DI 40101.015 Processing Center (PC) Foreign and Totalization Disability Claims
A. Foreign claims process
A Foreign claim is any one of the following disability claims:
Disability Insurance Benefits (DIB),
Disabled Widow(er)’s Benefits (DWB),
Childhood Disability Benefits (CDB), or
Disabled Minor Child (DMC).
Claims filed by or on behalf of an individual temporarily in the U.S. who is physically residing outside the:
District of Columbia,
American Samoa, or
The domestic field office (FO) loads the claim into Modernized Claims System (MCS) and Electronic Disability Collect System (EDCS) per DI 43501.000-DI 43535.000 and process as follows:
EXCEPTION: The U.S. northern border States FOs files and process Canadian claims. If the claim involves totalization, the FO also develops and combines the Canadian earnings.
B. Totalization claims for individuals with foreign coverage
The domestic FO loads into MCS any disability claim filed by or on behalf of an individual living in the U.S., who has earned foreign coverage under an international Social Security agreement (totalization). See list of agreement countries in GN 01701.005.
Disability claims filed by an individual covered by a totalization agreement will fall into one of three categories. The three categories are:
Claimant is insured for Social Security Disability Insurance (SSDI) benefits based on U.S. earnings alone;
Claimant is not insured for SSDI benefits based on U.S. earnings alone but has at least six U.S. quarters of coverage (QCs); or
Claimant has less than six U.S. QCs.
1. Category 1
If the claimant is insured for SSDI benefits based on U.S. earnings alone, the domestic FO transfers the disability claim to their Disability Determination Services (DDS) for development of medical evidence and preparation of the disability determination.
The domestic FOs should:
process the claim when the DDS returns the disability determination,
eCodes the TOTL screen in MCS, and
mail all totalization forms to Office of International Operations (OIO) for any necessary action with the foreign agency of the totalization country.
2. Category 2
If the claimant is not insured for SSDI benefits but has a least six U.S. QCs, the domestic FO processes the technical denial on U.S. earnings. To process denial, FO codes PC8 on DECI and TOTL screen in MCS and selects “FO No Determination” in EDCS. Totalization claims filed by or on behalf of individuals physically outside the 50 States, the District of Columbia, the U.S. Virgin Islands, Guam, American Samoa, or Puerto Rico are the jurisdiction of OIO. Transfer these claims to OIO in MCS and EDCS using FO code E15 for medical development and the disability determination.
The domestic FO then forwards any paper claims to OIO to determine if:
U.S. disability insured status is met based on combined U.S. and foreign coverage, and
there is any possible need for a medical determination.
If there is no paper folder, the domestic FO sends Modernized Development Worksheets (MDW’s) to PC8 for electronic claims and advises PC8 of the claim for totalization benefits.
NOTE: Canadian border FOs should process Category 2 through their State DDS and prepare the A101 or EF101 for OIO effectuation.
3. Category 3
If the worker does not have at least six U.S. QCs, the domestic FOs should:
process the technical denial on U.S. earnings,
code the TOTL screen in MCS, and
mail totalization forms to OIO for any necessary action with the foreign agency of the totalization country.
For a description of the totalization program, see GN 01701.005.
For specific FO routing instructions, see GN 01702.310 through GN 01702.420.