PROGRAM OPERATIONS MANUAL SYSTEMPart GN – GeneralChapter 017 – Totalization BenefitsSubchapter 02 – DO Development and Routing of Totalization ClaimsTransmittal No. 6, 09/15/2022
These changes update policies and procedures to be more in line with current practices in Operations, and to parallel recent changes to similar procedures for handling claims for disability benefits under a Totalization agreement.
Summary of Changes
GN 01702.310 Routing of Claims for U.S. Benefits Involving Totalization
Subsection B has been modified to remove references to routing slips and forwarding claims folders, and instead suggests transferred the claim via MCS and updating the MDW.
Subsections C and D have been struck in order to more closely follow the format provided in GN 01702.410
Whenever an applicant alleges on an application for U.S. benefits that the number holder (NH) has coverage in a country with which the U.S. has a Totalization agreement, you should route the claim to the Office of Earnings and International Operations (OEIO), Division of International Operations (DIO) if there is a possibility of entitlement to Totalization benefits. If there is no possibility of entitlement to Totalization benefits, route the application to the program service center (PSC) of jurisdiction. For routing of claims for U.S. Totalization disability benefits, refer to the instructions in GN 01702.410.
When the NH meets insured status requirements based on U.S. QCs alone and Totalization does not establish an earlier month of entitlement, Totalization benefits are not payable. In this case, develop and route the claim to the PSC of jurisdiction.
If Totalization establishes an earlier month of entitlement,
Complete the Modernized Development Worksheet (MDW) screen with a field office (FO) code of PC 8 for retirement or survivors benefits or E15 for disability benefits to show the date the claim is being forwarded to DIO.
Show “Totalization” as the ISSUE when completing the MDW screen.
Add a TICKLE date of the day after you take the action to add the MDW update.
Enter "ADM" as the category for retirement and survivors benefits; enter "2560" as the category for disability claims.
DIO will obtain the foreign coverage record and establish an earlier month of entitlement, if applicable.
When the NH has fewer than six U.S. QCs, entitlement to Totalization benefits is not possible since the NH must have at least six QCs based on U.S. coverage before foreign coverage can be considered (refer to GN 01701.110 for more information on eligibility for U.S. Totalization benefits). If the applicant insists on filing, take the appropriate applications and process the insured status denial. No further action is necessary.
When the NH has at least six U.S. QCs and alleges work in a country with which the U.S. has a Totalization agreement in force (see GN 01701.005B for a full list of Totalization countries), take the following actions:
Take the appropriate application(s).
Process an initial insured status denial (See GN 01702.315 for processing instructions.).
Transfer EDCS to E15 if TOT DIB is involved.
Complete the MDW screen with an FO code of PC 8 for applications for retirement or survivors benefits or E15 for applications for disability benefits to show the date the claim was forwarded to DIO. Show “Totalization” as the ISSUE when completing the MDW screen.
Claims that cannot be electronically routed should be mailed to the Division of International Operations (DIO) at the following address:
Upon receipt of a claim with possible entitlement to a Totalization benefit, DIO will request the foreign earnings record. If the NH is insured based on U.S. QCs but Totalization could establish an earlier month of entitlement, DIO will delete the language from the award notice that says Totalization is not possible because the NH is insured without the foreign coverage. When DIO receives the foreign coverage record, it will convert the foreign credits to QCs, adjudicate the claim and generate an award or disallowance notice, as appropriate.