DI 11020.135 Field Office (FO) Actions After a Disability Determination
After the Disability Determination Services (DDS) makes a disability determination and returns the case to the FO, take the following steps, depending on the type of determination.
NOTE: Great Lakes Processing Service Center (GLPSC)-Disability Processing Branch (DPB) has jurisdiction of Title II disability determinations in career railroad and dependent railroad annuitant claims.
A. Medical allowance
1. Processing Earnings Computation (EC) exclusions
If a new claim is an allowance that you cannot process through EC, prepare a Modernized Claims System (MCS) A101 or EF101.
For A101 instructions, see MSOM MCS 014.001 - MSOM MCS 014.025.
For EF 101 information, see Electronic Form 101 Process” MSOM T2PE 009.001.
2. Age 18 conversion cases
When a disability determination is made to continue a child's entitlement as a Childhood Disability Benefit (CDB) upon attaining age 18, the disability determination must be posted to the Master Beneficiary Record (MBR) to enable automatic conversion.
Use the Postentitlement Online System (POS) (see MSOM COMMON 005.017) to convert auxiliary child’s benefits to CDB in the following situations:
The child is age 17½ to 18 and is receiving auxiliary child’s benefits; or
The child is in T4 terminated status (see MSOM COMMON 005.017 “Develop for Child Disability Determination” and SM 00550.020 “Ledger Account File (LAF) Codes”).
However, if the child is receiving Supplemental Security Income (SSI) benefits, send the claim to the PC for manual action. PC manual action is also needed for other types of CDB allowances, such as a
CDB converted from student benefits;
Reentitlement for a beneficiary who is over age 18 with a T6 LAF code; or
CDB award to continue Child-in-Care benefits (see RS 00202.095 “Last Child in Care” and RS 00203.085 “Childhood Disability Development and Determination”.
B. Medical Denial
1. Processing Earnings Computation (EC) Exclusions
If the new claim is a denial and cannot be processed through EC, prepare a Manual Adjustment Credit and Award Data Entry (MACADE).
SSA-1418 inputs are required for District Office Workload Report (DOWR) credit.
2. Updating the Master Beneficiary Record (MBR) with denial data
If disability is not established for a claimant already on the rolls, the FO must make an appropriate systems input to establish or update the MBR (see MSOM COMMON 005.017 “Develop for Child Disability Determination”).
If systems input, such as Modernized Claims Systems (MCS) or Postentitlement Online System (POS) is not possible, the FO should use MACADE to update the MBR.
SM 00380.500 Overview of MACADE Disallowance Function
SM 00380.525 List of User and Edit Messages
C. Res Judicata denial
DDSs do not have the systems capability to input "S1" denials. Therefore, if the DDS denies a subsequent claim based on res judicata, DDS returns the claim to the FO to process the claim through the MCS EC, if possible. If not, then the FO inputs a MACADE action to process the "S1" denial.
The FO is able to determine when an S1 denial input is needed from a basis code "S1" entered in item 35 of the DDS-prepared SSA-831-U3 on the subsequent claim. In addition, the DDS annotates the route slip used to return the folder to the FO as follows: "Res judicata applicable to claim filed on (date of subsequent application). Please input an S1 denial.”
DI 11010.075 Title II Technical Denials, and Claims Not Requiring a Disability Determination
DI 27516.005 DDS Action on Subsequent Title II Claim -- Claimant Previously Denied Through Date Last Insured/Prescribed Period/Age 22.
D. Folder jurisdiction
Determine which PC has jurisdiction of the number holder’s (NH) SSN; then send any paper claims material (processing limitation/exclusion) for the CDB to that PC. Use the following guides to determine which PC has jurisdiction:
If the NH is entitled to a Disability Insurance Benefit (DIB) and is under age 54, the Office of Disability Operations (ODO) has jurisdiction of the claim.
All other Disability and Retirement, Survivors Insurance (RSI) claims are maintained by the servicing PC.
EXCEPTION: If any beneficiary on the NH's Earnings Record (E/R) has a foreign mailing address, the Office of International Operations (OIO) has jurisdiction of the claim.