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:
Adverse claim NON-DOFA Reason 3 on DECI;
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
Claims submitted by the FO to the Processing Center (PC) or Regional Office (RO) for a precedent decision, NON-DOFA Reason 1 on DECI.
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:
Foreign claims - send to Office of International Operations (OIO)
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.
Changed identity claims (see Sending Changed Identity Claims to the Office of Central Operations -DI 11010.270).
Claim filed by an individual residing in the U.S. possessions of the Virgin Islands or American Samoa - send to ODO or the PSC.
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.