TN 8 (11-23)
Sometimes the FO may need to request a policy decision or clarification in order to process a claim involving WC/PDB.
Develop the issue fully before requesting a policy decision/clarification.
Document the folder with a complete explanation of the issue to be resolved.
Submit the issue to the ARC-MOS Regional Office (RO) WC contact or a Regional specific vHelp request, if there needs to be a clarification on an unresolved WC/PDB issue. See FO Request for Interpretation of Policy in GN 01010.850. The RO WC contact may refer the issue to their Central Office WC contact in Office of Retirement and Disability Policy, Office of Income Security Programs, Office of Applications and Electronic Services Support Policy (ORDP/OISP/OAESP).
Establish a control for any development that is still pending. If processing an initial claim and MCS is available, establish a tickle for control of the issue. For PE situations, create an MDW with your own unit code to establish a tickle for control.
Impose offset in order not to delay payment while the issue is being resolved.
Sometimes the PC may need to request a policy decision or clarification in order to process a claim involving WC/PDB.
Review the case thoroughly and verify the presence of an unresolved issue.
Develop the issue fully for any additional information needed and diary to control the receipt of information.
If the issue cannot be resolved after receipt of development, review for any appropriate precedents or rulings. For WC/PDB precedents, see PR 02505.008 through PR 02505.054; for rulings, see Rulings & ARs listed under “Instructions” then “Other Instructions” on the PolicyNet homepage.
If no precedents or rulings apply, and the Claims Technical Expert (CTE) cannot resolve the issue, prepare a typed form SSA-559 - Transmittal Slip for Claims Folders, outlining the issue for submission.
Process the case, imposing offset in order not to delay payment. Document the paper folder or paperless folder with a complete explanation of the issue and establish a diary to control resolution of the issue.
Forward the case to the CTE who will then contact the PC WC analyst for advice.
If necessary, the PC WC analyst will refer the case on a post-adjudicative basis to ORDP, OISP, OAESP.
When the issue is resolved, annotate the folder and cancel any applicable control.
For recognized (or potential) reverse offset plans, see DI 52105.001.
Submit unresolved issues to the PC OAS analyst to refer to the Regional Office WC Contact. The RO staff will submit the issue to the Office of the General Counsel (OGC) for an opinion.