TN 3 (02-95)

GN 01703.245 Adjudicating Claims for U.S. Totalization Benefits After Foreign Coverage Record is Received

A. Introduction

After the foreign coverage record is received, the CS determines if the NH is insured based on combined U.S. and foreign coverage. See the specific agreement subchapter for rules on crediting foreign coverage.

B. Procedure

Follow the steps below once the insured status decision is made.

1. Totalization insured status is met

Proceed as follows if totalization insured status is met.

a. Development

Develop for any evidence still missing.

If the claim is for disability benefits, send the medical jacket to IDU for a disability determination. Be sure to show the date insured status is last met on the SSA-559 (Claims Folder Material Transmittal).

b. Award

If all other factors of entitlement are met, prepare a totalization award using the guidelines in MS MCS 014.001. Designate the appropriate paragraphs (See NL 00711.305).

Send the file to a BA for processing through MADCAP.

c. Denial

See GN 01703.310 if you must deny the claim for a reason other than lack of insured status; e.g., not disabled, relationship not established, etc.

d. Notification of foreign agency

If required by the individual country, send the file to the BET to prepare a final package informing the foreign agency of our decision. (See individual DIO agreement subchapters to determine if a final package is required.)

2. Totalization insured status not met

If totalization insured status is not met:

  1. Deny the claim using the guidelines in GN 01703.310.

  2. If required by the individual country, send the file to the BET to prepare a final package informing the foreign agency of our decision. (See individual DIO agreement subchapters to determine if a final package is required.)


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201703245
GN 01703.245 - Adjudicating Claims for U.S. Totalization Benefits After Foreign Coverage Record is Received - 01/27/2017
Batch run: 01/27/2017
Rev:01/27/2017