TN 1 (07-08)

DI 81020.127 Processing “No Determination” (ND) Claims

The Disability Determination Services (DDS) closes a claim with a “No Determination” (ND) reason when they:

  • cannot make a medical decision,

  • have done substantive work on the claim, and

  • do not expect to receive the claim back.

DDSs use the “No Determination” Decision code (See SM 06001.404 for a description of D831 decision codes) to close claims for a number of reasons. The ND code closes the case in the DDS system.

NOTE: Release of updated software contains new ND reasons that determine how the case is processed electronically, including whether a Field Office (FO) alert is generated. The DDS case processing system must be upgraded to the appropriate version to use the ND reasons. Regional Office will let users know when this function is available.

If the DDS does have the upgraded software, use the following chart to select the appropriate ND reason:

Type of Claim

ND Reason

Scenario

Result

FO Alert Created

Medically Reactivated Claim

“Original Decision Not Changed”

The claim was medically reactivated, but after development, DDS determines:

  • The original decision still applies; and

  • No SSA 831 data was changed.

The claim status and jurisdiction returns to the same as it was before the medical reactivation.

NO

 

“Mistakenly Reactivated”

The claim was medically reactivated by mistake. Should only be selected when there have been no changes at all to the claim. If non-decisional changes have been made, the user selects “original decision not changed”

The claim status and jurisdiction returns to the same as it was before the medical reactivation.

NO

CDR

Initial Claims Only

“No CDR Issue”

After receipting a CDR claim, the DDS determines that one of the screen-out reasons applies (per DI 28030.001E. and DI 28003.005) or the claimant dies.

The claim is closed with jurisdiction at the FO.

YES

CDR Recons Only

“PH Transfer to DH”

The DDS is unable to make a favorable decision after the Pre-Hearing review (PH) and the case must be routed to the Disability Hearings Unit (DHU). (For more information on Pre Hearing Favorable Decision see DI 81020.255B.1.b.)

NOTE: Enter the appropriate DDS as the destination.

An electronic folder interface (EFI) download is created and the claim level changes to DH.

The claim status is “pending” and jurisdiction to the specified office.

NO

CDR Recons Only

“DH Transfer to PH”

The DHU determines that a case needs to be returned for PH review. (For more information on DHU Processing see DI 81020.255B.2.b.)

NOTE: Enter the appropriate DDS as the destination.

An EFI download is created and the claim level changes to PH.

The claim status is “pending” and jurisdiction to the specified office.

NO

CDR Recons at FDDS Only

“DHU Quality Review - Disagree”

The Federal DDS disagrees with a DHU decision and routes the case to the DHU.

An EFI download is created and sent to the DHU.

The claim status is “pending” and jurisdiction to the specified office.

NO

Title II DIB or DWB

“Death in Waiting Period”

The claimant dies during the waiting period. For a concurrent Informal Remand (IR) case, the Title II claim(s) uses the ND reason code “death in the waiting period” and the Title XVI claim(s) uses the ND reason code, “unable to make a fully favorable determination”.

The claim is closed with jurisdiction at the FO. An IR claim is closed with jurisdiction at the originating Hearing Office (HO).

YES

Any Claim

(except reopened claims)

“FO Determination Requested”

The DDS determines that a FO determination is needed (for example, the claimant has returned to work) and routes the claim to the FO.

NOTE: For OQR returns when the controlled return is “Y” enter the OQR office as the destination after corrective action is complete. After review, OQR routes the claim to the FO.

The claim status is “pending” with claim jurisdiction at the FO.

YES

 

“Send to Another Office”

The DDS has performed substantive work on the claim but the claim must be routed to another office (e.g., the claimant moves to another state). Selecting this ND Reason allows the DDS to receive workload credit.

NOTE: If the DDS has not performed substantive work, or if they expect to receive the case back, then use the Transfer decision code (DEC=TR).

For reactivated claims, the DDS must cancel the reactivation before the claim can be sent to any office outside of the DDS state.

Reminder: When sending cases to another disability case processing component for workload assistance and the final determination will be made by the receiving office, use the Transfer (TR) decision code rather than a No Determination (ND) decision code to ensure proper workload credit. For information on transferring cases for workload assistance see DI 81020.125 Electronic Case Routing Before Final Determination.

An EFI download is sent to the designated office.

YES

 

“Stop Electronic Processing”

The DDS determines that a prior claim needs to be reopened, so electronic processing must cease on the current CEF per Processing Reopenings on Certified Electronic Folders (CEF) - DI 81020.115

NOTE: Enter the DDS as the destination and prepare a SSA-5002 (Report of Contact) and an electronic folder message.

The claim status changes to “Transferred” with jurisdiction of the claim at the DDS office. The “Transferred” status means that electronic processing has stopped.

Current Paper Folder Indicator must reflect paper

NO

Informal Remand

Unable to Make a Fully Favorable Decision (UFFD)

The DDS is unable to make a fully favorable allowance on the basis of evidence in file.

The claim is returned to the originating HO.

NO

 

Hearing Office Recall (HORC)

ODAR recalls the Informal Remand, or the DDS determines a fully favorable determination can be made on a CEF IR claim and a reopening of a prior paper folder is necessary.

The claim is returned to the originating HO.

NO

Subsequent Claim Filed

“Stop Processing Common Issue (DDS)”

A new initial claim is filed and an appeal is pending at the Appeals Council or remanded to the Hearing Office. DDS action not needed on new initial claim.

DDS stops working the new initial claim.

YES

NOTES:

  • The new ND reasons only apply to case processing systems that are at Release 12.0 and higher.

  • The new ND reasons and resulting behavior may not be applicable to a claim during an Office of Quality Review (OQR) review.

  • Within the DDS legacy system, the ND reason code “close assistance request” may be provided for use only when closing an assistance request (AR). This ND reason code is for internal legacy system use and is not sent to the Electronic Folder. No other ND reason code is valid for closing an AR.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0481020127
DI 81020.127 - Processing "No Determination" (ND) Claims - 11/03/2017
Batch run: 11/03/2017
Rev:11/03/2017