TN 49 (08-08)
DI 11010.260 Sending New Disability Insurance Benefits (DIB) or Freeze Claims to the Disability Determination Services (DDS) after a Previous Medical Denial or Cessation
A. Policy for sending new DIB/freeze claims to DDS
Send a new claim to the State Disability Determination Services when the disabled individual files a new claim after a previous medical denial or cessation, and he/she meet the earnings requirement (DIB or freeze) after the period adjudicated by the previous determination. Request the prior disability file. If it is located in another Field Office (FO), document the SSA-3367 (Disability Report-Field Office) alerting the DDS of the folder request (Prior Claims Activity - DI 11005.085). For claims entered into Electronic Disability Collect System (EDCS) EDCS, see Creating Electronic Disability Collect System (EDCS) Cases - DI 81010.020 and Paper Folder Indicators (PFIs) - DI 81001.020A.2.
B. Procedure - new claims situations – effective 01/06/86
Send any new disability claim in the categories listed below to the DDS. Include an explanation of the reason for the transmittal in the remarks section of the SSA-3367.
1. Prior denial for lack of medical evidence
A prior application was denied because the claimant did not submit medical evidence, and the claimant now indicates that he/she wants to submit medical evidence.
2. Prior withdrawal
There was a withdrawal of a prior application.
3. Reconsideration request
When the claimant files a timely request for reconsideration of a prior approved DDS determination (stating disagreement with a DDS date of onset determination), concurrently with a subsequent application, send the case to DDS. See Certified Electronic Folder (CEF) Exclusions and Limitations (DI 81010.030A.7.). Appeals of less than fully favorable decisions are EDCS exclusions and an official paper file is created.
4. Special insured status
When a prior application was denied because the claimant did not meet the regular insured status requirement, and he/she alleges onset of disability before age 31, and he/she meets the special insured status requirement for the younger worker, the case is sent to DDS. See Special Insured Status for Disability Before Age 31 - RS 00301.140. For CEFs see Certified Electronic Folder (CEF) Exclusions and Limitations - DI 81010.030A.7. and Processing Field Office (FO) Technical Reactivations - DI 81010.110 for instructions on processing reconsiderations of prior technical denials for CEF cases.
5. Administrative finality involved
When a new application is filed after the date of notice of the initial determination and the claimant submits new and material evidence of disability or indicates that such evidence is available, send the case to DDS. For CEF cases see Certified Electronic Folder (CEF) Exclusions (DI 81010.030).
6. Appeal pending at Appeals Council
See New Claim or Appeal Filed While a Prior Claim or Appeal is Pending Before the Appeals Council (AC) — Title II or Title XVI - DI 12045.027. For CEF cases, see Certified Electronic Folder (CEF) Exclusions -DI 81010.030C.
C. Procedure - new claims situations – prior to 01/06/86
Although these types of new claims are rare, this information is included for historical purposes and for the few cases meeting this criteria including Special Disability Workload (SDW) and SDW look alike cases.
1. Prior filing 08/02/62 – 12/01/64
Do not send the case to DDS when a prior application was denied because the claimant did not meet disability insured status within 18 months before filing, and he/she filed the prior application after 07/02/62 and before 12/01/64.
2. Denial on or before 07/30/65
Do not send the case to DDS when a prior application was denied at the initial determination level or at any level of appeal, such as reconsideration or hearing, on or before 07/30/65 (date of enactment of the 1965 amendments containing the new definition of disability).
3. Prior Title II medical denial before 01/06/86
Denial of a prior application before 01/06/86, because the claimant was not disabled through the date he/she last met the insured status requirement for entitlement, requires a DDS determination. A DDS determination is required because of changes in the law due to the 1984 disability amendments. This is true regardless of the level of the prior denial. (If the prior claim was denied on or after 01/06/86, see Title II Technical Denials and Claims not Requiring a Disability Determination - DI 11010.075C. and New Disability Insurance Benefits (DIB) Claim after Prior Administrative Law Judge (ALJ), or Appeals Council (AC) Denial - Insured Status Expired within Period Adjudicated by Prior Decision - Medical Evidence Submitted - DI 11010.080.)
When the new claim falls in this category, the FO takes the following actions:
Obtain the prior Title II claims folder and forward it with the new claim to the DDS.
If the prior folder cannot be located, DO NOT RECONSTRUCT. In this instance, the DDS prepares a substantive determination on the new claim. See DI 11010.205G.15. for appropriate remarks.
The FO documents the Title II claims folder to show any SSI involvement. This documentation includes the location of the Title XVI folder and the date of any SSI eligibility based on a period of disability.