TN 3 (02-95)
GN 01703.420 Processing Misrouted Claims in the Totalization Modules
GN 01702.310 and GN 01702.320 provides routing instructions for claims for U.S. totalization benefits filed by persons who are either insured based on U.S. coverage only or who have less than 6 U.S. QCs. These claims are rightfully the jurisdiction of a PSC, ODO, or modules 1 - 5 and not the totalization modules. The following procedure covers situations in which these types of claims are routed to the totalization modules in error.
B. Procedure - all cases
Claims Authorizer - Always take the following steps:
If there is a pending foreign agency assistance request with the U.S. claim or a claim for foreign benefits, retain that request/claim and any related material in a totalization folder.
Route the totalization folder to the LC to obtain the information requested by the foreign agency or prepare a claims package. (Return the totalization folder to files if the LC has already taken all necessary actions.)
If there is no pending foreign agency assistance request or claim for foreign benefits, instruct the RAC to delete the "TF" case control record and destroy the totalization folder.
Place the totalization application and any material related to that claim received from the foreign agency on the right side of the RSI folder.
Complete, sign, and reverse file a folder documentation notice (see Exhibit GN 01703.270.E) on the right side of the RSI or DIB folder.
C. Procedure - misrouted claim for U.S. benefits
CA -Handle a misrouted claim for U.S. benefits as follows:
1. RSI claim - Worker insured based only on U.S. coverage
If the rerouted claim is a retirement or survivor claim, and the worker is insured based only on U.S. coverage only, and
it is detected in screening - route the claim to module 1 - 5 or the servicing PSC, as appropriate
it is not detected in screening - process the RSI award and include the appropriate totalization denial paragraph. Transfer the RSI folder to module 1 - 5 or the servicing PSC, as appropriate
2. RSDI claim - Worker has less than six QCs
If the misrouted claim is a retirement, survivor, or disability claim, for which the worker has less than six QCs, and it is detected in screening or later transfer the RSDI folder to module 1 - 5 or the servicing PSC, as appropriate
3. Disability claim - Worker meets status based on U.S. coverage only
If the misrouted claims is a disability claim in which the worker meets disability insured status based on U.S. coverage only and:
at least one claimant has a foreign address, send the folder to CDB or module 1 - 5 for review and processing
no claimant has a foregin address, return the folder to the FO for proper routing if a disability determination has not been made. Send it to ODO or the PSC if a disability determination has been made.