Effective Dates: 05/07/2012 - Present Previous | Next

TN 3 (07-08)

DI 81010.155 Processing Subsequent Claims or Appeals Filed While a Prior Claim or Appeal is Pending at the Appeals Council (AC)

NOTE: If a claimant files a new disability application and has a prior disability claim for the same title and benefit type pending at any level of administrative review, see DI 51501.001- Procedural Change for Subsequent Disability Applications Effective July 28, 2011. However, if the claimant has an appeal pending for a different title or benefit type, process a new disability application according to the following instructions, as applicable.

A. Overview

When a claim is pending at the AC level and an individual files a subsequent claim, process the subsequent claim:

  • •

    As a new initial claim; and

  • •

    Under current claims processing procedures with normal appeals through the filing of a request for an Administrative Law Judge (ALJ) Hearing.

For instructions on handling subsequent claims filed while a claim is pending at the AC, see New Claims or Appeal Filed While a Prior Claim or Appeal is Pending before the Appeals Council (AC) – Title II or Title XVI - DI 12045.027.

B. Processing the subsequent claim or reconsideration as a Certified Electronic Folder (CEF)

If the subsequent initial or reconsideration claim is a CEF the FO:

  1. 1. 

    Establishes the claim in EDCS and processes per CEF procedures in Field Office Procedures – Certified Electronic Process - DI 81010.000;

  2. 2. 

    Follows instructions in New Claims or Appeal Filed While a Prior Claim or Appeal is Pending Before the Appeals Council (AC) – Title II or Title XVI - DI 12045.027; and

  3. 3. 

    Adds the flag type “Subsequent Claim” in EDCS. For more information on flags, see DI 81010.080 Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS). In the flag “Description” box, add the following information:

    • •

      Date the AC review was requested;

    • •

      Office of Appellate Operations (OAO) branch with jurisdiction of the ALJ decision; and

    • •

      “Claimant has filed a new application and has an appeal of an ALJ decision on a prior application pending at the Appeals Council. See CPMS Query.”

The FO is notified on the EDCS Actions Page when:

  • •

    DDS/OQR makes an allowance or denial determination on the subsequent claim;

  • •

    DDS/OQR closes the claim with a No Determination (ND) with reason “Stopped Processing Duplicate Claim”; or

  • •

    DDS/OQR cannot do an ND to stop processing the duplicate claim and the FO needs to do the ND with reason “Stopped Processing Duplicate Claim.”

  • •

    AC receives a change of address

1. Processing a favorable determination on subsequent claim or reconsideration

If DDS/OQR makes a favorable determination on the subsequent claim, the FO processes the claim following DI 12045.027D New Claim or Appeal Filed While a Prior Claim or Appeal is Pending Before the Appeals Council (AC) — Title II or Title XVI.

NOTE: If the AC appeal is pending in EDCS, the FO does not need to notify the OAO. EFI automatically sends a message to the AC stating “A favorable determination was made on another case for this SSN (insert SSN)” when the DDS/OQR determination is an allowance.

2. Processing an unfavorable determination on subsequent claim or reconsideration

If the DDS/OQR makes an unfavorable determination on a subsequent claim the FO:

  • •

    Processes any reconsideration or hearing request following DI 81010.150 Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS);

  • •

    Routes the claim to DDS or ODAR as appropriate; and

  • •

    Retains the “Subsequent Claim” flag when transferring.

3. AC makes fully favorable decision or remands the case to the Hearing Office (HO)

If the AC makes a fully favorable decision or remands the case to the HO and a common issue exists and subsequent application is pending in the DDS/OQR:

a. DDS/OQR at version 12.0 or higher

The DDS/OQR must close the claim with a No Determination (ND) with reason “Stopped Processing Duplicate Claim” when the AC has made a favorable decision or the case has been remanded to the HO and there is a common issue.

  1. 1. 

    Title II

    The FO takes the following actions in MCS:

    • •

      Completes the RPOC concerning duplicate claim; and

    • •

      Manclears the claim.

  2. 2. 

    Title XVI

    The FO takes the following actions in MSSICS:

    • •

      Updates the subsequent claim record to match the record of the case pending in the HO;

    • •

      Changes effective filing date to previous claim filing date;

    • •

      Inputs the DDS denial determination from prior claim;

    • •

      Loads the appeal information to the AC level so that the pending claim looks like the previous claim; and

    • •

      Annotates remarks field (e.g. “Duplicate claim of claim filed mm/dd/yy”).

b. DDS/OQR not at version 12.0 or higher

If DDS/OQR cannot do an ND with reason “Stopped Processing-duplicate claim” because they do not have the appropriate software version, DDS/OQR does an ND in NDDSS, transfers CEF to the servicing FO and adds a message to the CEF requesting an FO determination showing the reason “Stopped Processing Duplicate Claim.” The FO

  • •

    Closes the case in EDCS with an FO determination/ND with the reason “Stopped Processing Duplicate Claim.” See DI 81010.140 Processing Field Office (FO) Determinations.

  • •

    Takes actions in MCS and/or MSSICS per DI 81010.155B.3.a.

 

NOTE: EFI will automatically add a new document to the red section of the EF that states, “Processing stopped because the claim became a duplicate claim on (MM/DD/YYYY), at the request of the Appeals Council or Hearing Office.”

4. AC Appeal is remanded to Hearing Office and a subsequent application is pending at FO and has been entered into EDCS

If an AC appeal is remanded to the HO and a subsequent application is pending at the FO and it has been entered into EDCS, the FO:

  • •

    Receives a message on the Actions Page that there is a pending claim at the HO (“AC Remand-Multiple cases involved”); and

  • •

    Contacts the HO according to local arrangements (phone, e-mail, fax, etc.) regarding common issue per DI 12045.021 Appeal Processing Chart/Common Issue Cases.

a. HO determines a common issue exists

If the HO determines a common issue exists, the FO:

  • •

    Closes the claim in EDCS with FO Determination/No Determination with reason “Stopped Processing Duplicate Claim.”

    NOTE: EFI automatically adds a new document to the red section of the EF that states, “Processing stopped because the claim became a duplicate claim on (MM/DD/YYYY), at the request of the Appeals Council or Hearing Office.”

  • •

    Takes action in MCS and/or MSSICS per DI 81010.155B.3.a.

b. HO determines no common issue exists

If the HO determines no common issue exists, the FO:

  • •

    Processes the subsequent claim following DI 81010.000, FO Procedures - Electronic Process

5. AC Appeal is remanded to Hearing Office and a subsequent application is pending at FO and has not been entered into EDCS

If an AC appeal is remanded to the HO and a subsequent application is pending at the FO and it has not been entered into EDCS, and the:

a. HO determines a common issue exists

If the HO determines a common issue exists, the FO:

  • •

    Does not establish a new EDCS record. If the FO attempts to establish a subsequent application in EDCS while an appeal is pending at the HO, an edit will occur and will not allow the FO to take this action.

  • •

    Follows current procedures for closing out MCS and MSSICS. See DI 12045.027 New Claim or Appeal Filed While a Prior Claim or Appeal is Pending Before the Appeals Council (AC) — Title II or Title XVI.

  • •

    Faxes all new evidence from the subsequent claim into the pending HR level claim using eView. HO will receive an alert when the evidence is received.

  • •

    Adds a message to the pending HR level claim stating, “See ORS. Application filed on (MM/DD/YYYY).”

b. HO determines no common issue exists

If the HO determines no common issue exists, the FO:

  • •

    Creates a paper MDF with a subsequent claim flag attached; and

  • •

    Routes the folder to the DDS following DI 81010.000.

6. AC Decision Made and a Subsequent Claim Pending in FO

a. Fully favorable decision

When the FO is notified the AC has made a favorable decision on the AC case and the Subsequent claim is pending in the FO, the FO:

  • •

    Receives a message on the EDCS Actions Page that the “AC made a fully favorable decision on an earlier filed claim for this SSN (insert SSN). Stop processing subsequent application.”

  • •

    Closes the claim in EDCS with a FO Determination/FO ND reason “Stopped Processing Duplicate Claim.”

  • •

    Follows current procedures in DI 12045.027 New Claim or Appeal Filed While a prior Claim or Appeal is Pending Before the Appeals Council (AC)- Title II or Title XVI.

b. Less than fully favorable decision

When the FO is notified the AC has made a partially favorable decision, unfavorable decision, dismissal or denies request for review on the AC case and the Subsequent claim is pending in the FO, the FO:

  • •

    Receives a message on the EDCS Actions Page that the “AC made a (insert decision) on an earlier application for this (insert SSN).”

  • •

    Follows current procedures in DI 12045.027 New Claim or Appeal Filed While a prior Claim or Appeal is Pending Before the Appeals Council (AC) - Title II or Title XVI.

NOTE: When the AC decision is partially favorable, the FO receives a fax from the AC that includes the “SUBSEQUENT CLAIM FLAG” with a copy of the AC decision. The FO develops non-medical issues, if any remain to be resolved with respect to the subsequent claim.

C. Processing the subsequent claim or reconsideration as a Non-CEF

If the subsequent claim or reconsideration is a CEF exclusion (see Certified Electronic Folder (CEF) Exclusions - DI 81010.030),

  • •

    Create a paper Modular Disability Folder (MDF) for the claim per Certified Electronic Folder (CEF) Exclusions - DI 81010.030C; and

  • •

    Follow procedures in New Claims or Appeal Filed While a Prior Claim or Appeal is Pending before the Appeals Council (AC) – Title II or Title XVI - DI 12045.027.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0481010155
DI 81010.155 - Processing Subsequent Claims or Appeals Filed While a Prior Claim or Appeal is Pending at the Appeals Council (AC) - 05/07/2012
Batch run: 10/30/2024
Rev:05/07/2012