TN 8 (11-03)

DI 11005.085 Prior Claims Activity

A. Policy

The field office (FO) must determine whether the individual currently filing a claim has previously filed for disability benefits administered by SSA. Document ALL prior filings with a medical determination or decision, or SGA denial on the paper Form SSA-3367–F5 (or the EDCS 3367). The DDS does not need technical denials (e.g., N13, N04, N18, 090).

NOTE: If a claimant files a new disability application and has a prior disability claim for the same title and benefit type pending at any level of administrative review, see DI 51501.001 — Procedural Change for Subsequent Disability Applications Effective July 28, 2011.

B. Procedure

1. Identifying prior claims

Ask about prior filings early in the interview. Obtain information from the following sources, as appropriate, for purposes of folder documentation per

DI 11005.085B.2.; AACT, PCACS, SSI2 or SSI3, CPMS query, or a printout of the pre-interview screen showing no prior claims activity.

2. Documenting the folder

Complete item 7 on the SSA-3367 (Disability Report-Field Office), including the following items, when not sending a prior folder to the DDS:

  1. Summary of all prior claims with a medical determination or decision, or SGA denial (i.e., the type of prior claim(s), or a statement that there was no prior claim);

  2. SSN of prior claim;

  3. Date and level of last decision;

  4. Location code of prior folder;

  5. Date FO requested the prior folder.

3. Associating medical evidence of record (MER) from prior title XVI claims folders

The FO will remove and associate the SSA-831, any other decision related material (e.g., SSA-832, SSA-833), and MER from a prior Title XVI folder when:

  1. The FO adopts a Title XVI allowance;

  2. The Title XVI folder is in the FO; and

  3. The established Title XVI disability onset date relates to the alleged Title II disability onset date.

NOTE: The FO must annotate both titles Title II and XVI query records (i.e., MBR and SSID) to show that the MER was removed from the prior Title XVI folder.

4. Requesting and associating prior claims folders

The FO will request a prior file when:

  1. A subsequent claim is filed and the prior file is located in any field office. The FO with the current claim will request the folder(s) from another FO by phone or e-mail, to be routed directly to the DDS.

  2. A court case requires the prior file (e.g. Chavez in the Ninth Circuit).

  3. The FO is not adopting a decision because there has been a significant change in the disability evaluation criteria (e.g., revised Mental Impairment Listings), per DI 27515.030A.2.

  4. A disability claim is filed on one title, disability entitlement exists on the other title, the FO cannot adopt the decision, and the claim must be sent to the DDS for possible DDS adoption or a new determination. See DI 11011.005.

  5. Evidence in file indicates fraud or similar fault may be involved in the current or prior claim(s). See DI 11006.010.

  6. Any other situation where material from a prior folder is needed, such as a special project.

NOTE: The FO will not delay sending the new claim to DDS while obtaining the prior file. The current claim should be sent to the DDS immediately; item 7 on the SSA-3367 will be completed to show that the prior file has been requested. Since PCACS for T2 and the automated recall process for T16 will send the folder to the requesting office, that FO will control the request and send the prior file to DDS when it is received.

5. How to locate a prior file

Title II

Title XVI

Obtain queries-begin with a PCACS. If NIF, then obtain a FACT, DDSQ, and CPMS query. If you still can't locate, unarchive prior MCS record and check DW01 and Remarks for clues.

NOTE: If the prior file contained T2 denial over 5 years old and PCACS is NIF; the file most likely has been destroyed.

Obtain queries-begin with a SSID. If file can't be located, obtain a DDSQ and CPMS query. If you still can't locate, unarchive the prior MSSICS record and check the DW01 and Remarks for clues.

NOTE: Location codes: L47=destroyed; L50=lost; L51=lost; J00=lost.

6. How to find address/phone number for location code

a. Folder location is a 3-digit code

If folder location is a 3-digit code, use DOORS (formerly TRIDE) online system.

b. Folder location is a 4-digit code

Use the Detailed Office/Organization Resource System (DOORS) to obtain address and phone number information.

7. How to request a prior file

IF

THEN

AND

AND

Title II file is reading in ODIO or PSC.

Request file via PCACS Folder Request (MSOM PCACS 009.011).

System generates an automatic follow-up after 14 days.

If no movement after 30 days, phone the MOD in ODIO or PSC.

Title XVI file is reading in L00.

Request file via 8028, AR33 (SM 01201.210).

 

If no folder is received after 60 days, see SM 01201.235.

Title XVI file is reading in L86, L88, L89, L94, L95, L96, L97, L98, L99, L01, etc.

Request file via 8028, AR33

(SM 01201.210).

 

If no folder is received after 60 days, see SM 01201.235.

Title II or Title XVI file is reading in a FO.

Request via phone, fax, or E-mail.

If no reply in 7 days, make a 2nd request.

If no reply in 14 days, make a 3rd request to the FO manager.

Title II or Title XVI file is reading in Docket & Files (5012), SSA National Records Center (N88 or N93) or Appeals Council (5801-5824).

DO NOT

REQUEST

PRIOR FOLDER

NOTE: When contacting a field office to search for a file, request a search using the current name. Reference all prior names used, since the file may be stored under a different name.

Document your request efforts and keep all responses (positive or negative) that you received while trying to obtain the prior folder. No response is the same as a negative response.

If your search is unsuccessful, document the file with a list of all locations you have searched, responses from these locations, and a summary of your efforts on a Report of Contact (SSA-5002).

C. References

Prior pending court cases, see GN 03106.025

Continuing Disability Review Folders, see DI 13015.030 - DI 13015.080


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0411005085
DI 11005.085 - Prior Claims Activity - 05/01/2017
Batch run: 05/01/2017
Rev:05/01/2017