Effective Dates: 07/26/2024 - Present Previous | Next

TN 5 (07-24)

DI 11020.135 Field Office (FO) Actions After a Disability Determination

After the Disability Determination Services (DDS) makes a disability determination and returns the case to the FO, take the following steps, depending on the type of determination.

See Also:

  • •

    DI 11020.016 Childhood Disability Development and Determination

  • •

    RS 00203.085 Childhood Disability Development and Determination

NOTE: Great Lakes Processing Service Center (GLPSC)-Disability Processing Branch (DPB) has jurisdiction of Title II disability determinations in career railroad and dependent railroad annuitant claims.

A. Medical allowance

1. Processing Earnings Computation (EC) exclusions

If a new claim is an allowance that you cannot process through EC, prepare a Modernized Claims System (MCS) A101 or EF101.

See Details:

  • •

    For A101 instructions, see MSOM MCS 014.001 - MSOM MCS 014.025.

  • •

    For EF 101 information, see Electronic Form 101 Process” MSOM T2PE 009.001.

2. Age 18 conversion cases

When a disability determination is made to continue a child's entitlement as a Childhood Disability Benefit (CDB) upon attaining age 18, the disability determination must be posted to the Master Beneficiary Record (MBR) to enable automatic conversion.

Use the Postentitlement Online System (POS) (see MSOM COMMON 005.017) to convert auxiliary child’s benefits to CDB in the following situations:

  • •

    The child is age 17½ to 18 and is receiving auxiliary child’s benefits; or

  • •

    The child is in T4 terminated status (see MSOM COMMON 005.017 “Develop for Child Disability Determination” and SM 00550.020 “Ledger Account File (LAF) Codes”).

However, if the child is receiving Supplemental Security Income (SSI) benefits, send the claim to the PC for manual action. PC manual action is also needed for other types of CDB allowances, such as a

  • •

    CDB converted from student benefits;

  • •

    Reentitlement for a beneficiary who is over age 18 with a T6 LAF code; or

  • •

    CDB award to continue Child-in-Care benefits (see RS 00202.095 “Last Child in Care” and RS 00203.085 “Childhood Disability Development and Determination”.

NOTE: When the FO applies collateral estoppel in a CDB conversion case, the FO is not required to prepare a new SSA-831. Enter the remark “collateral estoppel, PC action necessary to manually establish listing code 589” and provide the disability onset date as well as other coding (e.g., diagnosis codes) on the PC paperless routing sheet or a report of contact, following instructions in RS 00203.085D.2. For more information on collateral estoppel case processing, see DI 11011.001.

B. Medical Denial

1. Processing Earnings Computation (EC) Exclusions

If the new claim is a denial and cannot be processed through EC, prepare a Manual Adjustment Credit and Award Data Entry (MACADE).

SSA-1418 inputs are required for District Office Workload Report (DOWR) credit.

2. Updating the Master Beneficiary Record (MBR) with denial data

If disability is not established for a claimant already on the rolls, the FO must make an appropriate systems input to establish or update the MBR (see MSOM COMMON 005.017 “Develop for Child Disability Determination”).

If systems input, such as Modernized Claims Systems (MCS) or Postentitlement Online System (POS) is not possible, the FO should use MACADE to update the MBR. 

See Also:

SM 00380.500 Overview of MACADE Disallowance Function

SM 00380.525 List of User and Edit Messages

C. Res Judicata denial

DDSs do not have the systems capability to input "S1" denials. Therefore, if the DDS denies a subsequent claim based on res judicata, DDS returns the claim to the FO to process the claim through the MCS EC, if possible. If not, then the FO inputs a MACADE action to process the "S1" denial.

The FO is able to determine when an S1 denial input is needed from a basis code "S1" entered in item 35 of the DDS-prepared SSA-831-U3 on the subsequent claim. In addition, the DDS annotates the route slip used to return the folder to the FO as follows: "Res judicata applicable to claim filed on (date of subsequent application). Please input an S1 denial.”

See Also:

  • •

    DI 11010.075 Title II Technical Denials, and Claims Not Requiring a Disability Determination

  • •

    DI 27516.005 DDS Action on Subsequent Title II Claim -- Claimant Previously Denied Through Date Last Insured/Prescribed Period/Age 22.

D. Folder jurisdiction

Determine which PC has jurisdiction of the number holder’s (NH) SSN; then send any paper claims material (processing limitation/exclusion) for the CDB to that PC. Use the following guides to determine which PC has jurisdiction:

  • •

    If the NH is entitled to a Disability Insurance Benefit (DIB) and is under age 54, the Office of Disability Operations (ODO) has jurisdiction of the claim.

  • •

    All other Disability and Retirement, Survivors Insurance (RSI) claims are maintained by the servicing PC.

EXCEPTION: If any beneficiary on the NH's Earnings Record (E/R) has a foreign mailing address, the Office of International Operations (OIO) has jurisdiction of the claim.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0411020135
DI 11020.135 - Field Office (FO) Actions After a Disability Determination - 07/26/2024
Batch run: 07/26/2024
Rev:07/26/2024