TN 2 (09-85)

GN 01704.835 Claims and Claims Leads

A. General (Except Belgium—See C. below—and Ottawa/Quebec—See D. below)

When foreign agencies forward totalization applications to OIO, BETs can readily determine if a valid claim exists. However, when foreign agencies (except Canadian agencies) request assistance for claims filed under the agreement, it is more difficult to determine whether or not a claim or claims lead exists.

Specific arrangements have been made with most foreign agencies to ensure that applications are taken from claimants for U.S. benefits and sent to OIO, or the claimants are referred to a U.S. FSP. Therefore, develop claims or claims leads based on the receipt of a request for assistance from a foreign agency (except a Belgian agency) only if:

  1. The claimant resides in the U.S. or a third country; or

  2. The claimant resides in any country and the NH has at least six U.S. QCs and either:

    1. The claimant is a survivor; or

    2. The NH is within 3 months of age 65 or older.

If either of these qualifications exist, follow the chart below to determine the correct action(s).

NOTE: Do not consider requests from INPS for medical evidence as potential claims leads because the requirements for Italian disability differ significantly from U.S. requirements.

 

RSDI
Beneficiary
Date Claim Filed Provided by
Foreign Agency*
Liaison Clerk Action Required
NOA.Prior to the effective date of the agreement or none provided.1.
 
2.
Take claims lead action.
 
Comply with foreign agency request.
     
 B.On or after the effective date of the agreement. Route folder to CA. If foreign agency has requested an ER, route to CA after ER is received. In addition, if foreign agency has requested a medical exam, route folder to FDE to initiate exam before routing to CA. DO NOT initiate any other development.
     
YES
(On Any SSN)
A.Prior to the effective date of the agreement or none provided.1.
 
2.
Take no claim or claims lead action.
 
Comply with foreign agency request.
     
 B.On or after the effective date of the agreement.1.
 
2.
Comply with foreign agency request.
 
Ascertain what DCF has been established for U.S. benefits.
    a. If earlier than DCF provided by foreign agency, take no claim or claims lead action.
    b. If later than DCF provided by foreign agency, route folder to CA.

*Assume the DCF is on or after 12/79 if the statement in Part III of the 12/83 revision of form D/USA 3 is checked.

B. Processing claims leads (except under Belgian agreement)

If a claims lead exists:

  1. Obtain an MBR and a case control read to be sure that development is not already in progress; and

  2. If the individual lives in a country with a claims-taking post, ask the FSP to take claims lead action; or

  3. If the individual lives in the U.S. or Canada, send claims lead letter; or

  4. If the individual lives in a country without a claims-taking post, except Canada, ask IBO to take claims lead actions; or

  5. If you are not sure which office to contact, request assistance from a CA or CATA.

C. Claims and claims leads based on form BE/USA 3 received from Belgian agencies

The Belgian agencies will not use a separate application form for claims filed under the agreement. They will obtain their national application which indicates any coverage in another country. If a claimant indicates work in the United States and is not already a U.S. beneficiary, the Belgian application is also a claim for U.S. benefits. Belgium will advise OIO that a claim has been filed by forwarding the liaison Form BE/USA 3. Since Belgium also will use the Form BE/USA 3 to request information from the United States, BETs must determine if the form indicates that a U.S. claim has been filed. The following chart provides guidelines for handling Form BE/USA 3.

 

RSDI
Beneficiary*
Date Claim Filed Provided by
Belgian Agency
Liaison Clerk Action Required
NOA.Prior to the effective date of the agreement or none provided.1.If the Belgian agency requested information, comply with the request.
   2.If claimant appears eligible for RSDI benefits send appropriate claims lead letter to U.S. resident or route the case to IBO for Belgian resident (see B. above).
     
 B.On or after the effective date of the agreement.1.If the Belgian agency requested information, comply with the request.
   2.Route the case to IBO for development of a claim from a resident of another country.
    NOTE: If the Belgian agency has requested a U.S. E/R, do not forward the folder to IBO or CA until the E/R is received.
     
YESA.Prior to the effective date of the agreement or none provided. If the Belgian agency requested information, comply with the request. If no information was requested, annotate form “NAN” .
     
 B.On or after the effective date of the agreement.1.If the Belgian agency requested information, comply with the request.
   2.Determine DCF for U.S. benefits (from MBR).
    a. If earlier than that supplied by foreign agency, handle as in “YES A.” above.
    b. If later than DCF supplied by foreign agency, route folder to CA.

*An RSDI beneficiary for this purpose is an individual who is entitled to benefits on the same SSN on which a totalization claim has been filed.

D. Ottawa and Quebec

A request from Ottawa or Quebec is NEVER a claims lead. Comply with the request and take no action to determine whether a claims lead exists—none does.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201704835
GN 01704.835 - Claims and Claims Leads - 08/26/2014
Batch run: 08/26/2014
Rev:08/26/2014