Effective Dates: 07/20/2012 - Present Previous | Next

TN 1 (11-02)

DI 12045.030 Same Title Claims – New Claim Filed, Prior Claim at Reconsideration Level

A. Introduction

This section covers what to do when a claimant files a new claim while a claim is pending at the reconsideration level under the same title.

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.

B. Definitions

1. Duplicate Claim

A claim is a duplicate if an individual filed a previous application for the same benefits and there has not been a final decision on that claim. See GN 00204.028A.

2. Related Claim

Disability claims filed by or for the same individual under the same title (DIB, DWB, CDB) are related if they share the same deciding issue, whether medical or substantial gainful activity (SGA).

C. Policy

1. Field Office (FO) Jurisdiction

If a prior claim is being reconsidered, the FO continues to process any new claims that are the jurisdiction of the FO.

2. Disability Determination Services (DDS) Jurisdiction

After any necessary action, the FO forwards new applications that are DDS jurisdiction to the DDS for determinations and required notice(s). The DDS will combine the claims and issue one determination or prepare two separate determinations and issue appropriate notices.

D. Procedure — SGA Issue

Take the following action if a new claim is filed and there is a request for reconsideration pending:

1. Duplicate Claims

If the new claim filed represents the same issue:

  • •

    Combine the claims and issue a combined notice.

If the FO affirms initial denial of the previous claim:

  • •

    Refer to the new application with a closeout paragraph.

If the SGA cessation of the previous claim is affirmed:

  • •

    Prepare two determinations, i.e., SSA-831-U3/C3 and SSA-833-U3/C3.

2. Related Claims

If a request for reconsideration is pending and the claimant files a related claim, take the following action:

  • •

    Escalate the related claim to the reconsideration level.

  • •

    Complete the reconsideration determination on the pending reconsideration claim.

  • •

    Prepare a combined determination for the related claim. Include the following remark on the SSA-831-U3/C3 - “Recon Escalation - Combined Initial and Reconsideration Determination”

  • •

    Prepare the appropriate notice to include the right to an ALJ hearing. Follow instructions in NL 00601.150.

  • •

    Prepare the personalized attachments for each claim.

3. Different Issues involved

If different issues are involved:

  • •

    Process the claims independently

  • •

    Document each claim as necessary.

E. Procedure — Medical Issue

  • •

    Contact the DDS to advise that a new claim has been filed.

  • •

    Certified Electronic Folder -- follow DI 81010.095 Using the Update-After-Transfer (UAT) Utility

  • •

    Paper Folder:

    • –

      Prepare a Report of Contact (RC) (SSA-5002) to include the date the claim was filed along with any updated information, i.e., new medical information, change in onset, etc. that may assist the DDS in completing their determination. Advise DDS to associate this information with the reconsideration request.

    • –

      Route RC with any updated medical information to the DDS via SSA-408 route slip.

    • –

      Annotate the route slip to associate this medical information with reconsideration dated (mm/dd/yy).

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412045030
DI 12045.030 - Same Title Claims – New Claim Filed, Prior Claim at Reconsideration Level - 07/20/2012
Batch run: 01/14/2019
Rev:07/20/2012