TN 3 (02-95)
GN 01703.210 International Benefits Office (IBO) Processing Instructions for Totalization
When a claim comes into IBO, several possibilities concerning totalization may exist. It is important to determine if the beneficiary indicated work in a totalization country and if any further development is necessary.
CAs in IBO - If the RSDI application indicates work under the system of an agreement country and the totalization claim is not developed, follow this procedure when processing claims filed with SSA which involve totalization benefits.
1. RSDI application indicates work under system of an agreement country - Totalization claim not developed
If the RSDI application indicates work under the system of an agreement country and the totalization claim is not developed,
Develop and adjudicate the RSDI claim. Be sure to input the TB FAC coding.
If the NH is insured without using foreign coverage or has less than 6 QCs, route the claim to module and take no further action.
If the NH has at least 6 QCs but is not insured with U.S. QCs only, request totalization applications through the FSPs or by direct mail, as appropriate. Route the RSDI claim to the module.
Diary the development requests for return to the CA in the totalization module. Be sure to provide the claimant with the module's address; e.g., P.O. Box 17769.
2. RSDI application and SSA-2490 restricted to U.S. - Worker fully insured or less than 6 QCs
If the RSDI application and SSA-2490 are restricted to a U.S. worker fully insured or with less than 6 QC's:
Develop and adjudicate the RSDI claim. Input the proper TB FAC coding.
Route the folder to module
3. RSDI application and SSA-2490 - Worker not insured with U.S. QCs only
If the RSDI application and SSA-2490 are for a worker not insured with U.S. QCs only:
Develop and adjudicate the RSDI claim. Be sure to input the proper TB FAC coding.
NOTE: If a foreign coverage certification is included with a claim for totalization benefits and the NH has at least 6 U.S. QCs but is not insured based on U.S. coverage alone, code the CAPS disallowance notice “I.” This will prevent a disallowance notice containing paragraph MX02 from being sent.
Forward the RSDI and totalization claims to the appropriate module for action.
4. RSDI application indicates work under system of a Non-agreement country
If the RSDI application indicates work under the system of non-agreement country:
Develop and adjudicate the RSDI claim.
Send a letter to the claimant explaining that at this time the U.S. does not have a totalization agreement with the country mentioned on the RSDI application.
Forward the RSDI claim to module.
5. RSDI claim with no U.S. Totalization claim - Possible foreign claim
If the claim is an RSDI claim with no U.S. totalization claim and is a possible foreign claim:
Review the folder for an indication of work under the system of a country with which the U.S. has totalization agreement as this is a claim's lead for benefits from the foreign country.
If the file contains a statement that the claimant has already filed for, is already entitled to, or does not wish to apply for foreign benefits, forward the RSDI claim to module.
Review the folder documentation to determine the action taken by the FSP on the foreign claim.
If the claim was taken by a claims-taking post in the country in which the claimant alleges work, assume that the FSP referred the claimant to the foreign agency to file a claim.
If the claim was not filed in the country in which the claimant alleges work, forward the claim, even if fully insured, to the totalization modules when the RSDI claim is processed as a DOFA. Annotate “Foreign Claims Lead” on the routing slip.
If the claim is being processed as a non-DOFA, route the claim to modules for processing. Include a subsequent routing notice to forward the processed claim to the BET in the modules for referral of the claims lead to a foreign agency. Annotate the routing form “Possible Foreign Totalization Claim for (BIC of application),” followed by the SSN of the applicant.
6. U.S. Totalization claim - Beneficiary currently entitled
If a U.S. totalization claim is filed in which the beneficiary is currently entitled:
Do not request an earnings record or any development on the claim.
Forward the application to the appropriate module.
7. Subsequent auxiliary and survivor claims for U.S. Totalization
Route subsequent claims for U.S. auxiliary or survivor totalization benefits unadjudicated to the appropriate module.
The following are examples of some unique situations and the proper routing for each.
A claimant files “A” (retirement) and “B” (spouse's) benefits simultaneously. The “A” claim is denied and routed to the proper module for determination. The “B” claim is awarded in IBO and is routed to modules to be associated with the corresponding “A” folder. If the totalization claim is awarded and dual entitlement exists, the CA in the module will request the “B” folder from module to be associated with the “A” totalization folder.
“A” is receiving totalization benefits. She files for “D” (widow's) benefits on the record of her fully insured spouse. Route the adjudicated “D” claim to the module when dual entitlement exists.
This example is also true when the “A” totalization beneficiary is filing for “B” benefits.
A “B” claimant is receiving benefits on the record of her fully insured spouse. She now files for “A” totalization benefits. The “A” denial is routed to the proper module. The CA will request the “B” folder from module if dual entitlement exists.