have someone helping you with your claim, you should contact him or her. You or your representative may also contact the attorneys in this case:

If you call or visit a Social Security office, please have this letter with you. It will help us answer your questions.

Si usted no entiende esta carta, llevela a la oficina de Seguro Social arriba mencionada para que se la expliquen.

cc: Legal Aid of Western Missouri

Attachment 9. Readjudication Flag for OHA Retention Cases

Cuffee Class Action Case

READJUDICATION  NECESSARY

Attachment 10. ALJ Dismissal to DDS

SOCIAL SECURITY ADMINISTRATION

OFFICE OF HEARINGS AND APPEALS

ORDER OF DISMISSAL

Attachment 11. Notice Transmitting ALJ Order of Dismissal

NOTICE OF DISMISSAL

Attachment 12. Readjudication Flag for No Common Issue Cases

Cuffee Class Action Case

READJUDICATION NECESSARY

Attachment 13. Text for Appeals Council Remand to DDS Class Member Claim Associated with Current Claim Pending Appeals Council Review

On ____________, the claimant filed a request for review by the Appeals Council on the issues raised by ((his/her) application dated ____________.) OR (the Administrative Law Judge's dismissal action.) The claimant has also been identified as a member of the Cuffee class action and is entitled to have the final administrative denial of (his/her) application(s) dated ____________ readjudicated by the Missouri Disability Determination Services under the terms of the December 2, 1993 Stipulation and Consent Order for settlement. The undersigned has determined that the current and class member claims have issues in common.

(Discuss the Appeals Council's reasons for remand of the current claim.)

[Use the following language if the Appeals Council finds a basis for remand unrelated to the fact of Cuffee class membership, and remands to the DDS for a consolidated reopening.]

Accordingly, the Appeals Council grants the claimant's request for review and vacates the Administrative Law Judge's (decision/dismissal action). Because the claimant is also entitled to relief at the reconsideration level under the Cuffee class action, the Council remands this case to the Missouri Disability Determination Services for reopening of the issues raised by the (dates of applications) applications. The Disability Determination Services will issue one determination covering (both or all) claims. If the Disability Determination Services does not issue a fully favorable determination, it will notify the claimant of the right to request a hearing before an Administrative Law Judge.

OR

[Use the following language if the Appeals Council would otherwise dismiss or deny the request for review or issue an unfavorable decision, and remands to the DDS for redetermination.]

Accordingly, the Appeals Council grants the claimant's request for review, vacates the Administrative Law Judge's (decision/dismissal action) and remands this case to the Missouri Disability Determination Services. The Disability Determination Services will redetermine, through the date of the Administrative Law Judge's decision or, if the Administrative Law Judge issued a dismissal, through the date of reconsideration, the issues raised by the (dates of applications) applications. The Disability Determination Services will issue one determination covering (both or all) claims. If the Disability Determination Services does not issue a fully favorable determination, it will notify the claimant of the right to request a hearing before an Administrative Law Judge.

Attachment 14. Text for Appeals Council Remand to DDS Class Member Claim Pending Appeals Council Review

On ____________, the claimant filed a request for review by the Appeals Council on the issues raised by ((his/her) application dated ____________.) OR (the Administrative Law Judge's dismissal action.) The claimant has also been identified as a member of the Cuffee class action and is entitled to have (his/her) claim readjudicated by the Missouri Disability Determination Services under the terms of the December 2, 1993 Stipulation and Consent Order for settlement.

(Discuss the Appeals Council's reasons for remand.)

[Use the following language if the Appeals Council finds a basis for remand unrelated to the fact of Cuffee class membership, and remands to the DDS for reopening.]

Accordingly, the Appeals Council grants the claimant's request for review and vacates the Administrative Law Judge's (decision/dismissal action). Because the claimant is also entitled to relief at the reconsideration level under the Cuffee class action, the Council remands this case to the Missouri Disability Determination Services for reopening of the issues raised by the ____________ application. If the Disability Determination Services does not issue a fully favorable determination, it will notify the claimant of the right to request a hearing before an Administrative Law Judge.

[Use the following language if the Appeals Council would otherwise dismiss or deny the request for review or issue an unfavorable decision, and remands to the DDS for redetermination.]

Accordingly, the Appeals Council grants the claimant's request for review, vacates the Administrative Law Judge's (decision/dismissal action) and remands this case to the Missouri Disability Determination Services. The Disability Determination Services will redetermine, through the date of the Administrative Law Judge's decision or, if the Administrative Law Judge dismissed, through the date of reconsideration, the issues raised by the ____________ application. If the Missouri Disability Determination Services does not issue a fully favorable determination, it will notify the claimant of the right to request a hearing before an Administrative Law Judge.