The Disability Determination Services (DDS) may at times receive a case from the Field Office (FO) for processing while another claim type is still pending further FO development or has not been identified for application. The DDS receives the subsequent claim while the original case is in process at some level. The original case can still be at the DDS or at the review component, or cleared to the FO for effectuation. Any claim under the same Electronic Disability Collect System (EDCS) filing are members of a concurrent case.

“Split samples” occur when all claims filed in a concurrent case do not arrive in the quality review case processing system at the same time. Specifically, this arises when one or more of the claims in a concurrent case are sampled (i.e., the claim(s) that the FO and the adjudicating component processed correctly), but the other non-sample claim(s) is still pending in the FO, adjudicating component, or another review component. Thus, the claims become split.

EXAMPLES:

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  The FO does not process the mainframe (i.e., Modernized Claims System (MCS), Modernized Supplemental Security Income Claims System (MSSICS)) or EDCS case transfers for one or more of the concurrent claims in the case; or

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  The adjudicating component does not properly process and transfer one or more of the concurrent claims in a case (e.g., the adjudicating component does not clear both claims in a concurrent Title II/Title XVI case at the same time). The review component encounters this situation most often.

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  The claims in a concurrent case (e.g., the claimant filed claims for both Title II and Title XVI benefits) may arrive at the review component for quality review at the same time; or

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  One or more of the non-sample claims in a concurrent case may arrive at the review component subsequent to the other claim(s).

1. 1. 

   Upon review initiation of a case, the reviewer compares the claims listed in eView and the claims included in the Quality Review (QR) case processing system and they do not coincide.

2. 2. 

   In the QR case processing system in an assigned case, the case is highlighted in pink and a message in the case displays “XX Claim is missing; case updates and closure will fail. Notify QRCPS Technical Support.”

3. 3. 

   In eView, determine the status of a claim by reviewing the information displayed after selecting the Status/History tab on the eView Case Selection page (if accessing the claim through the QR case processing system or on the Search window in eView).

   NOTE: The Search screen is usually bypassed when using the QR case processing system to open eView.

4. 4. 

   On the Search screen, after entering the SSN or the claimant's name and selecting the Search button, several items appear (e.g., the claimant's name, claim type, status and office code). This is the same information that displays after selecting the Status/History tab. If the review component has jurisdiction, “Pending” shows under Case Status and the Office Code shows “R##” (i.e., the numeric review component’s office code displays).

5. 5. 

   If there is a split sample situation in a concurrent case, and one or more claims have been sampled, the remaining non-sampled claim(s) still shows as pending in the FO or the adjudicating component (the component that last had jurisdiction). There may be instances where the remaining non-sampled claims do not always show as "Pending", but may be "Closed".

6. 6. 

   If one or more non-sampled claims exist, verify the status of the non-sampled claim(s) by using email or a phone call to contact the component shown as having the claim(s).

In a concurrent case, the quality reviewer is responsible for reviewing (and initiating corrective action, when appropriate) each of the disability determinations, even though quality review data are only recorded for the sampled claim.

Actions taken on one claim often affect the other claim(s) in a concurrent claim situation. Therefore, determine if a concurrent case situation exists by using eView as early in the review process as possible, and before the review component clears the sampled claim(s). Verify the status of the non-sampled claim(s) to ensure that it has not been inadvertently overlooked.

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  If the non-sampled claim(s) is a denial due to technical reasons or a no determination, complete case review actions and clear the sampled claim(s).

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  If the non-sampled claim(s) is not a denial due to technical reasons, ask the FO or adjudicating component to expedite processing and transfer the claim(s) to the review component for review. Do not clear the sampled claim(s) in the interim.