DI 13010.025: Field Office (FO) Responsibilities in Work Continuing Disability Reviews (CDRs)

changes
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~~Effective Dates: 07/11/2017 - Present~~
Effective Dates: 04/25/2018 - Present
TN 35 (09-12)
DI 13010.025 Field Office (FO) Responsibilities in Work Continuing Disability Reviews (CDRs)
CITATIONS: Social Security Act -- Section 222(c)(1) -(4), 223(a)(1)(D), 223(d)(4), 223(e), 702 note; Regulations -- 20 CFR 404.1571 -404.1575 , 404.1584 -404.1585 , 404.1592, 404.1592a
A. FO responsibilities in work CDRs
When the FO receives a work report or other evidence of work activity, the FO evaluates work activity to determine if eligibility for benefits continues. The FO:
* discusses and develops evidence of earnings and appropriate work incentive information;
* discusses and develops insured status issues, as necessary (for DIB insured status, see RS 00301.120 - DIB Insured Status)
* prepares the determination and appropriate notices;
* provides due process;
* effectuates the determination through direct input if possible, or requests manual action in the processing center (PC) on cases that are direct input exclusions;
* refers cases to the Disability Determination Services (DDS) when a continuing disability medical issue exists;
* assists with direct contact development at the request of the PC;
* processes FO jurisdiction work activity alerts produced by the Continuing Disability Review Enforcement Operation (CDREO);
* develops evidence to establish or disprove a suspicion of fraud;
* develops failure to cooperate (FTC) and whereabouts unknown (WU) cases referred from the PC; and
* initiates medical folder reviews (MFRs) in eWork on CEF cases, and work CDR decisions when the FO has jurisdiction of the case (or folder) at the time of the work CDR decision.
B. FO processing of work CDRs
1. Establishing work reviews in eWork
To begin the work review process, follow these guidelines:
* Select Initiate/Update Work Review from the eWork main menu;
* If this is the first work review established in eWork for this beneficiary, you must enter information on previous work determinations made outside of eWork.
* Review the master beneficiary record (MBR), the disability control file (DCF), and the folder (if available) for previous work determinations. Check the MBR special message field for prior modernized return to work (MRTW) activity. Check the MBR payment HISTORY. In addition to the DIB data not having the ADC, if HISTORY shows either a WIC-2 or prior S7 EPESGA suspense months, there has been a prior cessation If MRTW data migration was not successful, work development may be in another office. If necessary, contact the other office for needed information.
* Develop all work activity and work incentive information as necessary, and control all actions within eWork.
* Effectuate the determination in eWork when development is complete.
* Fax all documentation into eView or NDRed. Documents include forms SSA-833 (Cessation or Continuance of Disability of Blindness Determination and Transmittal) or SSA-899 (Continuing Disability Review), SSA-4268 (Explanation of Determination), SSA-821 (Work Activity Report - Employee) or SSA-820 (Work Activity Report Self-Employment), SSA-823 (Report of SGA Determination – For SSA Use Only), earnings verifications and any other supporting documents.
2. Pending work reviews in eWork
When you establish a work review in eWork, eWork establishes a simultaneous T2 work CDR in the DCF. To maintain control and avoid duplication of work efforts:
* keep the eWork review and the DCF together, pending in the same location; and
* if you need to transfer a work review to another component, use the eWork Case Movement function. eWork automatically transfers the T2 Work CDR in the DCF to the correct component.
If the eWork review is pending at another component determine proper jurisdiction by reviewing:
* the current address of the beneficiary;
* the stage of development of the current work review; and
* a beneficiary-initiated jurisdiction request.
Depending on jurisdiction either:
* transfer all development and the work review in eWork to the other component (use the view case movement feature); or
* contact the other component and request a transfer of the work review from eWork and the DCF to your location.
3. Use eWork to develop and adjudicate the CDR
When using eWork to develop earnings and to adjudicate the work CDR:
* Complete all development and adjudication of work CDRs using eWork (unless an eWork exclusion applies). Some cases appear to be eWork exclusions due to incorrect data on the master beneficiary record (MBR). The most common occurrence is a missing disability cessation date (ADC) code on the disability (DIB) line when we processed a previous cessation.
* Instead of processing these cases as eWork exclusions, correct the MBR by contacting the PC of jurisdiction using the modernized development worksheet (MDW) process with a high priority coding of 2560HP.
You can develop a work CDR exclusion case using the initial claim (IC) functionality. For more information on the IC functionality, see DI 13010.026.
4. Post-entitlement online system (POS) direct input exclusions and terminations, attainments, transfers, and Terminations (TATTER) exceptions
a. POS exclusions
Processing POS exclusions:
* eWork produces a DIB Cess Exclusion Fax that documents all suspension and reinstatement actions needed for POS exclusion cases. If manual action is needed, fax the DIB Cess Exclusion Fax document to the PC’s paperless processing center using the eWork bar code for eWork DECEFFECT/effectuations of eWork decisions. Paperless fax numbers are found at: Centralized FAX Numbers for ALL PSCs.
* eWork posts a DECEFFECT alert for 5 days (to show PC action is pending).
* When the alert matures, check the MBR payment history, DIB line, and the SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal) to determine if the PC updated the MBR. If the action has not processed, follow up with the PC of jurisdiction. PC contact information is located in: KCNET.
For detailed instructions on processing DECEFFECT alerts, go to the: http://kcnet.kc.ssa.gov/cdp/policy.DECEFFECT Tickle Guide.
b. TATTER exceptions
Follow the guidelines below to process TATTER exceptions:
* If the POS input does not process, the system generates a TATTER exception alert in PCACS with type of event levels (TOELs) of STATUS DIBCESS for the PC to resolve. If the POS input excepts, do not re-input your decision in POS.
* Set a DECEFFECT issue in eWork and tickle for 15 days. Continue to check the processing center action control system (PCACS) for status, and initiate a follow up in 15 days if the alert remains unresolved. You do not have to notify the PC for TATTER exceptions. For more information on suspension exceptions, see Suspending Benefits for Title II in DI 13010.160.
* Review the MBR after the PC processes the exception decision to verify that the MBR is correctly updated. If the MBR is not correctly updated, manually set a DECEFFECT tickle for another 15 days and refer the case to your regional office (RO) coordinator for corrective action.
* To ensure accuracy, carefully review the MBR changes for the beneficiary and auxiliaries that are eligible on this account.
5. Questionable results produced by eWork
eWork relies on the user to input accurate information. The ultimate responsibility for work determinations belongs to the adjudicator. If eWork does not produce the anticipated result:
* verify that all information you entered is correct; and
* contact your RO through your Area Work Incentives Coordinator (AWIC) to report systems problems or to request policy guidance.
6. Determining jurisdiction for a work review pending in PC
Use these guidelines to determine jurisdiction when a work review is already pending in the PC:
* Determine if PC initiated development by checking the PCACS query. Check for an action control record (ACR) with type of event levels (TOELs) of DISAB CDRENF, or DISAB CDRWORK, and DISAB WORK.
* If PCACS shows the location of the enforcement is “COS,” no development has begun. Assume jurisdiction of the Work CDR by establishing the eWork work review. Promptly transfer the T2 Work CDR in the DCF to your FO. Telephone the PC to clear the PCACS COS ACR. To obtain the telephone numbers for the PCs, go to the http://kcnet.kc.ssa.gov/cps/t2systems/psc_contacts/index.htm
* If PCACS shows one of the work CDR related ACR’s shown in the first bullet pending in a location other than COS, call the PC to determine jurisdiction of the work review based on the level of development already completed. If the PC has not begun development, assume jurisdiction of the Work CDR and advise the PC to clear their ACR.
* If telephone contact is unsuccessful, check eWork to determine if development has started. Assume jurisdiction if development has not started, and the case is not an eWork exclusion. Leave a telephone message advising the PC that you established a work review, and the PC can clear their Work CDR ACR.
* If telephone contact is unsuccessful, eWork does not show development, and the case is an eWork exclusion, leave a detailed telephone message to determine if PC has pending development.
* Follow up with PC via telephone contact. If you do not receive a response within 15 days, leave another message and update the DCF on the CDR Remarks (IRMK) Screen, that you transferred the DCF to your location and began development.
* If telephone contact is unsuccessful and eWork shows development started, but the beneficiary requests to work with local FO personnel, the PC must transfer eWork to your location before you can assume jurisdiction.
* Leave a detailed telephone message requesting PC contact you or transfer jurisdiction. If you do not receive a response within 15 days contact your RO to request jurisdictional transfer.
7. Jurisdiction when a medical CDR is pending in the FO and the work CDR is pending in the PC
If a medical CDR is pending in the FO and a work review or CDR enforcement is pending in the PC, check eWork and the DCF to determine if the PC has begun work development, then follow these instructions:
* If PC has not begun work development, jurisdiction belongs to the FO. Transfer eWork (and the DCF, if necessary) to your location. If PCACS shows a work CDR in “COS,” telephone the PC, advising them that you assumed jurisdiction of the CDR, and that they can clear their ACR.
* If PC began work development, allow at least 45 days from when the PC initiated the review for them to complete development. If after 45 days the PC has not completed development, contact your RO to request a jurisdictional transfer within 3 work days. Annotate eWork and the DCF Remarks screen with the reason for the work CDR transfer. If PC does not transfer the case, re-contact the RO for assistance. If the beneficiary is in the FO, do not wait 45 days. Call the RO immediately to resolve jurisdiction.
* Resolve any outstanding work development issues, make the substantial gainful activity (SGA) determination in eWork, and forward the case to the DDS for a medical determination.
See also:
* DI 81010.200 Electronic Continuing Disability Review (eCDR) Short Term Process Overview
* DI 81010.240 Transferring the Electronic Continuing Disability Review (eCDR)
8. PC jurisdiction for statutorily blind beneficiaries age 55 or over
The Office of Central Operations, PC Disability Processing Branch (OCO PSC-DPB) maintains jurisdiction for post-entitlement (PE) work issues involving statutorily blind beneficiaries age 55 or over. When you receive a work report or evidence of work activity or earnings :
The Disability Processing Branch in PSCs 1-6 maintain jurisdiction for all work CDRs for statutorily blind beneficiaries age 55 and older, and is responsible for making the comparability determination. When you receive a work report or evidence of work activity or earnings:
* establish a work review in eWork;
* develop and update work activity and earnings information in eWork;
* transfer the work review in eWork and the T2 Work CDR in the DCF to the proper PC of jurisdiction after all development is complete.
eWork automatically places a remark on the CDR Remarks Input Screen (IRMK) of the DCF documenting the reason for transfer (age 55 statutory blind case).
See also:
DI 13010.135 Continuing Disability Considerations in Blindness Cases-Title II

POMS Reference

DI 13010.025: Field Office (FO) Responsibilities in Work Continuing Disability Reviews (CDRs)