TN 8 (03-22)

GN 01703.110 How to Document Insured Status Decisions

A. Introduction

If a record of foreign coverage was obtained to adjudicate a claim, document the claims file to show that the foreign coverage was considered. Foreign periods of coverage should be credited only to the extent they are needed to provide totalization insured status. There are two methods (manual method and observation method) used for determining and documenting that insured status is met for retirement and survivor claims. When determining and documenting insured status for disability benefits use the Disability Insured Status Calculator (DISCO).

B. Procedure - Manual Worksheet Method (Retirement and Survivor claims only)

Follow the guidelines below for the manual worksheet method.

1. When to use

Complete a totalization insured status worksheet in the following situations:

  • Claims in which the deceased NH is currently insured.

  • Claims where insured status is not met after foreign coverage is credited.

  • Claims where it is too close to call; i.e., where insured status is met using combined coverage, but there are fewer than 5 foreign quarters of coverage (QCs) in excess of the number needed for totalization insured status.

2. How to complete

For each year in which there is a U.S. and/or a foreign QC:

  • Display a U.S. QC as “C.”

  • Display a foreign QC as “F.”

  • Display no QC as “N.”

  • Show QCs in proper order.

    Example: In 1968 there are 4 F QCs. In 1969, the first quarter is an “F” and the last quarter is a “C.” Enter, “1968 FFFF 1969 FNNC.”

  • Sign and date the form.

C. Procedure - Observation Method (Retirement and Survivor claims only)

Use the observation method when it is obvious from a quick review of the foreign coverage record that totalization insured status is met; i.e., the record shows far more foreign coverage than is needed.

Example: A NH requires 33 QCs to meet fully insured status. He has 30 QCs of U.S. coverage and the foreign coverage record displays 5 years of non-coinciding coverage.

D. Exhibit

TOTALIZATION INSURED STATUS WORKSHEET


 

Year                Quarters         




                      1  2  3  4       

Year                 Quarters




                      1  2  3  4       

1937

1980

1938

1981

1939

1982

1940

1983

1941

1984

1942

1985

1943

1986

1944

1987

1945

1988

1946

1989

1947

1990

1948

1991

1949

1992

1950

1993

1951

1994

1952

1995

1953

1996

1954

1997

1955

1998

1956

1999

1957

2000

1958

2001

1959

2002

1960

2003

1961

2004

1962

2005

1963

2006

1964

2007

1965

2008

1966

2009

1967

2010

1968

2011

1969

2012

1970

2013

1971

2014

1972

2015

1973

2016

1974

2017

1975

2018

1976

2019

1977

2020

1978

2021

1979

 

Claims Specialist:

Date:

Division of International Operations:

E. Procedure - Disability Insured Status Calculator (DISCO) and the Disability Wizard (DIBwiz)

The DISCO program retrieves online earnings, NUMIDENT, and Supplemental Security Record data to produce DIB insured status calculations. DISCO determines whether a claimant is insured for title II benefits. The Disability Wizard Quality Management Tool (DIBwiz QMT) helps to establish proper EODs (Established Onset Dates) and to identify prior entitlement and title II (T2) insured status. The FO may use either of these tools to assess key technical entitlement issues, such as insured status, earnings, and prior filings.

Additional information on DISCO, DIBwiz, and other tools are available on the toolbar.

When coding foreign QCs in the DISCO program use the number “8”. The number “1” is used to code US QCs only.

For each year in which there is a U.S. and or a foreign QC:

  • Display a U.S. QC as “1.”

  • Display a foreign QC as “8.”

    • Display no QC as “N.”

  • Show QCs in proper order.

Example: There are US QC’s for the year 1969 through the year 1999 and Foreign QC’s for the year 2000 through the second quarter of the year 2019.

Electronic F and C Chart

The following alerts have been added to the DISCO program to reflect the use of foreign QCs.

This alert will appear when the Modify QC pattern contains the number (8):

  • Totalization QCs involved refer to: GN 01703.100 Crediting Foreign Coverage, GN 01703.110 How To Document Insured Status Decisions GN 01701.140 Entitlement to Hospital Insurance (HI) in Totalization Claims.

This alert will appear when the Modify QC pattern contains the number (8) and MQGE is selected:

  • MQGE selected and Totalization QCs potentially involved. Totalization QCs cannot be used to establish premium-free HI refer to: GN 01701.140 Entitlement to Hospital Insurance (HI) in Totalization Claims, GN 01701.135 Totalization Benefits Payable by the United States.

This alert will appear whenever there is a totalization segment on the MBR:

  • Totalization data is present on MBR refer to: SM 00510.092 Totalization Data Line.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201703110
GN 01703.110 - How to Document Insured Status Decisions - 03/23/2022
Batch run: 03/23/2022
Rev:03/23/2022