TN 1 (05-89)

GN 04447.005 The Quality Assurance Review Process for Railroad Disability Determinations

A. Introduction

The QA review process begins after the DRS has made a disability determination on a railroad claim andafter the DRS has coordinated with or informed the Railroad Retirement Board (RRB) of the determination.

B. Operating Policy

The DRS selects sample claims and sends them to the Chicago DQB for QA review before effectuating the determination or releasing the notices. After the review is completed, the DQB must return all claims to the DRS.

C. Procedure

1. NONDEFIENCT CLAIMS

  1. Effectuatethe determination.

  2. Releasethe notices.

2. DEFICIENT CLAIMS

  1. Correct the deficiency(ies), and send the claim back to the DQB for review and recording of the results of the corrective action.

  2. Effectuatethe determination after the DQB completes the review and returns the corrected claim to the DRS.

3. OBTAINING ADDITIONAL DOCUMENTATION

You may need to obtain additional documentation through the field office (FO),State disability determination services (DDS)or RRB to correct deficient railroad disability determinations. If the determination is changed, inform or coordinate the change with the RRB.

4. REBUTTALS

If you believe the DQB has incorrectly cited a deficiency, you may rebut the finding. The DQB will either rescind or affirm the deficiency on rebutted claims. You may rebut a second time through the Office of Central Processing (OCP)to the Office of Program and Integrity Reviews (OPIR) , if you disagree with the DQB's action.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0204447005
GN 04447.005 - The Quality Assurance Review Process for Railroad Disability Determinations - 12/22/1989
Batch run: 01/27/2009
Rev:12/22/1989