DI 52115.020: DOL Data Exchange Black Lung Part C Alerts

changes
←	*	→

~~Effective Dates: 03/20/2012 - Present~~
Effective Dates: 08/07/2018 - Present
BASIC (09-08)
DI 52115.020 DOL Data Exchange Black Lung Part C Alerts
A. Department of Labor (DOL) Black Lung (BL) Part C Alerts Beginning July 2007
These alerts generate periodically when a match is done between the records of the DOL's Division of Coal Mine Workers Compensation and the Master Beneficiary Record (MBR).
1. Fields shown on the DOL BL Part C alert
The table below shows all of the fields on the alert.
Field
Description
SSN
Shows the Social Security Number (SSN) on which the match was found.
Miner’s Name
Shows the name of the miner.
Date of Birth
Shows miner’s birth date. (The first three fields are used to verify that the case is a true match.)
Date of Entitlement To Part C Benefits
Shows the first date for which BL Part C may be paid.
Miner’s Payment Status
Shows one of the following codes:
NC-Current Pay
NS-Suspense
NT-Terminated
NA- Suspended for Address
NN-Awarded but revised to non-entitlement
Last Total Family Amount Paid
Shows the entire payment to the family. This amount should include any dimes and should not be rounded down. (Offset this gross amount)
Date Last Amount Paid
Shows the month paid – (Like SSA benefits, BL Part C is paid one month behind.) This field will not show a true date in non entitlement situations. In suspense cases, shows the effective date of suspense
Alert Category
Shows the reason for the alert:
* Category 1(CA1) workers’ compensation (WC) Type (formerly Offset Code (OFC)) not present.
* Category 2 (CA2)
WC Type present and in current payment status (i.e. The ledger account file (LAF) on the MBR is C.)
* Category 3 (CA3)
* WC Type present and in suspense for WC offset (the MBR LAF is SW)
2. Offsetting BL Part C based on alerts – due process
The processing center (PC) takes the following actions:
* Process BL Part C Alerts as third party reports. If the adjustment action causes an overpayment, due process is required prior to any action. Follow GN 03001.025 - Processing Third Party Reports.
* Offset the gross amount of BL Part C as shown in the Last Total Family Amount Paid.
* If the proof in file is greater than one year old, develop for any changes in BL family composition between the last proven rate and the month of the alert and apply offset using the BL Part C actual payment rates shown on DOL’s website at http://www.dol.gov/owcp/dcmwc/benefits_part_c.htm
* Process via Interactive Computations Facility (ICF) (PDB) showing the Type as “BL”.
* If the miner alleges not receiving any BL Part C or disputes the payment rate shown on the alert, contact the WC Carrier, Responsible Miner Operation (RMO) or DOL as appropriate, to verify the payment amount and do not offset until the protest is resolved.
* Send an interim response advising the miner that if the protest is successful, benefits will not be reduced.
If development confirms that the miner is receiving or did receive BL Part C, impose offset via the Interactive Computation Facility (ICF WC/PDB) showing the Type as “BL”.
3. Action needed when BL Part C suspended – Miner’s Payment Status field shows “NS” or “NA”
The PC takes the following actions:
* Contact DCMWC in Washington D.C. by fax (202)-693-1395 or call the local DCMWC office per DI 52115.015C.3. to ascertain the reason for suspension. Always include the miner’s SSN when sending a fax. If DOL states that the benefits are suspended for address, do not provide the MBR address. PC staff with online access can verify the address on DOL records against the MBR. (If they are the same and the DOL payment is suspended for address then address development may be required. Do not take action to suspend benefits pending the development.)
* Contact DCMWC in Washington D.C. by fax (202)-693-1395 or call the local DCMWC office per DI 52115.015C.3. to ascertain the reason for suspension. Always include the miner’s SSN when sending a fax. If DOL states that the benefits are suspended for address, do not provide the MBR address. PC staff with online access to Agency Query System (AQS) for FECA information can verify the address on DOL records against the MBR. (If they are the same and the DOL payment is suspended for address then address development may be required. Do not take action to suspend benefits pending the development.)
* Remove offset for any month BL Part C is suspended for any reason other than address.
NOTE: Consider what effect, if any, the event causing suspension of the BL Part C might have on the disability insurance benefits (DIB).
* Set a 90-day diary for suspended BL Part C to resume.
* Verify resumption of the BL Part C when the 90-day diary expires.
4. Action needed when BL Part C terminated – Miner’s Payment Status field shows “NN” or “NT”
BL Part C usually terminates only if the miner dies or the allowance is reversed to non-entitlement. The PC will:
* Contact DOL's OWCP in Washington D.C. by fax (202)-693-1395 or the local DCMWC office as above to ascertain the reason for termination.
* If Part C BL entitlement has been reversed to non-entitlement, remove the offset that is due to BL Part C regardless of whether the overpaid BL Part C is reimbursed.
* If the miner is appealing the reversal, remove offset and set a 6-month diary for re-contact.
* Obtain a repay statement and input a Special Message to indicate that the repay statement is in file.
* If the appeal is successful and BL Part C is reinstated, reimpose offset and charge DIB overpayment accordingly.
5. Action needed when miner’s payment status is “NC” but last total family payment amount = $0.00
One possible reason for this inconsistency is that the RMO is making the payments. Develop to the DOL, DCMWC regional office per DI 52115.015 for the reason these codes were displayed in such a manner.
6. Alerts that do not require action
Any alert that meets any of the following criteria may be sent directly to files after adding a comment showing no action is necessary:
* Current DIB onset prior to 6/2/1965;
* HA in LAF T8 prior to the date of entitlement to BL Part C; or
* Notice cases where the offset terminated at age 62 and no other type of WC/PDB is involved. See DI 52170.040 for Notice Case information).
B. BL Part C alerts prior to July 2007
Prior to July 2007, the information shown on the alert was substantially the same. However, the data was placed in one long horizontal line on the output form without data field names, making it difficult to decipher. The top line of the alert contained the following data in this exact order:
* SSN (positions 1-9)
* CA (10-11)
* DOL/SSA EXC (12-22)
* Miner's name (last name-first 5 letters; first name-first initial) (23-29)
* Date of Birth (30-33)-MMYY
* Date of entitlement to Part C benefits (34-37)—MMYY
* Miners' payment status (38-39)
* Latest total family amount paid by DOL (includes separate payments to auxiliaries) (40-44)--$$$$c).
* Date the latest total amount was paid (45-48)-MMYY.
The second line of the alert contained the run date. For the so-called Notice Provision cases – cases where the Date of Onset of Disability is March 1, 1981 or earlier or the date of entitlement to disability insurance benefits (DIB) is September 1981 or earlier, (See DI 52170.040), this date would serve as the date of notice if the output provided SSA with the first notice.
Example:
123456789CADOL/SSA EXCPUBLIJOHNQ01480175NC112001291
0192

POMS Reference

DI 52115.020: DOL Data Exchange Black Lung Part C Alerts