63-005     Resolving the Issues Without a Hearing

 

Table of Contents
 
Section
General
005.1
Conditional Withdrawal (CWD)
005.2
Out of Hearing Resolution (OHR)
005.3
Out of Hearing Resolution (OHR) Procedures
005.4
Withdrawal
005.5
Abandonment of the Claim
005.6

 

63-005.1

General

Whenever possible, the Appeals Section will resolve the issues under appeal without a hearing.  The processes below are used for this purpose.

 

 

63-005.2

Conditional Withdrawal

(CWD)

When a household chooses to withdraw based upon certain conditions, the conditions of the withdrawal will specify the actions to be taken by the County and/or the household.

 

A Conditional Withdrawal (CWD) is a binding agreement that provides that the actions of both parties will be completed within 30-days from the date the CWD is signed by both parties and received by the County.

 

 

63-005.3

Out of Hearing Resolution

(OHR)

When the Appeals Representative assigned to a state hearing determines that the County action cannot be upheld in a hearing, and a CWD is agreed upon, an Out of Hearing Resolution (OHR) will be issued to the Family Resource Center (FRC).

 

If the Appeals Representative needs further clarification when evaluating whether or not an OHR is appropriate, the case and issues may be reviewed with:

 

·  The supervisor or worker; or

·   Public Assistance Fraud Division (PAFD), if a referral to that section was made.

 

The OHR instructions are binding on the FRC and it is mandatory that the FRC initiates the required action(s) immediately to meet the 30-day compliance deadline.

 

The guidelines for rescinding a FRC’s actions may include factors other than those concerning erroneous case actions.  Appeals staff may instruct  the FRC to rescind actions when it is determined that proceeding with the hearing is not appropriate because:

 

·   The FRC action was incorrect; or

·   The County has insufficient evidence to substantiate its position; or

·   There is new information that affects the action under appeal; or

·   The County is otherwise unable to support the action in a hearing.

 

 

63-005.4

Out of Hearing Resolution (OHR)

Procedures

The Appeals Representative will negotiate with the household, or Authorized Representative (AR), a Conditional Withdrawal (CWD) of his/her request for state hearing based on the County’s agreement to resolve the appealed action, and prepare an Out of Hearing Resolution form 03-13 HHSA (OHR) based on the conditions in the CWD.

Appeals will image the OHR into DoReS and notify the FRC.  The OHR will explain the required action(s) by the FRC, the reason for the action(s), and the regulations and/or policies involved.

Immediately upon being notified of the OHR, the FRC will take the required actions:

 

·         The worker assigned to complete the OHR will narrate in detail in CalWIN Case Comments all actions taken, any contact with the client, final results from the resolution action, and notify the Appeals Representative by the due date indicated on the 03-13 HHSA that the OHR has been completed.

·         Compliance with the OHR must not exceed the compliance due date stated on the OHR.  If the due date on the 03-13 HHSA cannot be met, the FRC must notify the Appeals Representative, who will determine if an extension can be granted with an extended due date.

·         If no response is received by the extended due date, the FRC Appeals Liaison will be contacted.

-          If a response is not received from the FRC Appeals Liaison regarding the reason for not meeting due date, the Appeals Representative will notify the FRC Manager.

·         If the FRC has new information or believes the OHR is incorrect the FRC Liaison must contact the Appeals Representative immediately.  If the decision is not reversed by Appeals, the action must be completed.

·         If the FRC wishes to request a formal review of the Appeals action, the FRC Manager may request a review by the Appeals Section Manager within five working days of receipt of the 03-13 HHSA.  However, compliance with the OHR instructions is required, even when the FRC intends to request a review.  To request a review, the FRC Manager will send a statement of the FRC’s position, with a copy of the 03-13 HHSA form attached to the Appeals Section Manager at Mail Stop W-402.

·         The review conducted by the Appeals Section Manager is designed primarily to monitor resolutions taken by the Appeals Section.  It will not serve as a reassessment of the individual case situation under dispute.  Only under exceptional circumstances will the Appeals Section Manager release the FRC from compliance with an OHR.

 

 

63-005.5

Withdrawal

When an action that was appealed has been rescinded, or the household decides not to proceed with the appeal, the Appeals Representative will request that the household sign a withdrawal (WD) form.

 

 

63-005.6

Abandonment of the Claim

When households request a state hearing, they are considered to have filed a “claim” regarding their case.  When households fail to appear for the hearing, they are considered to have abandoned that claim.