TN 1 (01-12)

DI 52165.030 Interactive Computations Facility (ICF) Workers’ Compensation/Public Disability Benefit (WC/PDB) Notices

A. ICF WC/PDB general notice information

Claims representatives (CRs), claims authorizers (CAs), and claims technical examiners (CTEs) are responsible for all WC/PDB data in ICF for awards and post-entitlement (PE) actions.

NOTE: Access all ICF WC/PDB screens via the SSA MENU - MAIN, and select Item #7 - Title II/Interactive Comps.

The ICF notice screens are:

  • WCNM (Notice Menu)

  • WCEP (Enclosure Notice Block - Primary)

  • WCDL (Dictated Notice Language - Primary)

  • WCNA (Auxiliary Notice Data)

See MSOM ICFT2 033.001 through MSOM ICFT2 033.003 for screen displays and detailed instructions for completing each data field on the ICF notice screens.

NOTE: ICF notice screens will not accept adjustment/overpayment paragraphs (for example, paragraph OPT163).

1. ICF #32 “WC/PDB: Adjudicate Claim”

The Title 2 Redesign (T2R) system processes ICF #32 (Adjudicate Claim) actions . The CR, CA, or CTE is responsible for coding all applicable notice information into ICF on the appropriate notice screens. If T2R does not generate a complete notice, the processing center (PC) uses the information input on the ICF notice screens to issue a notice through Aurora, a notice processing system available to PCs only. (See DI 52165.030F in this section for more information about Aurora.)

2. ICF #34 “WC/PDB: Online Record Entry” operation (OREO)

Use ICF #34 (OREO) in T2R or ICF processing limitation situations. OREO is a “fill-in-the-blank” approach, i.e., technicians manually compute offset and then enter their computation onto the appropriate ICF screens (entering both “input” and “results” data). This creates an electronic version of their manual WC/PDB computation. The CR, CA, or CTE is responsible for coding all applicable notice information into ICF on the appropriate notice screens.

OREO transmits actions adjudicated in the field office (FO) to the PC with jurisdiction of the claim. OREO routes actions adjudicated in either the FO or the PC to a benefit authorizer (BA) or benefit technical examiner (BTE) for processing. The BA or BTE includes the ICF notice information in MACADE (the Manual Adjustment Credit and Award Data Entry system), and MADCAP (Manual Adjustment Credit and Award Processes) processes the MACADE .

B. MADCAP paragraphs for preparing the ICF notice

1. System generated paragraphs and requested paragraphs

Effective May 2011, the MADCAP Universal Text Identifier (UTI) prefix of “J” for WC/PDB paragraphs is converted to a Target Notice Architecture (TNA) UTI prefix of “WCP.” The paragraphs are in NL 00720.395 WCP Workers’ Compensation, and there is a MADCAP to TNA Conversion Chart in NL 00720.015 containing all paragraphs. The conversion chart in DI 52165.030B.2. in this section contains only the WC/PDB paragraphs.

  • The reporting responsibility paragraph (previously J43, now WCP 032) automatically generates and does not require manual input in the Enclosure Notice Block (ENB) of the WCEP and WCNA screens in ICF.

  • Some Requested paragraphs have some or all system generated fill-ins.

2. Conversion Chart for MADCAP WC/PDB Paragraphs converted from prefix “J” to prefix “WCP”

The following chart shows every WC/PDB MADCAP Universal Text Identifier (UTI) paragraph (prefix “J”) and its equivalent conversion to Target Notice Architecture (TNA) paragraphs with a prefix of “WCP.” The chart indicates which paragraphs are System Generated (no input necessary) and which must be Requested (manual input necessary). In addition, the chart also indicates whether a Requested paragraph has some or all system generated fill-ins. For the actual paragraph and fill-in language, see NL 00720.395 WCP Workers’ Compensation.

OLD

UTI

NEW UTI

TITLE OF PARAGRAPH

GENERATED PARAGRAPH?

or

REQUESTED PARAGRAPH? -

(and if fill-ins are generated or requested)

J19

WCP012

Offset Imposed First Month N/H

Receives DIB and WC and/or

Other Disability Payment

REQUESTED

(Some fill-ins generated)

J20

WCP028

Benefits Offset N/H May File For Reduced RIB

REQUESTED

(Some fill-ins generated)

J21

WCP010

Total Or Partial WC Offset N/H Only

REQUESTED

(Some fill-ins generated)

J22

WCP048

Total Or Partial Offset Aux. Only

REQUESTED

(Some fill-ins generated)

J23

WCP049

Amount Of Benefit Received After Offset

REQUESTED

(Fill-ins manually completed)

J25

WCPR07

Amount Of Offset Based On Estimate For One Or More Years High 5

REQUESTED

(Some fill-ins generated)

J26

WCPR13

Offset Imposed After Date Of Notice

REQUESTED

(All fill-ins are System generated)

J27

WCP018

Removal Of Offset WC Or Other Disability Payments Terminated

REQUESTED

(Some fill-ins generated)

J28

WCP019

Removal Of Offset N/H Age 62 Or 65

REQUESTED

(Some fill-ins generated)

J29

WCP029

WC Or Other Disability Claim Pending N/H Only

REQUESTED

(All fill-ins generated)

J30

WCP008

WC Or Other Disability Claim Pending - Aux. Only

REQUESTED

(All fill-ins are System generated)

J31

WCP015

Increase In Benefits Due To A Redetermination

REQUESTED

(All fill-ins are System generated)

J32

WCP017

Increase In Benefits After WC Offset First Imposed

REQUESTED

(Some fill-ins generated)

J33

WCP021

Possible Excludable Expenses WC

REQUESTED

(Some fill-ins generated)

J36

WCPR20

Offset Based On Lump Sum Ending Date Of Proration

REQUESTED

(All fill-ins are System generated)

J37

WCP005

Offset Determined By ACE

REQUESTED

(Some fill-ins generated)

J38

WCP009

N/H Appealing WC Decision - N/H Only

REQUESTED

(Some fill-ins generated)

J39

WCPR02

N/H Appealing WC Decision - Aux. Only

REQUESTED

(All fill-ins are System generated)

J40

WCPR31

N/H Appealing WC Decision - N/H And Aux

REQUESTED

(All fill-ins are System generated)

J41

WCPR27

Offset Based On Unverified Allegation

REQUESTED

(All fill-ins are System generated)

J42

WCPR22

WC Excludable Amounts Deducted

REQUESTED

(Some fill-ins generated)

J43

WCP032

All Letters Involving Receipt Of WC Or Other Disability Payments N/H

GENERATED

J44

WCP004

N/H Receiving WC Or Other Disability Payments No Offset

REQUESTED

(Some fill-ins generated)

J45

WCPR23

Offset Based On Lump Sum Proration Method A

REQUESTED

(Some fill-ins generated)

J46

WCPR24

Offset Based On Lump Sum Proration Method B

REQUESTED

(Some fill-ins generated)

J47

WCPR25

Offset Based On Lump Sum Proration Method C

REQUESTED

(All fill-ins are System generated)

J48

WCP003

Definition Of WC Offset

REQUESTED

(No fill-ins)

J49

WCPR06

Amount Of Offset Based On Estimate For One Or More Years High 1

REQUESTED

(Some fill-ins generated)

J57

WCPR09

Interim Notice Pending ACE Determination

REQUESTED

(All fill-ins are System generated)

J59

WCP001

N/H Expressed Intent To File For WC and/or Another Disability Payment

REQUESTED

(All fill-ins are System generated)

J75

WCP050

Subsequent Adjustment To Proration Period Based On New Evidence

REQUESTED

(Some fill-ins generated)

J76

WCP051

Change In Amount Of The Average Current Earnings (ACE)

REQUESTED

(Some fill-ins generated)

J77

WCP052

Resumption Of Offset N/H Only

REQUESTED

(Some fill-ins generated)

J78

WCP053

Resumption Of Offset Auxiliaries Only

REQUESTED

(Some fill-ins generated)

J79

ENT075

New Beneficiary Entitled To Benefits

REQUESTED

(Some fill-ins generated)

J80

WCP026

Beneficiary No Longer Entitled To Benefits

REQUESTED

(Some fill-ins generated)

J81

WCP058

Change In WC Rate and/or Other Disability Payment And Offset Adjusted N/H Only

REQUESTED

(Some fill-ins generated)

J82

WCPR15

Change In WC Rate and/or Other Disability Payment And Offset Adjusted Auxiliary Only

REQUESTED

(Some fill-ins generated)

J83

WCP054

Verified Rate Of WC and/or Other Disability Payment

REQUESTED

(Some fill-ins generated)

J84

WCP055

Third Party Involvement

REQUESTED

(All fill-ins are System generated)

J85

WCP013

Change In Reduction Of Workers' Compensation Benefits (Because Of Change In State Law)

REQUESTED

(Some fill-ins generated)

J91

WCP057

Removal Of Offset Lump-Sum Proration Ended

REQUESTED

(All fill-ins are System generated)

N/A

WCP060*

WC/PDB Removal of Offset – NH Attains Full Retirement Age (FRA)

REQUESTED

(Some fill-ins generated)

N/A

WCP061*

Benefits Offset to FRA- NH May File for Reduced RIB

REQUESTED

(Some fill-ins generated)

*NOTE: Addition of two new paragraphs due to the ABLE Act effective December 19, 2015, WC offset termination now extends from age 65 to Full Retirement Age (FRA). See 2015 Amendment in DI 52101.005.

C. Preparing the ICF notice for dictated language

1. When dictated language may be necessary

Dictated language may be necessary if:

  • MADCAP paragraphs do not adequately provide all necessary notice information.

  • Enclosure Notice Block (ENB) characters exceed the 445 maximum amount allowed. If the notice exceeds 445 characters, use either dictated language in ICF or prepare form SSA-573 Special Typing Instructions- not both. (The PC processes SSA-573 notice instructions.)

2. Where to code dictated language in ICF

Code dictated language on the following two ICF screens:

  • WCDL (Dictated Notice Language - Primary)

  • WCNA (Auxiliary Notice Data) - this screen includes both the ENB field for MADCAP paragraphs and a dictated language field for dictated text.

3. How to add dictated language (text, tables, charts) on the ICF screens

To add dictated language, code either of the following UTIs in the ENB field:

  • AAA031 - for dictated language (i.e., text)

  • TBL019 - to construct a table or chart

You can use both UTIs multiple times at different points in the notice. However, do not code the same UTI back-to-back (for example, do not code C*AAA031*AAA031*etc).

Place AAA031 or TBL019 where you want the dictated language or chart to appear:

EXAMPLE#1 - WCEP (Enclosure Notice Block - Primary) Screen:

ENB: C*WCP012,10/2010*AAA031*TBL019*WCPR22,4200.00*AAA031.

After completing the ENB with AAA031 or TBL019, answer “Y” to the question “Dictated Language Needed?” on the WCEP screen to generate the WCDL screen for the number holder (NH). When MADCAP encounters a # sign in the dictated language, it returns to the ENB until it encounters another AAA031 (or TBL019), then it returns to the dictated language portion of the notice.

NOTE: For auxiliary notices, code both MADCAP paragraphs and dictated language on the WCNA screen.

EXAMPLE #2 - NH notice with dictated language and chart:

WCEP (Enclosure Notice Block - Primary) screen:

ENB: C*AAA031*TBL019.

Printer Friendly Version

WCDL (Dictated Notice Language - Primary) Screen:

Our records show that we paid you $700.00 more than you are due for January 2010 through December 2010.#
DatePaidPayableDifferenceOverpaid
January 2010April 2010$1,402.00 $1,392.00 $10.00 $40.00
May 2010October 2010$1,402.00 $1,397.00 $5.00 $30.00
November 2010December 2010$1,402.00 $1,087.00 $315.00 $630.00
Total Overpayment$700.00#

D. Coding tips and guidelines for ICF notice input

Follow these tips and guidelines when coding ICF notice information:

  • Text: Type dictated language (text) using the appropriate upper and lower case (text appears on the notice exactly as typed).

  • Spelling/grammar: There are no edit features for spelling or grammar on the language screens. However, you may type dictated language in Microsoft Word, using spell-check, then cut and paste the text onto the notice screen, or you may use the NOT Screen Processor described in DI 52165.030C in this section, with link).

  • Wrap feature and hyphenating words: The dictated language fields of the ICF notice screens do not include the word wrap feature (i.e., long words cannot be broken and wrapped onto the next line). If the last word on a line does not fit completely on the line, do not hyphenate the word and continue the word on the next line. Instead, hit the “Enter” key to drop down and start the next line with the complete word.

  • Ending sentences and starting/ending paragraphs: End each occurrence of dictated language with a # sign. If the dictated language includes multiple paragraphs within a single block of text, insert an asterisk. (*). The program will skip a line to create a new paragraph.

  • When all dictated language is typed, enter the # sign. The # sign must be the last character on that line.

  • Inserting dictated language or charts - see DI 52165.030B.2.c. in this section.

E. Online notice tool

Paragraph Finder/ENB Propagator: Use this tool to locate MADCAP paragraphs and to propagate the Universal Text Identifiers (UTIs) to the ICF ENB in the proper format.

F. Aurora WC/PDB notices

The PCs use Aurora to create notices. Aurora is a notice processing system that automatically posts the notices to the Online Retrieval System (ORS) for viewing. See NL 00702.001 through NL 00702.240 for Aurora functioning and content. PCs can use standard WC/PDB notices available through Aurora to develop proof.

G. Local Processing Center (PC) Direct Contact (DIRCON) letters in Aurora

There are local PC WC DIRCON letters in Aurora for the following:

  1. PCWCP7001 - Request for Workers’ Compensation Information

  2. PCWCP5008 - Request for Public Disability Benefit Information

  3. PCWCP3001 - Request for Workers’ Compensation Information

  4. PCWCP5001 - DIRCON for WC and/or PDB Information

  5. PCWCP5002 - DIRCON for WCSP3

  6. PCWCP5005 - Verification of California SDI

  7. PCWCP5007 - DIRCON California Offset Removal

  8. PCWCP0L01 - WC Cleanup DIRCON Letter

  9. PCDIR7002 - Request for WC or PDB Information

H. References

  • DI 52101.005 - Social Security Amendments with Workers’ Compensation/Public Disability Benefits (WC/PDB) Offset Provision

  • MADCAP Paragraph Title Scanner

  • MSOM ICFT2 033.002 - WC/PDB Offset-Notice Menu (WCNM)

  • MSOM ICFT2 033.003 - WC/PDB Offset-Enclosure Notice Block-Primary (WCEP)

  • MSOM ICFT2 033.004 - WC/PDB Offset-Dictated Notice Language - Primary (WCDL)

  • MSOM ICFT2 033.005 - WC/PDB Offset-Auxiliary Notice Data (WCNA)

  • NL 00719.015 - Enclosure Notice Block Data Elements-MADCAP History Input Screens.

  • NL 00719.025 - Dictated Text (NOT) Screens

  • NL 00720.015 - Conversation Chart for MADCAP to TNA

  • NL 00720.395 - WCP Workers’ Compensation paragraphs


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0452165030
DI 52165.030 - Interactive Computations Facility (ICF) Workers' Compensation/Public Disability Benefit (WC/PDB) Notices - 10/20/2016
Batch run: 10/20/2016
Rev:10/20/2016