TN 49 (08-08)

DI 11010.295 Excepting Disability Insurance Benefits (DIB), Disabled Widow(er) Benefits (DWB), Freeze and Medicare Qualified Government Employee (MQGE) Claims from Field Office (FO) Authorization

Procedure for excepting DIB/DWB/freeze/MQGE claims

Except the following types of DIB, Freeze and MQGE claims from final authorization in the FO:

NOTE: (See Exclusions from District Office Final Authorization (DOFA) - GN 01010.027 and Decision Input (DECI) – MSOM MCS 009.013:

  1. Adverse claim NON-DOFA Reason 3 on DECI;

  2. Current award where there is a prior claim with an appeal pending. 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 claims that can be fully adjudicated by the FO while an appeal is pending at the Appeals Council; and

  3. Claims submitted by the FO to the Processing Center (PC) or Regional Office (RO) for a precedent decision, NON-DOFA Reason 1 on DECI.

  4. The following cases, for which SSA has jurisdiction for disability determination, are identified by Non-DOFA Reason 2 on DECI. SSA has jurisdiction for disability determination:

    1. Foreign claims - send to Office of International Operations (OIO)

    2. Emergency Clause Cases -- see Transferring Emergency Clause Cases by Disability Determination Services (DDS) to Office of Disability Operations/Flexible Disability Unit (ODO/FDU) or Program Service Center/Disability Processing Branch (PSC/DPB) - DI 11010.290.

    3. Changed identity claims (see Sending Changed Identity Claims to the Office of Central Operations -DI 11010.270).

    4. Claim filed by an individual residing in the U.S. possessions of the Virgin Islands or American Samoa - send to ODO or the PSC.

    5. Subsequent claim filed after a prior Administrative Law Judge (ALJ) or Appeals Council (AC) decision (made before 01/06/1986), or court decision (made on or after 01/06/86), that the claimant was not disabled and that insured status requirements expired within the period adjudicated by the prior determination and- claimant submits medical evidence -- see Subsequent 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.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0411010295
DI 11010.295 - Excepting Disability Insurance Benefits (DIB), Disabled Widow(er) Benefits (DWB), Freeze and Medicare Qualified Government Employee (MQGE) Claims from Field Office (FO) Authorization - 09/13/2011
Batch run: 09/13/2011
Rev:09/13/2011