Basic (03-12)

DI 71001.010 Border Field Office (FO) Process for Title II Initial Disability Claims Canadian Residents File in the United States

In 2001, The Office of International Operations (OIO) implemented a pilot to allow designated border field offices (FO) and Disability Determination Services (DDS) in the Boston, Chicago, Denver, New York, and Seattle regions to make final disability determinations for Canadian residents without signoff by an OIO Foreign Disability Examiner. The pilot is now a permanent business process and includes designated border FOs and all DDSs in: Alaska, Idaho, Maine, Michigan, Minnesota, Montana, New York, North Dakota, and Washington.

NOTE: These instructions do not apply to continuing disability reviews (CDRs). For CDR processing instructions, see DI 28000.000.

A. Border FO initial claim procedures

1. Eligibility for title II benefits

A Canadian claimant may be eligible for title II disability benefits if he or she:

  • meets disability insured status based on U.S. work; or

  • meets disability insured status requirements based on combined U.S. quarters of coverage (minimum 6 Social Security quarters of coverage (SSQCs) and Canadian (either Canada or Quebec) work credits as described in GN 01702.410 Routing of Claims for U.S. Totalizaiton Disability Benefits.

After determining the claimant’s insured status, follow the steps in the table below.

NOTE: If a non-border field office (FO) receives, a claim filed by a Canadian resident, forward the claim to the Office of International Operations for a medical disability determination.

Number Holder Status

Border FO Action

If the number holder meets disability insured status based on U.S. work

  • Transfer the claim to the DDS based on proposed date last insured (DLI) based on U.S. quarters of coverage (QCs) alone; and

  • Continue to develop the non-medical aspects of the claim simultaneously with the DDS medical development.

If the number holder meets disability insured status based on combined U.S. (6 SSQCs) and Canadian or Quebec work credits,

  • Process a 090 denial;

  • Reload Modernized Claims System (MCS) claim;

  • Transfer the medical portion of the claim to the DDS with the proposed DLI based on Totalization insured status; and

  • Continue to develop the non-medical aspects of the claim simultaneously with the DDS medical development

If the number holder has less than 6 SSQCs,

  • Do not develop medical evidence;

  • Process a 090 denial; and

  • Forward the claim to OIO PC8.

If the number holder has at least 6 SSQCs but does not meet disability insured status when the alleged work (Canadian or Quebec) is considered

  • Process a 090 denial; and

  • Forward the claim to OIO PC8.

NOTE: The border FO verifies Canadian work credits. If the claimant meets Totalization insured status, the FO forwards the claim to the DDS for a medical determination.

2. Initial claims interview

Follow these steps during the initial claim interview process:

  • Collect claimant information in the Modernized Claims System (MCS) and the Electronic Disability Control System (EDCS);

  • Complete all required forms (i.e., application, medical reports and medical releases);

  • Advise all Canadian disability claimants that if a consultative examination (CE) is necessary, the Disability Determination Services (DDS) will try to schedule the CE with his or her medical source(s). If it is not possible, he or she may be required to attend a CE in the U.S. and;

  • Ask the claimant if he or she has a passport or other documents that allows him or her to travel between Canada and the U.S. for the CE, and document this information on the SSA-3367 (Disability Report-Field Office).

3. Non-medical development

a. Concurrent FO and DDS development

Fully develop the non-medical portion of the title II claim simultaneously with DDS medical development. If at any time during the development process, you determine that a claim does not require a medical determination, contact the DDS to request that they transfer the claim back to border FO as a No Determination, according to the instruction in DI 81020.127, Processing “No Determination” (ND) Claims.

b. Non-medical and substantial gainful activity (SGA) denials

Fully develop and resolve potential SGA denials before sending the claim to DDS for a medical determination. If a SGA denial is appropriate

  1. 1. 

    complete all SGA development,

  2. 2. 

    prepare a denial, date, and

  3. 3. 

    release the notice.

After processing the non-medical denial, forward the claim to OIO according to the instructions in DI 71001.010E in this section.

4. Medical development

If the claimant submits medical evidence, follow the instructions in DI 81010.125 Receiving Medical Evidence in the Field Office (FO). If you receive medical evidence after transferring the claim to the DDS, immediately fax evidence into the electronic folder.

B. Adjudication process after receiving a DDS determination

After receiving the DDS determination, associate the disability development and the determination with the non-disability development and complete the following steps.

1. Title II allowance

Trigger payment as a A101 claim and forward the claim to OIO. For paper folders, complete an SSA-3601 Claims Routing, and route the claim to OIO at the following address:

OIO
PO Box 17769
Baltimore, MD 21235-7769
System Destination Code: PC8

2. Title II denial

Update the master beneficiary record with the medical denial code and hold the title II denial claim in the border FO until the claimant files an appeal, or the 6-month retention period expires.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0471001010
DI 71001.010 - Border Field Office (FO) Process for Title II Initial Disability Claims Canadian Residents File in the United States - 03/27/2017
Batch run: 03/27/2017
Rev:03/27/2017