TN 49 (08-08)

DI 11010.300 Routing Concurrent Disability Insurance Benefits –Retirement and Survivor Insurance (DIB-RSI) Claims

A. Background

Modernized Claim System Earnings Computation (MCS/ EC) processes concurrent Retirement Insurance Benefits/Disability Insurance Benefits (RIB/DIB) claims when a disability claim is a denial and there is an active Master Beneficiary Record (MBR) for “A” Beneficiary Identification Code (BIC). MCS/ EC processes a DIB allowance over a Retirement Insurance Benefit (RIB) allowance as long as the DIB Month of Entitlement (MOE) is the same or prior to the RIB MOE. The MCS claim creates segments allowing the Claims Representative (CR) to process both claims completely.

In concurrent RIB/DIB claims where the DIB MOE is later than the RIB MOE:

  • Process the RIB claim through EC and the disability claim segments.

  • After the RIB and DIB claims have segmented, process the RIB only.

  • Go back to the DW01 (on the RIB segment) and “XXXXXX” out any issues pertaining to the DIB claim only.

  • Process the disability award using the Automated Determination of Award (A101); and if an exclusion exists, process an EF101.

B. Procedure – routing the DIB claim to Disability Determination Services (DDS) for a Disability determination

Use the following procedure:

  • Forward the DIB claim to the appropriate DDS unless it is excluded from electronic processing. See Certified Electronic Folder (CEF) Exclusions and Limitations DI 81010.030. For DIB claims entered into Electronic Disability Collect System (EDCS) see Creating Electronic Disability Collect System (EDCS) Cases DI 81010.020 and Transferring Cases in Electronic Disability Collect System (EDCS) DI 81010.085.

  • Do not delay sending the DIB claim to the DDS for the RSI claim development.

  • Document the official folder with any material pertinent to the DIB claim.

  • Complete development of the RSI claim, adjudicate, and route to the Processing Center (PC) if there is an action to be taken. Due to signature proxy, frequently there is no material to be routed to PC for the RSI claim.

  • Use the electronic cover sheet produced by MCS if there are paper materials to be forwarded to PC for retention.

C. Procedure – non-DDS cases requiring PC/DPB determination

If a claim is an exception to DDS jurisdiction, it is normally the Disability Processing Branch (DPB) jurisdiction in a DIB/Retirement Insurance Benefit (RIB), widow’s, or parent's insurance benefits case because the primary number holder (NH) is age 54 or older. To determine if the case is other than DPB jurisdiction, see Cases to be Processed By DPB - SSI Emergency Clause Case DI 11055.110, and send the claim to the component that has jurisdiction. For claims entered into EDCS see Creating Electronic Disability Collect System (EDCS) Cases DI 81010.020. Route the claim to the appropriate PC/DPB. Transfer any claims entered into EDCS. See Transferring Cases in Electronic Disability Collect System (EDCS) DI 81010.085.

1. Claimant insured for DIB; eligible for RIB, Widow’s, or Parent's insurance benefits

When development is complete, assemble the official folder according to General Overview of the MDF DI 70005.005 (paper folder) Transfer the MCS disability claim to the appropriate PSC/DPB.

When the RIB, aged widow(er), or parent's claim is completely developed:

  • Adjudicate the Retirement and Survivors Insurance (RSI) claim;

  • Assemble the RSI claim material; and

  • If paper documents exist, forward the entire RSI file to the PSC with the electronic cover sheet prepared by MCS. If there is no action by the PC send the paper folder/material to National Record Center (NRC).

When the DIB-RSI claims are ready for transfer to the PSC/DPB at the same time:

  • Adjudicate the RSI claim completely;

  • Wait one day and then transfer the remaining MCS DIB claim to the appropriate PSC/DPB;

  • Assemble the official DIB folder/file under regular procedures.

  • If there is an electronic folder and a prior paper folder, route the electronic folder using the electronic procedure, see Transferring Cases in Electronic Disability Collect System (EDCS) DI 81010.085, and forward the paper folder to the correct PSC/DPB using a SSA-408 (Route Slip);

  • For official paper folders where signature proxy does not apply, staple the RSI claim on the front cover of the DIB folder and annotate the MCS cover sheet of the need for a disability determination on the attached non-DDS jurisdiction claim.

  • When transmitting a prior RSI claims folder, if signature proxy does not apply, place the current RSI claim, in the prior paper RSI folder, staple the back cover of the DIB folder to the front cover of the RSI folder and forward both to the PC/DPB.

  • When signature proxy does not apply place a copy of the MCS cover sheet on the front of the DIB file and annotate the cover sheet to state that a non-DDS jurisdiction decision is needed on the disability claim.

2. Claimant insured for DIB - not eligible for RIB

When a claimant is insured for DIB but not eligible for RIB:

  • When the RIB claim is completely developed, adjudicate the RIB denial.

  • When the DIB development is complete, forward the DIB file to the PSC/DPB.

  • When the official DIB folder is paper and DIB-RIB files are ready for transmittal at the same time, staple the RIB claim with the MCS cover sheet, to the front cover of the entire DIB folder and forward both to the PC/DPB. Annotate the cover sheet stating the need for a Non-DDS decision.

  • For claims entered into EDCS see Creating Electronic Disability Collect System (EDCS) Cases DI 81010.020 and route the claim to the appropriate PC/DPB.

  • Transfer any claims entered into EDCS, see Transferring Cases in Electronic Disability Collect System (EDCS) DI 81010.085.

D. Procedure - PC and DDS or DPB determination required

1. DIB- freeze claimant also files for Wife's, Mother's, or unreduced RIB

Use the following procedure:

  • FO prepares an award or disallowance of the claim, as appropriate, when the FO finds that a DIB claimant is eligible or ineligible for spouse's or mother's/father's benefits.

  • Forward the completed claim with any pertinent material on the same SSN to the PSC or Office of Disability Operations (Determining Processing Center Jurisdiction GN 01050.055).

  • Forward the DIB file to the DDS per DI 11010.300B (in this section) or to the DPB as per DI 11010.300C (in this section).

  • For claims entered into Electronic Disability Collect System (EDCS), see Creating Electronic Disability Collect System (EDCS) Cases DI 81010.020 route the claim to the appropriate PC/DPB. Transfer any claims entered into EDCS per Transferring Cases in Electronic Disability Collect System (EDCS) DI 81010.085.

  • Document the official folder by completing a Report of Contact (RC). For claims entered into EDCS, see eForms DI 81010.115.

  • Transfer the RIB file to the PSC via MCS when a disabled claimant, who is at least full retirement age (FRA), but not more than 12 months past FRA, applies for a period of disability and RIB. Annotate the cover sheet to say "RIB-Freeze.”

2. DIB claimant not eligible for Widow’s or Parent's insurance benefits

Use the following procedure:

  • Forward the completed RSI file to the PSC. (If claim was proxy signature there may not be any material to send to the PC.)

  • Forward the DIB file. For claims entered into EDCS see Transferring Cases in Electronic Disability Collect System (EDCS) DI 81010.085.

  • Complete a RC to document that the claimant is not eligible for Widow’s or Parent's Insurance Benefits For claims that have been entered into EDCS see eForms DI 81010.115.

  • Send the documentation with the claim to the DDS or the DPB, as appropriate, per DI 11010.300B and DI 11010.300C. (in this section). See the routing guide in Claims Routing Guide GN 01050.075.

E. Procedure - DIB-RIB claimant lacks DIB insured status - either eligible or ineligible for RIB

Use the following procedure:

  • If the claimant lacks DIB insured status at alleged onset date (AOD) or after the period adjudicated by the last prior determination or decision of denial, and is either eligible or ineligible for RSI benefits, deny the DIB claim in accordance with Title II Technical Denials, and Claims not Requiring a Disability Determination DI 11010.075. For technical denials other than SGA denials, it is not necessary to access EDCS if it is known that the claim is denied before the EDCS case is created. See Processing Field Office (FO) Determinations DI 81010.140.

  • If the claimant indicates he/she does not intend to appeal the DIB claim and, if the official folder is paper send it to the PC with the RIB.

  • If the claimant files an appeal on the disability claim, forward the RIB claim to the PSC.

  • If the claimant has not expressed his/her intention with regard to the DIB claim, where the official folder is paper, retain it in the FO.

  • If the claimant is deceased, do not process a DIB denial. Forward both claims to the PSC.

F. Procedure - DIB-RSI claimant ineligible for RSI but possibly eligible for DIB

If the claims are on the same earnings record and the DIB is not a DDS jurisdiction case, keep the claims together throughout the processing when the official folder is paper. If the claims are on different earnings records, annotate the cover sheet accordingly on the RSI claim and forward to the PC.


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http://policy.ssa.gov/poms.nsf/lnx/0411010300
DI 11010.300 - Routing Concurrent Disability Insurance Benefits -Retirement and Survivor Insurance (DIB-RSI) Claims - 12/11/2014
Batch run: 12/11/2014
Rev:12/11/2014