TN 5 (07-90)

NL 00601.770 Totalization Claims Notices

A. Policy

An application for totalization benefits is also an application for regular (nontotalization) benefits. Therefore, when an award/disallowance is prepared, we must notify the claimant of the disposition of both types of benefits.

B. Process

OIO is responsible for the preparation of all notices (award or disallowance) after receipt of the foreign record.

C. Procedure

Refer to each benefit separately in the notice.

EXAMPLE: Concurrent disposition of benefits:

Totalization benefits are not payable since regular benefits are being awarded based on U.S. coverage alone.

  • State in the award notice that foreign coverage was not considered since the NH was insured without it (CAPS paragraph MX04 or RX04).

  • The general closeout language which states the claimant is not eligible for any other type of benefit is not sufficient.

EXAMPLE: No concurrent disposition of benefits:

A claim for regular RSDI benefits is disallowed for lack of insured status, and no decision on the totalization benefit can be made until the record of coverage is received from the foreign country.

  • Send the claimant a disallowance notice for regular RSDI benefits; and

  • advise the claimant in the notice that the disallowance does not apply to totalization benefits (CAPS paragraph MX02 or RX02); and

  • provide the reason for the delay on a decision on the totalization benefit (e.g., pending receipt of information from the foreign agency, CAPS paragraph MX02 or RX02).

D. Description of caps process

CAPS will produce language which covers the totalization benefit, based on the entry of totalization factor codes on the input document.

The CAPS language will either

  • dispose of the totalization benefit because

    • NH fully insured without foreign coverage (MX04);

    • NH has less than 6 QC's (MX01);

    • Some other factor of entitlement not met (MX03); or

  • advise the claimant that the decision on the totalization benefit is still pending because a foreign coverage record has been requested (MX02).

To Link to this section - Use this URL:
NL 00601.770 - Totalization Claims Notices - 01/15/1991
Batch run: 06/10/2013