DI 23550.001 Disability Determination Services (DDS) Review and Development of Totalization Claims

CITATIONS:

Section 233 of the Social Security Act; Social Security Act; Public Law 95-216 ; 20 CFR 404.1901 - 404.1915 ; 20 CFR 401 , 422 ; SSR 81–8

NOTE: For field office (FO) processing instructions, see Totalization Benefits, GN 01700.000.

A Totalization agreement (also known as International Social Security agreements) is a formal agreement between the United States (U.S.) and another country, which provides for limited coordination of the U.S. Retirement, Survivors, and Disability insurance program and comparable programs in the other country. Totalization agreements eliminate dual social security coverage and tax liability and do not include Medicare or Supplemental Security Income (SSI) benefits; however, a claimant entitled to totalization benefits may be eligible to apply for and receive Medicare or SSI benefits.

Totalization agreements allow claimants to establish insured status and qualify for benefits by combining qualifying work in both countries and help to eliminate situations in which workers fail to qualify for Social Security benefits because they have worked in both the U.S. and abroad.

See Details

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GN 01701.005 for a list of the countries that have totalization agreements with the U.S.
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GN 01701.000 for additional information on eligibility and applications for totalization benefits.
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GN 01702.410 for information on routing claims for disability claims involving totalization benefits.

A. DDS process for completing development and making disability determinations for totalized claims

Develop medical evidence and prepare medical determinations for totalization claims sent by the field office (FO) only in the following situations:

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A claimant is insured on U.S. earnings alone; or
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A claimant files a concurrent claim for SSI disability benefits.

B. DDS claim processing actions based on claimant insured status

Process the claim based on the claimant’s insured status at the time he or she filed the claim.

1. Claimant insured for U.S. coverage only

Upon receipt from the FO:

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Handle the claim according to normal procedures (i.e., non-totalization case);
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Prepare a disability determination; and
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Annotate the folder that the claim is not a totalization claim.

2. Claimant insured for combined U.S. and foreign coverage

Upon receipt from the FO:

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Locate the remark “Totalization Case - No Determination Necessary” in item 34 of the SSA-831-U5 (Disability Determination and Transmittal);
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Indicate the case was received in the case control system;
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Obtain medical evidence of record (MER) as requested by the FO on the SSA-847-U3 (SSA Request For Case Action);
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Ensure MER is complete and accurate to establish correct onset and disability;
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Follow regular development procedures, including re-contacting the physician to clarify inconsistencies or correct any serious omissions;
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Do not complete an SSA-831-U5;
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Route the case to the servicing FO;
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Report the case as a clearance in the case control system.

3. Claimant not insured for U.S. coverage

If the Office of International Operations (OIO), International Disability Unit (IDU) submits an SSA-883-U3 (Request for Evidence or Assistance Disability Case) to develop medical evidence, process according to the following instructions. For electronic assistance request procedures, see DI 81020.100.

Upon receipt from OIO, IDU:

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Locate the remark “Totalization Claim - Medical Development Request from (Name of Country) — No Determination Necessary” on the SSA-847-U3 (SSA Request for Case Action)
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Do not enter information in the case control system;
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Prepare an internal manual control;
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Develop the MER OIO requested, as shown on SSA-847-U3;
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Schedule any consultative examinations (CE) and tests, as appropriate according to the instructions in When to Purchase a CE DI 22510.005;
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Scan documents into the certified electronic folder when possible, or for paper folders, return the material in an envelope to the claims examiner in OIO. (for the address see DI 23550.001D in this section).

For additional instructions on processing no determination claims, see DI 81020.127 (electronic case) or DI 32005.020 (paper case).

NOTE: These requests may not include an SSN.

C. DDS procedures for processing reconsideration requests

The claimant may file a written request for reconsideration, hearing, or appeal, under the same conditions as other determinations. Process the claim according to the applicable procedures in DI 27000.000.

D. DDS procedures for handling totalization claim inquiries

There are four categories of inquiries. Use the following chart to determine the appropriate action(s).

If the inquiry concerns:	Take the following actions:
Worker Insured for U.S. Coverage Only	Process the case as usual under the existing guidelines in DI 23550.001B.1. in this section.
Requirements of Totalization Program	Refer calls or forward inquiries to the claimant’s servicing FO
Application Procedures	Refer calls or forward inquiries to the claimant’s servicing FO
Benefits, Decisions, and Claims Status	Forward the inquiry and nonmedical material in an envelope addressed to: Office of International Operations, Totalization P.O. Box 17049 Baltimore, MD 21235

E. Reference

GN 01701.000, Totalization Benefits Table of Contents

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423550001

DI 23550.001 - Disability Determination Services (DDS) Review and Development of Totalization Claims - 06/29/2011
Batch run: 01/15/2019
Rev:06/29/2011

Program Operations Manual System (POMS)