The FO should refer reopened PPV technically denied claims (DS = N25) with one of the following case characteristics to the DDS for a disability determination:

• •

  No subsequent claim after an N25 technical denial;

• •

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

• •

  Subsequent non-Clark technically denied claim;

• •

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

• •

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

NOTE: This list is not all inclusive.

The FO normally reinstates payments on cases with a medical allowance that terminated because of N25 PPV suspension. However, the FO cannot reinstate cases when there is a subsequent medical denial determination. The FO should refer these cases to the DDS for a decision to vacate the subsequent medical determination. When the DDS vacates the subsequent medical denial, the FO can reinstate payments.

We require an (age 18) adult disability determination. If a child recipient’s benefits terminated because of a PPV warrant, the FO will reinstate payments from the N25 PPV suspension month and continuing until:

• •

  the DDS determines the recipient is disabled as an adult; or

• •

  the DDS medically denies the case.

If the DDS medically denies the case, the FO should follow normal processing procedures including payment continuation, if requested timely. The FO will send title XVI Clark childhood disability claims to the DDS to make an adult disability determination to allow payment past age 18 as a disabled adult.

The FO must determine if it can request a DDS determination for a Clark case via the Electronic Disability Collect Systems (EDCS). If the initial claim was:

• •

  technically denied and never had a DDS determination, process the case through EDCS unless an exclusion applies. (Follow the instructions for EDCS cases in DI 52522.001C in this section. See list of EDCS exclusions, in DI 81010.030A.)

• •

  technically denied and the claimant filed a subsequent claim that had a DDS determination, the case is an EDCS exclusion. (Follow the instructions for non-EDCS cases in DI 52522.001D in this section.)

NOTE: If a claim is a Modernized Supplemental Security Income Claim System (MSSICS) exclusion, the FO cannot create the claim in EDCS. See list of MSSICS exclusions in MSOM MSSICS 001.003.

This group of cases involves records that the DDS medically allowed, then terminated because of PPV suspension, and then had a subsequent filing with a medical denial. For these records, the FO should:

1. a. 

   Complete a redetermination (RZ) from the earliest N25 PPV suspension through the present; DO NOT place record into current pay and DO NOT release past due payments;

2. b. 

   Complete an SSA-5002 (Report of Contact) requesting DDS to vacate the subsequent medical denial determination; and

3. c. 

   Reactivate and forward the subsequent claim to DDS:

   • •

     For a Certified Electronic Folder (CEF), follow the EDCS procedures in DI 52522.001C in this subsection. To determine if a folder is a CEF, see DI 81001.005; or

   • •

     For a Modular Disability Folder (MDF), follow the instructions for non-EDCS cases in DI 52522.001D in this section.

When you receive the vacated decision on the subsequent claim from DDS, place the record into current pay and release past due payments, based on the installment procedures in SI 02101.020.

An adult DDS determination is required to reinstate payments for former child recipient whose payments terminated because of a PPV warrant. The FO should:

• •

  obtain the medical forms required in DI 11070.030 for age 18 disability redeterminations;

• •

  complete a redetermination (RZ) from the earliest N25 PPV suspension month through the present; and

• •

  refer the age 18 disability redetermination to DDS.

Add a court case flag in EDCS according to DI 81010.080. In the remarks section of the flag enter Clark Court Order and one of the following case characteristics:

• •

  No subsequent claim after an N25 technical denial;

• •

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

• •

  Subsequent non-Clark technically denied claim;

• •

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

• •

  Title XVI claim with a title II allowance determination or decision with an established onset date later than the title XVI application date of the N25 technically denied claim;

• •

  FO can reinstate benefits-vacate subsequent medical denial determination;

• •

  Age 18 adult disability redetermination; or

• •

  Other (explain reason for referral for disability determination if not one of the items listed above.

Explain to DDS on an SSA-5002 that you need a disability determination for the period from ­­­­­­­­­­­­__________ to_______. For example: “Clark case – disability determination needed from MM/DD/YYYY (protective filing date) to the present.” If requesting the DDS to vacate a subsequent medical determination, explain why you are requesting the DDS to vacate the prior decision. For more information see Storing Non-Medical Evidence in the Electronic Folder (EF) in DI 81010.135.

Transfer the case to the DDS via EDCS according to DI 81010.020.

Send any prior paper folders or electronic folders to the DDS to associate with this claim. For converting CEF cases to paper, see DI 81010.030C.

Attach a paper Clark Court Order flag, located in DI 52522.001E in this section, to the front of the MDF. Complete the recipient’s information and indicate the case characteristics.

Explain to the DDS on an SSA-5002 that you need a disability determination for the period from ­­­­­­­­­­­­__________ to_______. For example: “Clark case – disability determination needed from MM/DD/YYYY (month before subsequent claim’s protective filing date). Subsequent claim filed MM/DD/YYYY (protective filing date) and a favorable (or unfavorable) determination made on MM/DD/YYYY (date of previous DDS determination).” If requesting DDS to vacate a subsequent medical determination, explain why you are requesting the DDS to vacate the decision. Attach SSA-5002 to the blue section of the MDF and place on top.

Attach any prior and subsequent paper folders to this claim before transferring to the DDS.