BASIC (12-10)

A. Office of Disability Operations (ODO) and PC jurisdiction for disability claims

SSA jurisdiction for disability insurance benefits (DIB), childhood disability benefits (CDB), disabled widow(er)’s benefits (DWB), Medicare qualified government employment (MQGE), and freeze disability determinations (and responsibility for final authorization) include the following types of claims:

1. Changed identity claims;

2. PC Project Agreements with DDS (See DI 40101.035);

3. Claimant residing in the U.S. territories of the Virgin Islands, Guam or American Samoa;

4. Number Holder (NH) is a career railroad (RR) worker or the disabled dependent of a deceased career RR worker. For processing RR, see DI 44001.105A Great Lakes Program Service Center (GLPSC) only. The GLPSC-DPB makes the disability determination, and then returns the case to the FO for effectuation. For clarification see DI 44001.101A.2. Fifth bullet, DI 44001.110A, and DI 40101.020;

5. Foreign Claims - (Office of International Operations (OIO only) except Canadian claims and residents of Mexico who file for benefits in the State that shares their southern border; or

6. Subsequent claim filed after a prior Administrative Law Judge (ALJ), Appeals Council (AC), or court decision that the claimant was not disabled and the prescribed period or insured status requirements not met within the period adjudicated by the prior determination - claimant submits no new medical evidence.

See Also:

For additional information on Withdrawals and Unprocessed Technical Denials, see DI 40105.000.

B. Route cases to the PC after final adjudication

The FO routes the following claims to the appropriate PC after final authorization. NOTE: Due to their nature, ODO (PC 7) should not encounter these cases.

1. Retirement Insurance Benefit (RIB) or survivor claim filed while DIB claim is pending in the FO or DDS

The following is a list of situations:

1. The number holder (NH) dies within the waiting period of the alleged onset date (AOD) and a different onset date, which would permit entitlement to a DIB or to freeze, could not possibly be established. For example, the claimant worked steadily until AOD. The impairment is traumatic or of acute onset. There is no reason to question the AOD and there was no prior freeze or DIB, which ended within 5 years before that the month the current disability began.

   In this situation, the Disability Determination Services (DDS) examiner enters (in item 27 of the SSA-831-U5) “Death in waiting period—no possibility of earlier onset” and signs his or her name and date. The DDS does not complete any other items on the SSA-831. The FO documents when the case comes back from DDS.

2. Establishing a freeze could not possibly increase the primary insurance amount (PIA) or affect entitlement to any benefits. The FO should explain on a report of contact why a disability determination is not necessary;

3. Disability application is withdrawn. The FO should explain on a report of contact why a disability determination is not necessary. For disability claims withdrawals, see GN 00206.120;

4. DIB insured status is not met and the NH is deceased; or

5. AOD is within 5 months of attaining full retirement age (FRA), the NH did not have a prior period of disability that ended within 5 years before the current disability began, and there is no possibility of an earlier onset.

2. DIB claim filed in or after the 12th month following the month of attainment of full retirement age (FRA)

If an applicant files for freeze, DIB, or both freeze and DIB in or after the 12th month following the month of attainment of FRA, the FO should not request a disability determination. FO routes the claim to the PC. (This situation does not apply to individuals who file an application before or within 36 months after the month of FRA attainment and who may have been physically or mentally incapable of executing an application for a period of disability before the attainment of FRA.) For additional information on extension of the filing period for disability, see DI 25510.010.

3. Disability application filed after death

If a DIB application is filed after death, consider:

1. A DIB freeze claim to be not timely filed per GN 00204.005 through GN 00204.030;

2. NH died during the waiting period and DDS could not possibly establish an earlier onset date to permit entitlement to a freeze, (e.g., he worked steadily until the AOD, the impairment was of traumatic or acute onset, and there is no reason to question the AOD); and

3. DIB insured status not met on or after the AOD and DDS cannot establish an onset prior to the date last insured.

4. Father or mother beneficiary under age 50 filing for determination for Medicare purposes or widow(er) beneficiary age 60-64 alleging disability after the prescribed period ends

The FO sends the PC a request for a disability determination made by DDS for a widow(er) under age 50 receiving mother's or father's benefits or a widow(er) age 60-64 who alleges a disability after the prescribed period ends.

NOTE: The prescribed period for Medicare purposes extends to age 65 rather than age 60 for DWB cases.

This chart reminds all of FO responsibilities:

NOTE: The FO is also responsible for adjudicating all allowances, withdrawals, or denials of claims for disability benefits except as listed in DI 40101.010A (in this section).