TN 31 (10-10)

DI 11015.015 Field Office (FO) Processing of a Disabled Widow(er)’s Claim for an Electronic Disability Collect System (EDCS) Exclusion or Limitation Case

A. Prepare the paper modular disability folder (MDF)

When an EDCS exclusion or limitation is present for any claim associated with a case, the paper MDF is the official case record.

NOTE: Although the official folder is paper for EDCS limitations, the case is not totally removed from electronic processing. The field office (FO) may use EDCS to collect information (e.g., 3368, 3367) and other components (Disability Determination Services (DDS), Office of Disability and Review (ODAR), etc.) may use the electronic file to collect and store documents that will be converted to paper when the case is closed.

To create the MDF:

  • Enter the deceased number holder’s (NH) Social Security number (SSN) on the face of the folder tab. DO NOT enter the Disabled Widow(er)’s Benefit (DWB) claimant's own SSN.

  • Print the surname of the widow(er) and his or her first initial on the reverse of the folder tab with the surname first.

  • Complete the appropriate paper forms (e.g., SSA-3368, SSA-3367, SSA-827) and store them in the appropriate section of the paper MDF.

NOTE: The FO must annotate the SSA-3367 (Disability Report – Field Office) with the prescribed period and the controlling date for the Disability Determination Services (DDS). Use the chart in DI 11005.050C to compute these dates and enter them on the form.

When a claimant is filing a DWB and a Disability Insurance Benefit (DIB) or Supplemental Security Income (SSI) claim simultaneously:

  • prepare the paper MDF, following instructions in Paper Modular Disability Folder DI 70005.000; and

  • staple the back flap of the DIB folder to the front flap of the DWB folder.

If either claim folder does not require DDS review, prepare a report of contact (RPOC) in the Modernized Claims System (MCS) detailing this information, print it, and place it in the DIB folder.

References:

  • DI 11005.016 – Forms Used in Disability Claims

  • DI 11010.210 – Assembling and Transmitting the Official Folder to Disability Determination Services (DDS)

  • DI 81010.030 – Certified Electronic Folder (CEF) Exclusions and Limitations

B. Make a substantial gainful activity (SGA) determination for any work issue

Develop work activity in the usual manner, recording the SGA development on the appropriate form, i.e., SSA-821 (Work Activity Report – Employee) or SSA-820 (Work Activity Report – Self Employed Person), and store it in the blue section of the MDF.

References:

  • DI 10505.035 – Documenting Employment Cases Using the SSA-821-BK (Work Activity Report-Employee) and the SSA-823 (Report of SGA Determination-For SSA Use Only)

  • DI 11010.190 – Initial or Subsequent Disability Claims – Claimant Engaging in Substantial Gainful Activity (SGA)

  • DI 11010.205 – Completing the Paper SSA-831

C. Prepare the paper SSA-831 (Disability Determination and Transmittal)

For a disability case that is an EDCS exclusion, transferring the claim is not possible via EDCS. Complete items 1-14 of the paper SSA-831, noting the following specific instruction for a DWB claim:

  • Item 4 (SSN): Enter the SSN of the deceased NH and show the claim symbol, e.g., W, E, D.

  • Item 6 (NH's Name): Enter the number holder’s name.

  • Item 7 (Type Claim (Title II)): Enter DWB.

Ensure that the DDS is aware of any specific situation by entering the appropriate remarks (Item 11) on the SSA-831, as noted below:

1. Initial concurrent DWB-DIB

If you are processing concurrent DWB-DIB claims, enter “Also filing as disabled widow(er) on (SSN)” on the DIB SSA-831 and “Also filing for DIB on (SSN)” on the DWB SSA-831.

2. DWB claimant is currently entitled to DIB

If a DWB is already receiving DIB, but a determination is required (e.g., for an earlier onset or to meet the prescribed period), enter “Widow(er) entitled to DIB on SSN.”

3. Filing for Medicare purposes only

To distinguish deemed DWB for Medicare-only cases from regular DWB cases, enter “For Medicare purposes only,” when the claimant is:

  • a widow(er) age 60-65; or

  • age 50 or over and currently entitled to mother’s or father’s benefits.

4. Railroad Board (RRB) involved

If the DWB claimant has 120 months (or 60 months after 1995) of railroad (RR) service, enter “Career RR Case.”

If an individual, who is also entitled to a disability survivor’s annuity with RRB, files a claim on an account other than the deceased RR worker, enter “Dependent RR Annuitant.”

GLPSC-DPB has jurisdiction for the disability determination on these cases. See Details:

  • DI 11050.015 – Jurisdiction of Disability (DIB) and Freeze Applications for Career Railroad (RR) Employee and Surviving Dependent RR Annuitant

  • DI 11050.040 – Initial Claims Processing Involving Railroad (RR) Employment

  • DI 11050.060 – Transferring Non-Electronic Disability Collect System (EDCS) Cases to the State DDS or Great Lakes Program Service Center - Disability Processing Branch (GLPSC-DPB)

5. Application of res judicata possible

If, after a prior denial, a DWB claimant re-files for the same period, obtain the prior case folder. If you transfer the subsequent DWB claim to the DDS, enter the remark “Prior claim attached - Review for application of Res Judicata.”

If you cannot locate the prior claim, enter: “Prior claim not located. Substantive determination necessary.”

See Details:

  • DI 11015.030 - Field Office (FO) Authorization of a Disabled Widow(er)’s Benefit (DWB) Technical or Non-Medical Denial

  • DI 27516.001 – Field Office (FO) Res Judicata Development and Processing

D. Transfer the claim to the office of jurisdiction for a medical determination

Transfer material to the DDS promptly for a medical determination.

In concurrently filed MCS- and EDCS-exclusion cases, when you develop and forward both claims simultaneously (e.g., DIB-DWB), prepare a paper SSA-831 for each claim and transfer for a medical determination.

If you do not transfer both claims simultaneously:

  • release the other case immediately to the DDS, and

  • include an RPOC in each folder regarding the development status of the other claim.

References:

  • DI 11010.255 – Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determination Services (DDS)

  • DI 23545.001 – Foreign Cases - Determining Jurisdiction and Processing Transfers

  • GN 01701.005 – International Social Security (Totalization) Agreements

  • GN 01702.000 – DO Development and Routing of Totalization Claims


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0411015015
DI 11015.015 - Field Office (FO) Processing of a Disabled Widow(er)'s Claim for an Electronic Disability Collect System (EDCS) Exclusion or Limitation Case - 08/28/2012
Batch run: 08/28/2012
Rev:08/28/2012