GN 03104.385: Processing the Prior Claim (FO/PC)
Effective Dates: 05/15/2006 - Present
- TN 4 (04-01)
- GN 03104.385 Processing the Prior Claim (FO/PC)
- A. PROCEDURE -- TITLE II
- Use MADCAP to process the prior claim and generate notices.
- B. PROCEDURE -- TITLE XVI
- If the AC allows the prior claim, processing depends on the status of the subsequent claim:
- * If the subsequent claim was allowed and there is no active claim iteration on MSSICS, follow One-Time-Payment (OTP) procedures in SM 01901.000 for the benefit payments due for the period prior to the new record. Issue the FO-prepared notice for the AC decision effectuation.
- * If the subsequent claim was denied and there is no active claim iteration on MSSICS, the subsequent claim is considered a duplicate claim. Terminate the subsequent claim and establish and process the prior claim using existing procedures for processing an AC award. Issue the FO-prepared notice for the AC decision effectuation.
- * If there is an active claim iteration on MSSICS, an OTP is not needed. Correct the EFFECTIVE FILING DATE to match the filing date of the prior claim. Complete the living arrangement, income, and resource screens to cover from the EFFECTIVE FILING DATE of the prior claim through the EFFECTIVE FILING DATE of the subsequent claim. Follow instructions in MSOM MSSICS 008.003 and SM 01005.030 for EFFECTIVE FILING DATE. Update Disability Clearance Data (CDIB) with the established date of onset and other disability information contained in the AC decision. Build the SSR. Issue the FO-prepared-notice for the AC.
- FAX a copy of the award notice to OAO:Kathy Doehling Office of Appellate Operations (OAO) FAX number (703) 605-7101 or E-mail Kathy Doehling @HQ-Exchange
If the AC issues an unfavorable decision or denies the request for review, it will retain the claims file for 120 days pending a possible civil action. If the folder is needed before the 120 days expires, direct requests to the appropriate ODAR location as shown on CICS (obtain an OHAQ). The folder is held either in the ODAR Megasite or the Disability Program Review Branch with jurisdiction over the case. T he Megasite may be contacted by fax at (703)274-0001. At the end of 120 days, the AC will return the claims file to the component which has the subsequent application.
- C. EXHIBIT
After completing appropriate action on the subsequent application, attach the flag at GN03104.390 and the OHAQ when routing the subsequent application and/or claims folder to the AC. This will alert offices to the fact that there is a request for review pending at the AC on a prior claim.
x← This means that the line was removed and was added – in other words, the "Effective Dates" line at the top of the document has been updated to reflect that the new version is effective as of the date the change was made.