TN 2 (03-10)

DI 44001.115 Dual Eligibility Case Processing

Upon receipt of claim, determine correct jurisdiction and process cases as follows:

A. Disability Processing Specialist (DPS) screens new case

  • Review the case to determine if it is Great Lakes Program Service Center-Disability Processing Branch (GLPSC-DPB) jurisdiction per DI 44001.105. If not, reject or transfer the claim back to the field office (FO) for proper disposition and explain the reason for return.

  • Screen the case to determine if technical denial is appropriate based on non-medical issues, (e.g., insured status not met at alleged onset date, or claimant still working at the substantial gainful activity level). If technical denial is appropriate, transfer the claim back to the FO for disposition of the technical denial.

  • Review the evidence for an immediate allowance (if medical evidence was submitted with the claim).

B. Initial contact with the Railroad Retirement Board (RRB)

If immediate disposition of the claim is not possible per the instructions above in DI 44001.115A:

  • Contact RRB by phone or by email the same day you receive the new claim, or shortly thereafter.

  • Ascertain if the claimant filed for a disability annuity with RRB.

  • Ask RRB to forward copies of all pertinent medical and vocational evidence from their folder, including a copy of the RRB determination, and medical consultant assessment(s) as available.

  • Send an e-mail to the RRB Group mailbox site to follow up if RRB does not reply within two workdays.

  • Document all initial contacts with RRB using SSA-415 (Notice of Disability Determination) or SSA-5002 (Report of Contact).

  • Record the name and phone number of the RRB examiner, and the date, time, and the result of the contact. Include your name on the form.

C. DPS case review – available evidence is sufficient

  • If the available evidence in the claims folder is sufficient to adjudicate the claim without additional medical evidence from RRB, make a determination using the same basic disability criteria and guidelines provided for the disability determination services (DDS), unless specifically instructed otherwise, for dual eligibility RR cases.

  • If both physical and mental impairments are involved, secure a physical and a mental assessment, unless a fully favorable determination is possible following the first assessment.

  • Refer the case for medical consultant/psychological consultant (MC/PC) review and sign-off.

  • Inform or coordinate the decision with the RRB per DI 44001.125.

D. DPS case review – additional development needed

If the available evidence is insufficient to adjudicate the claim,

  • Develop additional medical and vocational evidence as needed.

  • Follow the same basic criteria and development guidelines provided for the DDS, unless specifically instructed otherwise, for RR claims.

  • Request medical evidence of record from the medical sources alleged by the claimant per Evidence – Medical and Nonmedical Evidence DI 22505.001 and Developing Medical Evidence DI 44001.120.

  • If the MC/PC authorizes a physical or mental consultative examination (CE), request the DDS in the claimant’s state of residence to arrange for a CE per DI 20101.040A.

  • Obtain an SSA-3369 (Work History Report) to develop additional vocational information when necessary per DI 22515.030.

If there is any indication of a mental impairment

  • Contact the claimant or a collateral source by phone or mail to obtain a description of daily activities using SSA-3373 (Function Report-Adult) per DI 22511.005.

  • Refer the case for MC/PC review and sign-off when all development is completed.

  • Inform or coordinate the decision with the RRB per DI 44001.125.


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http://policy.ssa.gov/poms.nsf/lnx/0444001115