TN 59 (07-99)

DI 11011.015 FO Adjudication of Adopted Claims

A. Procedure — fully favorable claims

Follow the steps below for fully favorable claims.

1. Get the following queries

  • MBR

  • SSID

  • DDSQ

  • QMID

    NOTE: The CDR Query Medical Information (QMID) Screen is in the Disability Control File (DCF) and contains information relating to medical determinations made and the medical re-exam diary date. See DI 13010.660 and MSOM Chapter 185-W.

2. Prepare forms

  • SSA-831-U3. For electronic cases, use the Electronic Disability Collect System (EDCS) to complete the SSA-831 and store in the electronic folder.

  • Award Forms SSA-101-U3/SSA-3687-U2, as appropriate.

  • Indicate the appropriate notice and/or paragraphs.

  • Process the claim as a DOFA unless a DOFA exclusion applies. See GN 01010.008 and GN 01010.027.

  • If the claim is a DOFA exclusion, prepare the SSA-101-U3 and forward it to the appropriate PSC for processing to payment status and filing.

  • If the claim is not a DOFA exclusion, but additional notice language is needed from the PSC, process the claim to pay status, and forward to the appropriate PSC to complete and release the notice and place the claim in files.

IMPORTANT: Prepare the appropriate diary according to DI 11011.005C., before forwarding the claim to the PSC.

B. Procedure — partially favorable claims

Follow the steps below for partially favorable claims.

1. Get the following queries

2. Prepare forms

  • SSA-831-U3. For electronic cases, use EDCS to complete the SSA-831 and store in the electronic folder.

  • SSA-101-U3/SSA-3687-U2, partial award as appropriate.

  • Indicate the appropriate notice and/or paragraphs.

  • Document the folder with an SSA-5002, stating the reason for the partial award and that the claim must be forwarded to the DDS after all payment actions, for consideration of a possible earlier onset.

  • Process the claim as a DOFA unless a OFA exclusion applies. If partial adjudication can be triggered by the FO, the FO should process the claim, then forward it to the appropriate PSC for completion of the notice and forwarding to the appropriate DDS for consideration of an earlier onset date.

  • If a DOFA exclusion applies, forward the claim to the appropriate PSC for processing to payment status and forwarding to the DDS.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0411011015
DI 11011.015 - FO Adjudication of Adopted Claims - 03/21/2017
Batch run: 03/21/2017
Rev:03/21/2017