Identification Number:
DI 42010 TN 8
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Effectuating ALJ, AC, and Court Decisions (Single Appellant, Single Issue) Sections
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 420 – Processing Appeals Reopenings and Material Received After a Determination
Subchapter 10 – Effectuating ALJ, AC, and Court Decisions (Single Appellant, Single Issue) Sections
Transmittal No. 8, 10/18/2018

Audience

PSC: BA, CA, CS, DE, DEC, DTE, ICDS, IES, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, BIES, CR, ERE, FDE, PETL, RECONE, RECONR, RECOVR;
OCO-ODO: BET, BTE, CCE, CR, CTE, CTE TE, DE, DEC, DES, DS, PAS, PETL, RECONE;

Originating Component

ODP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

DI 42010.010 Deferral of Non Disability Development

Adjusted format of this POMS section, including correcting NOTE: font, and fixing broken links.



DI 42010.010 Deferral of Non Disability Development

A. Background

Nondisability development will be deferred on title II disability claims (and on the title II portion of concurrent title II/title XVI disability claims) until a favorable decision is made. (In title XVI claims, nondisability development is deferred until a favorable decision or hearing request is received.)

B. ODO/DRS procedure

Upon receipt of a title II ALJ reversal in which nondisability development has been deferred, ODO will immediately initiate all nondisability development either through the DO, or directly, as appropriate. The DRS will forward cases to the Reconsideration Branch for development of nondisability factors.

  1. 1. 

    To expedite effectuation of the ALJ reversal, requirements are modified:

    Workers' Compensation development need not be completed prior to effectuation of the ALJ reversal. If the actual amount of compensation has not been verified, the ALJ reversal may be effectuated using the claimant's allegation or the State's maximum amount, respectively. Lag earnings affecting only benefit amounts need not be developed prior to effectuation of the ALJ reversal. This applies only to those cases where lag would affect the benefit amount but is not needed to establish insured status. When proof of age is not critical to eligibility (see DI 11010.055), proof of age development need not be completed before effectuation of the ALJ reversal.

    NOTE: In all of the above situations, the deferred development must be completed following effectuation of the ALJ reversal.

  2. 2. 

    Following effectuation of the ALJ reversal, undertake the following, if necessary:

    1. a. 

      Initiate all previously deferred nondisability development, including auxiliary claims.

    2. b. 

      Most auxiliary claims (including CDB's and DWB's) should be processed as subsequent claims. However, if it is possible to effectuate payment to the NH and auxiliaries simultaneously without delaying payment to the NH, (e.g., the auxiliary development is complete at the time the NH's claim is ready for effectuation) effectuate all claims following existing procedures. Also, if the NH has a future month of entitlement at the time of ALJ reversal (e.g., case is still in the waiting period), ODO or the PSC may delay effectuation until the auxiliary development is complete so that all the claims can be effectuated together. This optional procedure should somewhat reduce the number of subsequent auxiliary claims. However, this procedure should only be used when it is clear that effectuation of the primary and auxiliary claims will be done soon enough to assure timely payment to the NH.



DI 42010 TN 8 - Effectuating ALJ, AC, and Court Decisions (Single Appellant, Single Issue) Sections - 10/18/2018