TN 57 (07-16)

DI 11010.035 Avoiding Unnecessary Development in Disability Insurance Benefits (DIB) Claims

A. Development guidelines

This policy applies to all interviewers who conduct Title II Disability Insurance Benefit (DIB) or concurrent Title II/XVI disability claims interviews.

Most disability claims can be processed using Earnings Computation (EC) in the Modernized Claim System (MCS), which does not require separate inputs for an earnings record. See DI 11010.010 Modernized Claim System (MCS) and Earnings Computation (EC). The Informational Certified Earnings Record System (ICERS) is used when a certified earnings record is not available using EC.

B. Insured status questionable

When an MCS abbreviated application (ABAP) or skeleton SSA-16 (Application for Disability Insurance Benefits) is taken, review the EC screens. See GN 00204.009 Abbreviated Applications--Title II. When determining disability insured status, consider railroad compensation quarters and military service quarters as well as the various types of disability insured status.

NOTE: ABAP applications have no provision to add lag earnings. The EARN screen is not a part of the ABAP application screens path. If lag earnings are involved, obtain an ICERS or Disability Insured Status Calculator Online (DISCO) to determine insured status since EC does not have lag data and change the ABAP application to a full disability application.

Appropriate action is necessary in accordance with the following:

1. Earnings Record (E/R) Received-Insured Status Met

If the earnings computation screens show that the claimant meets the disability insured status test for U.S. coverage either at the alleged onset date (AOD) or in a possible earlier onset date, change the ABAP to a full disability application and forward the claim to the:

  1. Disability Determination Services (DDS), or

  2. Disability Processing Branch (DPB) of the Program Service Center (PSC) for SSA jurisdiction claims, or

  3. Great Lakes Program Service Center- Disability Processing Branch (GLPSC-DPB) for Railroad Retirement Board (RRB) medical jurisdiction claims.

For prior year self-employment income (SEI) see RS 01804.100 Establishing Lag SEI. For current year SEI see RS 01804.110 Establishing Current Year SEI.

2. E/R Received-Insured Status Not Met

If the quarters of coverage, (QC) information on the E/R or DISCO shows that DIB insured status is not met for U.S. coverage, or that the onset of disability occurred after the number holder (NH) last met insured status, do not undertake any further non-medical development. Document the file according to DI 11005.001 Field Office Disability Interviews; provide explanations as to why gaps in work are not related to the impairment. Complete and document non-medical development on any earnings or coverage issue, which must be resolved, even though the claim is denied. This policy also applies in concurrent Retirement Insurance Benefits/Disability Insurance Benefits (RIB/DIB) claims.

3. Earnings record received—combined coverage

If the NH has at least six QCs, but does not meet insured status under U.S. coverage alone and has reported foreign earnings from a country in which the U.S. has entered into an international Totalization Agreement, consider combined coverage to meet insured status. If entitlement to a Totalization benefit, or an earlier month of entitlement is possible forward the claim to:

Social Security Administration
Office of International Operations
Totalization
PO Box 17049
Baltimore, MD 21235-7049

Print “Totalization Claim” on the route slip. See GN 01702.410 - Routing of Claims for U.S. Totalization Disability Benefits.


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http://policy.ssa.gov/poms.nsf/lnx/0411010035
DI 11010.035 - Avoiding Unnecessary Development in Disability Insurance Benefits