BASIC (10-93)

GN 01724.005 How the Totalization Modules Review and Complete Claims Taken by a Field Office (FO) or International Benefit Office-IBO

A. Introduction

An explanation of how the FO processes claims for benefits under the agreement is given in GN 01702.100 and GN 01723.215.

B. Procedure

Follow these steps for reviewing claims in a totalization module.

 

StepAction
1Have applications listed in GN 01702.120 and GN 01723.215.B been completed?
 
  • If yes, go to Step 2.

  • If no, request FO to obtain missing applications.

2

Is a work history statement in file?

  • If yes, prepare a photocopy for the file. Go to Step 3.

  • If no, does the file show that the worker is a French beneficiary?

  • If yes, go to Step 3.

  • If no, and the claimant is filing for benefits from the U.S., telephone the applicant if the number is available, or send a letter explaining why this information is important. Document the file with the response.

REMINDER: When asking about the work history, impress upon the applicant the fact that without at least information about the last place of employment and the type of job, France may not be able to locate a copy of their French coverage record. Even if they cannot remember the precise name and mailing address of their last French employer, they should be able to recall the town they worked in and the type of work they did.

3

Is a U.S. totalization earnings record in file which shows earnings through:

  • the quarter of death in survivor claims;

  • the quarter of disability in disability claims; OR

  • the quarter of retirement in retirement claims?

    1. If yes, go to Step 4.

    2. If no, request a U.S. totalization earnings record. Develop lag earnings, if necessary.
       
      If the claimant is still working (employed or self-employed), develop earnings through the last year the claimant has filed a tax return. Inform France that the claimant is still working and the current earnings information will not be available until the middle of the next calendar year. Do not diary for later contact.

4.

Is claim for disability benefits from France?

  1. If yes, did the claimant submit medical evidence OR is medical evidence of record available in DIO?

    • If yes, include copies of medical evidence in the claims package.

    • If no, send a Medical Report Form (SE 404-4) to the claimant.

      Ask the claimant to have the doctor complete the form.

      Include a pre-addressed return envelope with your request, and

      hold the claims package pending receipt of the form.

  2. If no,

    • prepare a claims package for France.

      NOTE: France has agreed to contact the claimant directly to secure the French national application and any other necessary documentation.

    • send a letter to the claimant informing him/her that the claim was sent to France and that questions about the claim should be directed to the French agency shown in the letter.

C. Exhibit - Medical report form SE 404-04

 

 

G-SE-404-04-1

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G-SE-404-04-2