BASIC (04-11)

DI 52520.010 Disability Determination Services Martinez Case Processing Instructions

A. Introduction

There is no special coding, tracking, or notice required by the disability determination services (DDS) for processing Martinez cases. The DDS follows existing case development and adjudicative procedures and disability policy.

NOTE: The DDS may have to adjudicate periods different from typical title XVI claims in which the DDS generally evaluates the period from the application date forward. Before transmitting the case to the DDS, the field office (FO) will identify the case characteristics on the Martinez Court Case flag.

B. Processing title XVI post-2006 Martinez cases

The FO will send the following title XVI post-2006 Martinez cases to the DDS for a disability determination. The following are DDS instructions for processing these cases.

1. No subsequent claim after an N25 technical denial

Adjudicate the Martinez claim from the application date of the technically denied claim to the present.

If the DDS determination is an allowance, use the application date of the technically denied claim for determining the onset date of disability. See DI 25501.370, Onset in Title XVI and Concurrent Title II/Title XVI Claims.

2. Subsequent claim with a disability determination or decision after an N25 technical denial

Adjudicate the Martinez claim from the application date of the technically denied claim through the month before the application date of the subsequent disability claim.

If the adjudication of the Martinez claim results in a medical denial, do not disturb the subsequent determination (allowance or denial). Inform the claimant in the denial notice that we reviewed the earlier period under the Martinez settlement provisions and found him or her not disabled for that period.

If the Martinez claim is an allowance, and the subsequent claim was a disability denial, adjudicate the claim as though no denial determination was made, and vacate the subsequent determination as follows:

  • For paper cases, follow normal reopening process.

  • For electronic cases, receipt in the subsequent claim as a reactivation.  

  • Document the claim with a Report of Contact (SSA-5002) stating: “Martinez settlement requires the DDS to vacate the subsequent claim determination made on ___________. Accordingly, the DDS vacates this disability determination.”

  • Annotate all documents with the remark “Determination was vacated.” in the Notes column in eView.

  • Close the case with No Determination (ND) decision code, selecting the ND reason “FODR – FO Determination Requested.”

  • Transfer the claim to the FO.

3. Subsequent non-Martinez technically denied claim

Adjudicate the Martinez claim from the application date of the N25 technically denied claim through the month before the application date of the subsequent non-Martinez technically denied claim. Make a closed period disability determination for the Martinez period.

4. Title XVI claim with a title II disability denial determination or decision for the same period or later

The prior title II denial determination or decision cannot be adopted under the Martinez settlement. Evaluate all available evidence, including the evidence used in making the prior determination or decision, and any additional evidence received to make an independent determination on the title XVI claim. A favorable Martinez determination is possible only if there is a reason to reopen the title II determination or decision.

5. Title XVI claim with a title II allowance determination or decision with an established onset date (EOD) later than the title XVI application date of the N25 technically denied claim

Adjudicate the Martinez claim from the application date of the N25 technical denial through the title II established EOD and apply collateral estoppel to provide title XVI post-2006 Martinez relief from the title II EOD through the present. If the disability determination on the Martinez claim is a denial, do not disturb the title II allowance. Inform the claimant in the denial notice that we reviewed the earlier period under the Martinez settlement provisions and found the person not disabled for that period.

If the Martinez determination is favorable, the FO determines nonmedical eligibility for the earlier period and effectuates payment.

6. FO can reinstate benefits-vacate subsequent medical denial determination

If the recipient received title XVI disability benefits and the case terminated because of N25 fugitive felon suspension, and then we denied a subsequent disability claim, the FO will request the DDS to vacate the subsequent denial determination. A new disability determination is not required in this situation because the FO will reinstate title XVI disability benefits on the previously terminated case. See DI 52520.005A.2.

Vacate the subsequent claim as follows:

  • For paper cases, follow normal reopening process.

  • For electronic cases, receipt in the subsequent claim as a reactivation.  

  • Document the claim with a Report of Contact (SSA-5002) stating: “Martinez settlement requires the DDS to vacate the subsequent claim determination made on ___________. Accordingly, the DDS vacates this disability determination.”

  • Annotate all documents with the remark “Determination was vacated.” in the Notes column in eView.

  • Close the case with No Determination (ND) decision code, selecting the ND reason “FODR – FO Determination Requested.”

  • Transfer the claim to the FO.

7. Age 18 disability redetermination

If a child recipient’s benefits terminated because of an unsatisfied felony arrest warrant, the FO cannot reinstate payments from the month after attainment of age 18 to the present until the DDS determines the recipient is disabled as an adult. An age 18 disability determination is required under the adult standards to establish continuing eligibility before Martinez relief can be granted. For information about processing these cases, see DI 23570.020 Development and Evaluation of Childhood and Age 18 Disability Redeterminations.

NOTE:The above case characteristics are the most common. However, the FO may refer other types of technically denied claims to the DDS, as appropriate.

C. Title XVI pre-2007 Martinez case characteristics

One characteristic all pre-2007 Martinez cases will share is an application date of April 1, 2009. Although the N25 fugitive felon technical denial or termination based on fugitive felon suspension occurred prior to this date, the Martinez settlement allows the recipient to file a new application with a protective filing date of April 1, 2009.

The FO will send the following pre-2007 title XVI Martinez cases to the DDS for a disability determination. The following are DDS instructions for processing these cases.

1. No subsequent claim filed after 4/2009

Adjudicate the Martinez claim from the application date of April 1, 2009, to the present. If the DDS determination is an allowance, use the application date of April 1, 2009, for determining the onset date of disability. See DI 25501.370, Onset in Title XVI and Concurrent Title II/Title XVI Claims.

2. Subsequent claim filed after 4/2009 with a disability determination or decision

Adjudicate the Martinez claim from the application date of April 1, 2009, through the month before the application date of the subsequent disability claim.

If the adjudication of the Martinez claim results in a denial, do not disturb the subsequent determination (allowance or denial). Inform the claimant in the denial notice that we reviewed the earlier period under the Martinez settlement provisions and found him or her not disabled for that period.

If adjudication of the Martinez claim results in an allowance, and the subsequent claim was a disability denial, adjudicate the claim as though no denial determination was made, and vacate the subsequent determination as follows:

  • For paper cases, follow normal reopening process.

  • For electronic cases, receipt in the subsequent claim as a reactivation.  

  • Document the claim with a Report of Contact (SSA-5002) that states: “Martinez settlement requires the DDS to vacate the subsequent claim determination made on ___________. Accordingly, the DDS vacates this disability determination.”

  • Annotate all documents with the remark “Determination was vacated.” in the Notes column in eView.

  • Close the case with No Determination (ND) decision code, selecting the ND reason “FODR – FO Determination Requested.”

  • Transfer the claim to the FO.

3. Subsequent technically denied claim filed after 4/2009

Adjudicate the Martinez claim from the application date of April 1, 2009, through the month before the application date of the subsequent technically denied claim. Make a closed period disability determination for the Martinez period.

4. Title XVI claim with a title II disability denial determination or decision for the same period or later

The prior title II denial determination or decision cannot be adopted under the Martinez settlement. Evaluate all available evidence, including the evidence used in making the prior determination or decision, and any additional evidence received to make an independent determination on the title XVI claim. A favorable Martinez determination is possible only if there is a reason to reopen the title II determination or decision.

5. Title XVI claim with a title II allowance determination or decision with an established onset date (EOD) later than the title XVI application date of 4/1/2009

Adjudicate the Martinez claim from the application date of April 1, 2009, through the title II EOD and apply collateral estoppel to provide title XVI pre-2007 Martinez relief from the title II EOD through the present.

If adjudication of the Martinez claim results in a denial, do not disturb the title II allowance. Inform the claimant in the denial notice that we reviewed the earlier period under the Martinez settlement provisions and found the person not disabled for that period.

If the Martinez determination is favorable, the FO determines nonmedical eligibility for the earlier period and effectuates payment.

NOTE:Even though these case characteristics are the most common, you may receive other types of cases from the FO. The FO will provide specific information in the case file.


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DI 52520.010 - Disability Determination Services Martinez Case Processing Instructions - 11/20/2012
Batch run: 11/20/2012
Rev:11/20/2012