TN 13 (08-97)

DI 12015.006 FO Procedures - Case is No Longer Part of the Test

A. Procedure - Action Required on Receipt of the Claims Folder

Follow these instructions when you receive a former FPM claim which is no longer in the test.

  • Send any FPM Case Flag, Job Tickets, or SDM Questionnaire marked “change of address” to the address below:

    • OD Redesign Staff
      Attn: FPM Oversight
      560 Altmeyer Bldg.
      6401 Security Blvd.
      Baltimore, MD 21235-6401

  • For action on unadjudicated claims transferred from a test site, follow B. below. For action on any appeals or inquiries, follow C. below.

B. Procedure - Claims Processing Procedure

1. DDS/DTU/ODIO Denial Notices or Initial Claims Award Notice Has Been Sent Under the FPM

FPM claims award notices contain special language to explain that for the disability issue the next step in the appeal process is a hearing.

If a FPM claim drops out of the test, do not issue a new notice, even if the claimant files an appeal.

2. Initial Claims Notice Has Not Been Issued

If the claim drops out of the test prior to release of the award notice, the current process award notice, explaining that reconsideration is the next step in the appeal process, applies. Take the following actions for unadjudicated former FPM claims for which the DDS made a fully or partially favorable disability determination.

a. Title XVI

  • Input disability decision data for all disability allowances. For systems input of partially favorable determinations, see SM 01305.001 and SM 01305.930 (closed period of disability) and SM 01305.855D. (later onset).

  • Complete any necessary non-disability development. Follow usual claims adjudication procedures.

b. Title II

  • Complete any non-disability development;

  • Input disability data to MCS (DICL and, for closed period of disability cases, DICL and BECF screens); and

  • Follow usual claims adjudication procedures.

C. Procedure - Appeals Procedure

Take the following action if a claimant who received a notice under the FPM questions the decision on the claim.

1. Advise the Claimant of the Appeal Process

Document the file that you explained the following to the claimant.

  • His/her claim was selected for a test of a new disability claims process.

  • Under that test, the reconsideration step was eliminated. Therefore, the notice we sent explained that a hearing was the next step in the appeal process.

  • Because the claimant moved from the area where the test is being conducted, the test process no longer applies. Therefore, if the claimant disagrees with the determination the next step of appeal is a reconsideration.

2. Follow the Usual Reconsideration Procedures

If the claimant appeals the disability determination, follow the usual reconsideration procedures. Include the folder documentation above in the material sent to the DDS.

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DI 12015.006 - FO Procedures - Case is No Longer Part of the Test - 06/22/2012
Batch run: 06/22/2012