DI 40101: Processing Center (PC) Processing of Initial Claims
BASIC (12-10)
Processing Centers (PCs) process some Title II favorable Disability Determination Services (DDS) and Disability Hearing Office (DHO) reconsidered determinations, Administrative Law Judge (ALJ), and Appeals Council favorable disability decisions. PCs also process DHOs Title II cessation determinations when it involves vocational rehabilitation.
A. Disability determination decided at the initial or reconsideration level
Personnel in the Disability Determination Section (DDS) or the PC Disability Processing Branch (DPB) make the medical determination for disability claims at the initial and reconsideration level. The DDS or DPB then transfers the claim to the parent field office (FO) to effectuate their determination (allowance or disallowance) of the disability claim.
FO claims representatives (CRs) adjudicate and process most claims decided at the initial and reconsideration level, through the Modernized Claims System (MCS). If a CR cannot process a claim through MCS, the FO transfers the adjudicated claim to the PC of jurisdiction for processing through the Manual Adjustment Credit and Award Data Entry (MACADE) system.
B. Disability determination at the ALJ level or above
Processing Center Claims Authorizers (CA’s) adjudicate and process Administrative Law Judge (ALJ) level or above claims. A CA will attempt to process the claim through MCS but if that attempt fails, the CA sends the record to a Benefit Authorizer (BA) for MACADE processing.