TN 2 (03-10)
DI 44001.105 Jurisdiction of Dual Eligibility Claims
The Great Lakes Program Service Center-Disability Processing Branch (GLPSC-DPB) has jurisdiction of dual eligibility claims filed by career railroad (RR) employees and certain dependent RR survivor disability annuitants. The State disability determination services (DDS) does not have jurisdiction.
These cases are processed in GLPSC-DPB, location code V32, to facilitate the coordination of medical evidence and disability determinations with the Railroad Retirement Board (RRB), which is also located in Chicago, Illinois.
A. GLPSC-DPB jurisdiction of dual eligibility claims
GLPSC-DPB has jurisdiction of the following RR related claims:
1. Career railroad case
A disability claim filed by a RR worker who has at least 60 months of creditable RR service earned after 12/31/95 (or 120 months earned at any time).
2. Dependent RR survivor disability annuitant case
A disability claim filed with SSA by an individual who is also receiving or filing for a RR disability annuity with RRB on the account of a deceased RR employee. The disability claim with SSA must be filed on a different Social Security number (SSN) than that of the deceased RR worker.
EXAMPLE: An individual who is receiving a disabled widow’s annuity from the RRB files with SSA for disability insurance benefits (DIB) and Supplemental Security Income (SSI) benefits on her own account.
NOTE: If the spouse or child of a living career RR worker files for DIB or SSI on his or her own SSN, GLPSC-DPB does not have jurisdiction of the claim. Route the claim to the DDS in the claimant’s state of residence per DI 11050.010.
If the claimant has a foreign address transfer the claim and all material to the Office of International Operations, location code V22, for processing. The foreign address takes precedence over the RR issue in determining jurisdiction. For instructions, see Foreign Residency Involvement with Career Railroad (RR) or RR Annuitant Cases Processed by Great Lakes Program Service Center-Disability Processing Branch (GLPSC-DPB) DI 43505.075.
End Stage Renal Disease (ESRD) only
These cases are the jurisdiction of the Office of Disability Operations PC7. See these instructions for Processing ESRD Claims DI 45001.005 and Certified Electronic Folder (CEF) Exclusions and Limitations DI 81010.030A.7.
If GLPSC-DPB receives a claim that is not their jurisdiction, transfer the claim back to the FO for proper disposition.
B. GLPSC-DPB jurisdiction of dual eligibility reconsiderations
If the claimant files for reconsideration on a dual eligibility claim, GLPSC-DPB has jurisdiction, even if the DDS processed the initial determination.
GLPSC-DPB is responsible for the reconsideration even if the claimant resides in a Prototype state.
C. Jurisdiction of disability survivor claims with railroad involvement
When a railroad worker dies, either RRB or SSA will have jurisdiction of any survivor claim on the deceased worker’s SSN. Only one agency will have jurisdiction. RRB makes the jurisdiction decision and sends an electronic notification of jurisdiction to SSA systems. The field office (FO) can access this information by obtaining the initial earnings record. Program service center (PSC) and the Office of Central Operations (OCO) employees can access this information via a disability, railroad, alien, and military service (DRAMS) query.
More information can be found in Jurisdiction Determinations of Survivor Benefits RS 01601.300 and Field Office Processing of Survivor Claims RS 01602.200.
1. RRB has jurisdiction of survivor claim
If RRB has jurisdiction of the survivor claim, the FO should send the claim to the RRB. GLPSC-DPB does not have jurisdiction over these survivor claims.
However, if RRB has jurisdiction of the survivor claim, and the claimant files a claim with SSA for DIB and/or SSI on his or her own SSN, then the GLPSC-DPB has jurisdiction of the DIB/SSI claim. In these cases, the FO should send the survivor claim to RRB, and forward the DIB/SSI claim(s) to GLPSC-DPB, location code V32.
EXAMPLE: During an appointment at her local SSA FO, Mrs. Jones files a claim for disabled widow’s benefits on the SSN of her deceased husband, who worked in the railroad industry for more than 10 years. The Modernized Claims System (MCS)-Earnings Computation screens show that RRB has jurisdiction of the survivor claim. The FO routes the widow’s claim material to the RRB. However, since Mrs. Jones is also insured for DIB on her own earnings record, the FO also takes an application for disability benefits and routes the DIB claim to GLPSC-DPB, location V32. DPB will adjudicate the DIB claim and coordinate their disability determination with RRB. The folder should be annotated that a survivor claim was sent to RRB.
2. SSA has jurisdiction of survivor claim
If SSA has jurisdiction of the survivor claim, the FO routes the disabled survivor claim to the DDS, not to GLPSC-DPB. If SSA has jurisdiction, there is no disability entitlement with RRB, and therefore there is no reason to coordinate the SSA disability determination with RRB. However, if the widow(er) or childhood disability claimant has 60 months of creditable RR service earned after December 31, 1995 (or at least 120 months earned at any time), the GLPSC-DPB has jurisdiction of all of the claimant’s disability claims.
3. Survivor jurisdiction determination
Obtain a DRAMS query to ascertain if RRB or SSA has jurisdiction of the survivor claim:
Using QUERY MASTER, enter a check mark in “DRAMS box, and select “Get Queries” button , OR
On SSA MAIN MENU, select functions: 09 (MFQ) 16 (MISM) 01 (DRMQ)
EXHIBIT: DRAMS query
DRAMS DTE: 06/24/09 SSN: 111-33-2222 DOC: PC4 UNIT: D PG: 001
RRB HAS DETERMINED THAT SSA HAS JURISDICTION
DATE DETERMINED: 10/24/2008
RRB STOP DATE WAS 06/2004
D. Obtaining RR earnings information for Disability (DIB) or Disability Freeze (FZ) insured status
Before identifying a claim as career RR, the FO is responsible for verifying that a claimant has the required months of RR service.
Before beginning disability development, the disability processing specialists (DPS) should also verify the claimant’s RR service months by checking the railroad employment screens in Modernized Claim System (MCS).
1. In MCS
Select screen #23. The Number Holder Railroad (NHRR) Employment screen contains the number of months the claimant alleges working for the railroad after 1936. See Modernized Systems Operation Manual (MSOM) MCS 005.036.
2. In MCS/EC
The Railroad Earnings (DRRE) screen contains entries:
If RR 1996 – to date is 60 or more, or RR 1937 – to date is 120 or more, the case is a career RR case. See Railroad Earnings Data (DRRE), MSOM MCSEC 001.020.
NOTE: If the claimant has fewer than 60 RR SM 1996 – TD, or 120 RR SM 1937 – TD, but has military service (MS) months creditable under the Railroad Act, the MS months can be added to the RR service months for purposes of determining career RR jurisdiction. The FO is responsible for determining creditable MS months per DI 11050.001. To determine when the RRB can use MS months refer to RS 01601.400 through RS 01601.450.
3. Use of RR compensation for DIB insured status and for FZ insured status
If the NH has less than 60 months of creditable RR service earned after 12/31/95 (and does not have a total of 120 months earned at any time), we combine the RR earnings with SSA earnings to meet the disability insured status requirement for DIB and for a period of disability freeze.
If the NH has at least 60 months of creditable RR service earned after 12/31/95 (or 120 months earned at any time), we consider the NH to be career RR, and RR compensation can be used to meet the disability insured status requirement for the period of disability freeze only. DO NOT use RR compensation to compute DIB insured status for cash benefit purposes.
RS 00301.122, Relationship Between Period of Disability and Insured Status
RS 00301.131, Use of Railroad Compensation and Military Service Credits for Freeze Insured Status
IMPORTANT: If a claimant who is insured only for a period of disability freeze files a claim for DIB, the FO should explain that he or she is not insured for cash benefits using only FICA wages, and recommend the claimant restrict his or her Title II claim to a freeze only. The FO should use a “Claim Type” of “FZ”, not “DIB,” for these freeze only cases. GLPSC-DPB is not able to process a claim type of “DIB” if the claimant is not insured for cash DIB benefits.
If the claimant insists on filing a claim for cash benefits, the FO should process a technical denial of the DIB claim for lack of insured status, and transfer the claim for freeze only (“FZ”) to GLPSC-DPB.
E. Inappropriate DDS determinations on dual eligibility claims
If a career RR or dependent RR survivor disability annuitant claim has been erroneously transferred to the DDS, the FO will immediately phone the DDS and ask them to transfer jurisdiction of the case to GLPSC-DPB, location code V32, according to the instructions in this section.
If GLPSC-DPB is the first to discover the erroneous transfer, the DPB will contact the DDS to request the transfer.
1. Case pending in DDS before final determination – No consultative examination (CE) scheduled
Phone the DDS and ask them to transfer jurisdiction to GLPSC-DPB, location code V32. Ask the DDS to forward any additional evidence they receive on the case to GLPSC-DPB.
NOTE: In a fully electronic case, the DDS should scan any additional evidence into the EF.
2. Case pending in DDS before final determination – CE appointment scheduled
Phone the DDS and advise them that the claim is properly the jurisdiction of GLPSC-DPB and that GLPSC-DPB will make the disability determination on the case once the DDS development is complete. Ask the DDS to continue processing the claim until the CE has taken place and they have received the CE report. Ask them to transfer jurisdiction of the claim, including any additional evidence, to GLPSC-DPB, (V32) upon receipt of the CE report.
3. Final determination completed – DDS case closure to FO jurisdiction – Notice released
If the notice on the medical determination has already been released (including the release of the SSA-L1157 explaining a partially favorable onset determination), the DDS determination becomes the official determination. There is no reason to return the case to GLPSC-DPB for review unless there is an obvious error on the face of the determination. The FO should always notify GLPSC-DPB of the DDS determination for coordination with the RRB.
If a subsequent request for reconsideration is filed, the FO should transfer the case to GLPSC-DPB for processing of the reconsideration determination. See DI 44001.105B in this section for more information.
4. Determination completed – DDS case closure to FO jurisdiction – Notice not released
If the notice of the medical determination has not been released, the FO notifies GLPSC-DPB of the error. The DPS and MC/PC review the case to determine if the DDS determination may be adopted. This MAY require the FO to medically reactivate the case.
NOTE: The FO must contact GLPSC-DPB before sending a medical reactivation to DPB due to erroneous processing per DI 81020.117. The DPB must agree with the FO decision to medically reactivate the claim.
DPB action upon case review:
a. DPS adopts DDS determination
Annotate the DDS SSA-831(s) in the electronic folder with a NOTE: “DDS determination adopted by GLPSC-DPB”
Dispatch the case to the Modernized Integrated Disability Adjudicative System (MIDAS) disability assistant (DA) for case closure following current procedures for a “No Decision” (ND) determination, and transfer jurisdiction to the appropriate FO or PC for effectuation of the DDS determination.
NOTE: If the case is closed and not medically reactivated, print the existing 831, make annotations, and fax back into the CEF.
b. DPS does not adopt DDS determination
Medically reactivate the case
Prepare a new SSA-831 determination and rationale
Annotate the erroneous DDS SSA-831 with a NOTE: “Do not process. See SSA-831 dated _________.”
Process the determination and transfer the closed case to the FO for final processing.
NOTE: For paper case folders, continue to follow the procedures in Inappropriate DDS Determination DI 40115.020B.