DI 52155.040: Processing Disability Claims with a Federal Public Disability Benefit (PDB)

changes
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~~Effective Dates: 09/25/2008 - Present~~
Effective Dates: 05/29/2018 - Present
BASIC (09-08)
DI 52155.040 Processing Disability Claims with a Federal Public Disability Benefit (PDB)
A. Processing initial claims involving Federal PDB
The Modernized Claims System (MCS) application screen Claimant Military Retirement/ Federal Benefits (CLMR) and the Windfall Elimination Provision Input (WEPI) Common screen (which is accessed from the MCS path) collect data on federal pensions and the coverage status of the work on which the pension is based.
The Modernized Claims System (MCS) application screen Claimant Military Retirement/ Federal Benefits (CLMR) and the Windfall Elimination Provision Common screens (which are accessed from the MCS path) collect data on federal pensions and the coverage status of the work on which the pension is based.
If an MCS claim cannot be taken, ask the individual to complete and return the Form SSA-150, Modified Benefit Formula Questionnaire. See form exhibit in OS 15010.130 - Form SSA-150.
B. Interpreting the Civil Service Data Screen (DCSD) in MCS Earnings Computation (EC)
All initial disability (DIB) claims are matched against the Office of Personnel Management (OPM) annuitant database. If there is a match, the Civil Service Retirement System (CSRS) disability data will appear on the Civil Service Data screen (DCSD) (see MSOM MCS EC 001.011).
NOTE: The OPM data only shows the most recent civil service (CS) amount being paid and its effective date (CS PAYMENT AMOUNT EFF field). If any previous amounts are needed, develop per DI 52130.001 – Types of Federal Public Disability Benefit (PDB) Payments.
The table below describes the fields on the DCSD screen:
Field
Description
Action
Annuitant SSN
SSN of the individual with CS data.
Make sure it is the number holder (HA) with the CSRS involvement.
SSA Claim Numbers
Individual’s SSA claim number
None
CS Status
Shows individual’s status on the OPM file. Possible statuses are:
PMT SUSPENDED
ACTIVE
ACTIVE BUT NO NET PAY PENDING CASE
SPECIAL PAY CASE
If other than Active, develop to OPM per DI 52130.001 prior to offsetting.
CS ID
Shows claimant’s OPM claim number followed by his/her first and middle initials and first six characters of the surname.
Use CSRS claim number as the WC/PDB Claim Number in MCS Common Screens or ICF.
DOB:
Shows the Date of Birth present on the OPM file. (May differ from MCS DOB)
None. Follow normal proof of age procedures.
CS DOE
Shows the Civil Service date of eligibility.
Use to determine exemption status.
CS DIB
“Y” appears in this field if the annuitant is receiving a Civil Service disability annuity. “N” appears if the CS annuity is not disability.
If “N” do not offset. Develop to OPM if any question arises.
Offset may apply if “Y”.
CS Months
This field displays the total number of months on which the CS annuity is based.
If the number of covered service months is known, use to determine if 85% covered service exclusion test is met.
CS Annuity SSA COV
“Y” appears in this field if the CS annuity is based on Social Security covered employment. An “N” appears if it is not.
Develop to determine if the 85 percent covered service exclusion is met.
CS Payment Amount EFF
Shows the date of the last change and the amount of the payment
If CSRS is offsettable, offset this amount.
* The details on the MCS EC DCSD screen are proof of the fact and amount of any federal pension.
* Verify any allegation that any of the propagated information is incorrect.
* Explain to the individual that we must offset using the gross amount of the pension before any deductions.
* If it appears the offset exclusions in DI 52130.001 may be met but a determination cannot be made from the DEQY alone, obtain proof of any alleged covered employment. Ask the beneficiary for OPM form SF-2801-1 (Certified Summary of Federal Service), which shows each federal agency and military branch worked for and may be used to verify any covered service shown.
NOTE: Verify any federal service alleged but not shown on the SF 2801-1. Review the Detailed Earnings Query (DEQY) to certify that the earnings meet the covered service exclusion.
* If offset applies:
* Complete the WC/PDB Common screens in MCS to impose PDB offset.
* Code FM for the Source of Compensation on the WC/PDB Claim Data (WPCL) screen in the MCS path. See DI 52155.001 - Completing Modernized Claims System (MCS) Screens When Workers’ Compensation/Public Disability Benefit (WC/PDB) Is Involved.
* After processing a claim involving federal PDB through MCS EC, send an MCS diary or modernized development worksheet (MDW) to the PC indicating that the correct CSPDB indicator – 1 if offset applies or 2 if offset does not apply – needs to be input. MCS does not post the CSPDB indicator. For information on the CSPDB indicator, For more information on the CSPDB indicator, see DI 52130.025 - Field Office (FO)/Processing Center (PC) Input of the Civil Service Public Disability Benefit (CSPDB) Indicator).
NOTE: If the initial claim is processed in the PC, the adjudicator will forward the case to the benefit authorizer (BA)/benefit technical examiner (BTE) via local procedures.
* If an ICF input is needed for an EF101 manual award or an A101 where offset applies and the WC/PDB data fails to propagate or MCS EC fails to produce a correct offset computation, take the ICF action first. Show the Type on the WC/PDB Offset – Claims (WCCL) screen in ICF as FM and code a CSPDB of 1 on the WC/PDB OFFSET – DISPOSITION (WCDA) screen.
NOTE: Offset will still be imposed even if the WC/PDB Offset – Claim Data (WCCD) screen in ICF is coded with a “Y” to the question “Covered Service Excluded?” and the next field shows a percentage of covered service in excess of 85 percent. Neither these fields nor the CSPDB indicator are connected to the computation logic. Therefore, if offset does not apply, do not enter an ICF action.
C. MCS EC PDB Remarks
When you adjudicate a claim involving PDB through MCS EC, the system generates one of a number of remarks to alert you to the possibility of PDB offset or a PDB offset exclusion. Some development is still needed because the system cannot always make all of the determinations necessary to arrive at the correct conclusion regarding offset. Also, when processing the initial claim, consider the reductions and offsets listed in DI 52130.001- Types of Federal Public Disability Benefit (PDB) Payments, subsection C. – Relationship of Federal PDB to other offsets.
1. PDB Offset
This remark means the CSRS annuity is subject to SSA offset because it is not based on any service covered for SSA purposes. This remark will be generated on all cases with a DIB onset of 03/01/1981 through 04/30/1986 and MOET 09/1981 or later where the CS COV = N on the DCSD screen.
2. PDB EXCL
This remark appears on cases with a DIB onset 03/01/1981 through 04/30/1986 when the month of entitlement (MOET) is 09/1981 or later and the CS COV = Y.
Verify that the covered employment is actually from the federal job and not a second job in private employment.
3. PDB Offset 85 Percent Not Poss
If this remark is present, offset the CS disability benefit. Two conditions will generate this alert message:
4. DOO is 05/01/1986 or Later and CS COV = N
Offset. The CS disability benefit is not based on any covered service.
5. Onset is 05/01/1986 or Later and CSCOV = Y
Offset. The system has determined that while some covered employment exists, there is not enough covered employment to meet the covered service exception.
6. Poss PDB Offset Verify 85 Percent
This remark appears for cases with DIB onset of 5/1/1986 or later, when CS COV = Y and the system determined that the individual may meet the 85 percent exclusion but cannot make the final determination.
Verify whether the covered service exclusion is met. Often, the covered service picked up by the system is from private employment outside of the federal government, which of course does not figure into the exclusion determination.

POMS Reference

DI 52155.040: Processing Disability Claims with a Federal Public Disability Benefit (PDB)