TN 3 (02-95)
GN 01703.120 How to Process Amended Foreign Coverage Records
Occasionally DIO receives an amended foreign coverage record, which periods of coverage that are different from the coverage shown on an earlier record. This is not a record showing additional recent coverage. Rather it is a record, which shows additional or deleted coverage which would cause the initial determination to change.
Action is taken on the amended coverage record only if the totalization claim is still pending or if the totalization claim has been adjudicated and both of the following conditions are met:
The additional or deleted foreign coverage would change SSA's earlier determination of insured status or month of entitlement (MOEN), and
The rules of administrative finality permit reopening the initial decision. See GN 04001.010, GN 04010.001, GN 04020.070, and GN 04020.090 for further discussion of administrative finality.
Use the following procedure for an amended foreign coverage record.
Ensure that the amended foreign coverage record is for the same person with the same SSN as the earlier record.
Return the record to the foreign agency citing the difference if the record is for a different worker.
Determine if you have an explanation of why the foreign agency added or deleted coverage. (Possibly LAG Earnings were added)
If there is no explanation, return the record to the foreign agency and request an explanation. Adjudicate the claim using the earlier record if still pending.
If there is an explanation and the totalization claim is still pending, adjudicate the claim using the amended coverage record.
If there is an explanation and the totalization claim has been adjudicated, determine if the amended record will affect insured status or the month of entitlement.
If not, no further action is necessary. Place a disposition note on the coverage record to document your decision.
If the amended record will affect insured status, or the month of entitlement, determine if the rules of administrative finality permit reopening.
If yes , go to the next bulleted step.
If no, route the case to DTPS.
Determine if the totalization claim was previously denied.
If yes, award benefits from the earliest MOE if all other factors of entitlement are met.
If no, go to the next bulleted step.
Determine if the claim was previously awarded.
Instruct the BTE to terminate entitlement beginning with the initial MOE if insured status no longer exists after foreign coverage is deleted. Provide the BA with the proper language to include in the termination letter. Follow normal procedure to recover any overpayment.
If previous decision was a denial and the NH is still not insured based on the amended record, send a notice informing the NH that he still does not meet insured status.