TN 2 (03-10)

DI 44001.110 Dual Eligibility Responsibilities

A. Field office (FO) responsibilities

The FO processes railroad (RR) related claims and transfers specific RR claims to Great Lakes Program Service Center-Disability Processing Branch (GLPSC-DPB), location code V32, instead of the State disability determination services (DDS).

GLPSC-DPB adjudicates the case and forwards it to the FO for final processing.

Complete FO instructions are located in DI 11050.000.

B. Overview of GLPSC-DPB responsibilities

New claims received in GLPSC-DPB are assigned to the disability processing specialists (DPS). The DPS receives either a certified electronic folder (CEF) claim in the MIDAS legacy system or a paper modular disability folder (MDF) if the claim is excluded from Electronic Disability Collect System processing per DI 81010.030.

The DPS:

  • Screens the case for the possibility of technical denial or improper routing. If found, returns the case to the FO.

  • Immediately contacts the Railroad Retirement Board (RRB) to determine if they have a disability claim and secures copies of their determination plus any medical evidence per DI 44001.115B.

  • Reviews all claims forms and medical evidence submitted with the case or received from RRB to see if an immediate allowance is possible based on the available evidence per DI 44001.115C.

  • Develops medical and vocational evidence from the claimant’s medical sources as appropriate per DI 44001.115D.

  • Sends the case for medical consultant/psychological consultant (MC/PC) assessment upon completion of medical development.

  • Requests a consultative examination (CE) as required by MC/PC assessment(s). Upon receipt of CE report (or failure to attend CE documentation), the DPS refers the case for MC/PC final assessment per DI 44001.115D.

  • Makes the disability determination, together with the MC/PC.

  • Prepares the case for effectuation of the disability determination.

  • Coordinates determination with RRB.

  • Processes determination(s), and routes closed cases to the FO for final processing.

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DI 44001.110 - Dual Eligibility Responsibilities - 03/23/2010
Batch run: 01/15/2019