TN 1 (04-89)

GN 04442.010 Quality Assurance Review of Railroad Disability Claims Flow

A. Operating Policy - General

The DRS selects sample claims and sends them to the DQB for quality review.

B. Operating Policy - Claims Selection

Claims are selected for review:

1. ACTIONS PRIOR TO SELECTION

  1. The regional medical consultant and the DRS examiner sign the determination, and

  2. SSA informs or coordinates its determination with RRB.

2. ACTIONS AFTER SELECTION

  1. The determination is not effectuated, and

  2. Claimants and beneficiaries are not notified.

C. Procedure - After Reviewing Claim

1. CLAIM IS CORRECT

Return claim to the DRS to effectuate.

2. CLAIM IS DEFICIENT

Return claim to the DRS to correct.

D. Description - DRS Action on Claim Returned from DQB

1. CLAIM IS CORRECT

The determination is effectuated.

2. CLAIM IS DEFICIENT

The deficiency is corrected and the claim returned to the DQB.

3. DEFICIENCY IS REBUTTED

The claim is returned to the DQB.

E. Procedure - Claim Returned from DRS

1. CORRECTED CLAIM

  • Accept corrective action and return to the DRS to effectuate and release the notices; or

  • Decide whether further corrective action is needed and return to the DRS.

2. REBUTTAL CLAIM

Either rescind or affirm the deficiencies and return to the DRS for appropriate action.

F. Operating Policy - Policy Issues

1. REFERRAL OF CLAIMS

Either the DRS or DQB can refer claims involving policy issues to the Office of Disability (OD) for clarification. See GN 04442.705.B.

2. CLARIFICATIONS

OD's policy clarification determines what subsequent actions, i.e., rescinds, reversals, etc., are taken on the claim.

G. Procedure - Final Claim Disposition

1. RESULTS FORM

Prepare a results formin deficient claims to record the final disposition after corrective action(s) or rebuttals are complete.

2. RETURNING CLAIMS

Return nondeficient and corrected claims to the DRS for effectuation and release of notices.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0204442010
GN 04442.010 - Quality Assurance Review of Railroad Disability Claims Flow - 11/08/1996
Batch run: 01/27/2009
Rev:11/08/1996