The FO will refer reopened fugitive felon technically denied claims (DS = N25) with the following case characteristics to the DDS for a disability determination:

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  No subsequent claim after an N25 technical denial; or

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  Subsequent claim with a disability determination or decision after an N25 technical denial; or

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  Subsequent non-Martinez technically denied claim; or

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  Title XVI claim with a title II disability denial determination; or decision for the same period or later; or

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  Title XVI claim with a title II disability allowance determination or decision with an established onset date (EOD) later than the title XVI application date of the N25 technically denied claim.

NOTE: The listed case characteristics are the most common. However, the FO may refer other types of technically denied claims to the DDS, as appropriate.

The FO normally reinstates payments on cases with a medical allowance that terminated because of N25 fugitive felon suspension. However, the FO cannot reinstate cases when there is a subsequent medical denial determination. The FO will refer these cases to DDS for a decision to vacate the subsequent medical determination. Once DDS vacates the subsequent medical denial, the FO can reinstate payments.

If a child recipient’s benefits terminated because of an unsatisfied felony arrest warrant, the FO cannot reinstate payments from the month after attainment of age 18 to the present until the DDS determines the recipient is disabled as an adult. An age 18 disability determination is required.

The FO will send title XVI post-2006 Martinez childhood disability claims to the DDS to make an adult determination to allow payment past age 18 as a disabled adult.

The FO will refer several types of cases to DDS for a disability determination.

The FO will only refer initial claims with a protective filing date of 4/1/2009. The FO must determine if it can request a DDS determination for a Martinez case via EDCS. If there is:

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  no subsequent claim filed after 4/2009, process the case through EDCS unless an exclusion applies. See list of EDCS exclusions in DI 81010.030A.

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  a subsequent claim filed after 4/2009 that had a DDS determination, the case is an EDCS exclusion. Follow the instructions for non-EDCS cases in DI 52520.005C.4. in this section.

NOTE: If a claim is a Modernized Supplemental Security Income Claim System (MSSICS) exclusion, the FO cannot create the claim in EDCS. See list of MSSICS exclusions in MSOM MSSICS 001.003.

Follow the instructions in DI 81010.087 Electronic Disability Collect System (EDCS) Routing Form to prepare tthe form and include the following:

1. a. 

   Add a Court Case flag in the Flag – View Details/Edit Tab. In the remarks box of the flag, identify the case as a post-2006 or pre-2007 Martinez settlement case and indicate the case characteristics in the remarks box of the flag. Example: “Post-2006 Martinez Case – no subsequent claim”

   Post-2006 Martinez case characteristics:

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     No subsequent claim after an N25 technical denial; or

   • •

     Subsequent claim with a disability determination or decision after an N25 technical denial; or

   • •

     Subsequent non-Martinez technically denied claim; or

   • •

     Title XVI claim with a title II disability denial determination or decision for the same period or later; or

   • •

     Title XVI claim with a title II allowance determination or decision with an established onset date later than the title XVI application date of the N25 technically denied claim; or

   • •

     FO can reinstate benefits-vacate subsequent medical denial determination; or

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     Age 18 disability redetermination; or

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     Other (explain reason for referral for disability determination if not one of the items listed above).

   Pre-2007 Martinez case characteristics:

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     No subsequent claim filed after 4/2009; or

   • •

     Subsequent claim filed after 4/2009 with a disability determination or decision; or

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     Subsequent technically denied claim filed after 4/2009; or

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     Title XVI claim with a title II disability denial determination or decision for the same period or later; or

   • •

     Title XVI claim with a title II disability allowance determination or decision with an established onset date later than the title XVI application date of 4/1/2009; or

   • •

     Other (explain reason for referral for disability determination if not one of the items listed above).

2. b. 

   Explain to DDS on an SSA-5002 (Report of Contact) that you need a disability determination for the period from ­­­­­­­­­­­­__________ to_______. If requesting DDS to vacate a subsequent medical determination, explain why you are requesting that the DDS vacate the prior decision. See DI 81010.135 Storing Non-Medical Evidence in the Electronic Folder (EF). EXAMPLE: “Post-2006 Martinez claim- a disability determination is needed from MM/DD/YYYY (protective filing date) to the present”.

3. c. 

   Transfer the case to the DDS via EDCS using the instructions in DI 81010.020.

4. d. 

   Send any prior paper folders or electronic folders to the DDS to associate with this claim. For converting CEF cases to paper, see DI 81010.030C.

If the FO cannot use EDCS to send a Martinez case to the DDS, create a paper Modular Disability Folder (MDF) as described in DI 71005.005. Include the following:

a. Add the Martinez Court Flag, located in DI 52520.005E in this section, to the front of the MDF. Indicate on the flag whether the claim is a post-2006 or pre-2007 Martinez claim with the proper case characteristics.

The case characteristics for post-2006 and pre-2007 Martinez relief are located in DI 52520.005C.3.a in this section.

b. Explain to the DDS on an SSA-5002 (Report of Contact) that you need a disability determination for the period from ­­­­­­­­­­­­__________ to_______. If requesting DDS to vacate a subsequent medical determination, explain why you are requesting that DDS vacate the decision. Attach SSA-5002 to the blue section of the MDF and place on top.

EXAMPLE: “Post-2006 Martinez claim - a disability determination is needed from MM/DD/YYYY (protective filing date) to MM/DD/YYYY (month before subsequent claim’s protective filing date). Subsequent claim filed MM/DD/YYYY (protective filing date) and a favorable/unfavorable (select one) determination was made MM/DD/YYYY (date of previous DDS determination)”.

c. Attach any prior and subsequent paper folders to this claim before transferring to the DDS.