TN 1 (02-06)
DI 28057.005 General Work Flow
A. Procedure - Field Office Responsibilities
The FO discusses the criteria for being reinstated with the individual and provides a comparison of the possible effects of filing expedited reinstatement (EXR) versus filing a new initial claim. If the individual decides to request EXR the FO helps complete the request for reinstatement, obtains the prior folder, and determines whether the individual meets the applicable non-medical criteria. See DI 13050.045 for FO EXR procedures.
2. FO Jurisdiction Denial
The FO denies a request for EXR that does not meet the non-medical requirements for EXR. See DI 13050.005A.2. for technical denial situations.
3. Medical Determination Needed
When an individual meets the non-medical requirements for EXR, the FO obtains the necessary medical development forms (SSA-454, etc.), forwards the folder to the DDS for an EXR medical decision, and initiates provisional benefits.
4. Award or Denial Procedure
When the DDS returns the file, the FO sends notice of the medical denial decision to the individual and terminates provisional benefits, or prepares the necessary award. The denial notice will include the individualized medical notice language provided by the DDS. The FO expedites an EXR award to the appropriate OCO/PC for final processing.
When all FO and OCO/PC award processing actions are completed, the FO (or OCO/PC) forwards the EXR file for filing.
B. Procedure- DDS Responsibilities
The DDS Reviews the current medical evidence and determines if the individual's current impairment is the same as or related to the impairment that led to the previous entitlement to benefits (the comparison point decision, or CPD). If the same as or related impairment exists, determine whether the individual is disabled based on the medical improvement review standard (MIRS).
Prepare a SSA-832-U3 (Title XVI Cessation or Continuance of Disability) or a SSA-833-U3 (Title II Cessation or Continuance of Disability) to document the determination and return the file to the FO. To expedite processing, fax the SSA-832/833 (see note below) to the FO prior to returning the file (or use a locally established method of expediting the decision to the FO). See DI 28057.000 for a more complete discussion of DDS processing.
NOTE: As an EXR determination is input as a continuing disability determination, it is subject to automated selection for quality review (QR). If selected for QR, the file must be sent to the appropriate regional Disability Quality Branch rather than to the FO. Do not fax an allowance decision, or mail the file, to the FO until the systems alert has been received verifying the case has not been selected for QR.
C. Procedure - OCO/PC Responsibilities
OCO/PC processes all EXR awards for title II benefits through District Office Final Authorization (DOFA) processing. OCO/PC terminates provisional benefits, if necessary, and adjusts the award benefits payable for provisional benefits that have already been paid. OCO/PC effectuates Medicare entitlement, as appropriate and prepares and sends the appropriate award and overpayment notices.