RS 01602: Processing Claims with Railroad Involvement
TN 12 (01-14)
A. Processing life claims for vested RR workers
As of January 01, 2002, a vested RR worker is a worker with 60 months of RR service accrued after December 31, 1995, or 120 total months of RR service accrued at any time.
To process life claims for vested RR workers:
Process the claim using normal automated systems. MCS EC is capable of processing most RR Cert claims. Import iClaims involving RR Cert just like any other claim.
If applicable, annotate RR certification on the MCS BECF screen, Option 4, per MSOM MCS 009.003.
When an MCS exclusion applies, verify that required railroad coding and RR-Cert entries are present for the Automated 101 (A101) or Electronic Form 101 (EF101) per MSOM MCS 0014.003, MSOM MCS 014.004, MSOM T2PE 009.006, and MSOM T2PE 009.011.
For RR-Cert cases where payment is due, and the case qualifies as a critical case based on RS 02809.015, the PSC Inquiries Specialist will contact the RRB by telephone to request expedited payment.
B. Processing life claims for non-vested RR workers
As of January 01, 2002, a vested RR worker has 60 months of RR service accrued after December 31, 1995, or 120 total months of RR service.
For those claimants with RR work who are not vested RR workers:
Process the claim using normal automated systems, and
Use RR earnings for SSA purposes.
Do not include RR lag earnings until proven. For information on the use of RR lag earnings, see MSOM MCS 005.028.
Include RRB008 paragraph in the notice. To view paragraph language see NL 00720.315.
Certify benefits to the RRB if the claimant meets any of the requirements in RS 01601.310.
For those claimants with no RR work, such as the widow(er) of a deceased railroad employee where the RRB has jurisdiction of the claim for survivor’s benefits, the claim is a RR CERT case (LAF E and not LAF C).
C. Processing claims for Health Insurance/Supplemental Medical Insurance (HI/SMI) under RRB jurisdiction
Follow normal HI/SMI processing procedures to enter HI/SMI entitlement, as well as RRB jurisdiction. Follow procedures in RS 01602.150A in this section. If processing requires an Automated 101 (A101) or Electronic Form 101 (EF101), include RRB jurisdiction of Medicare on the HI Data screen per MSOM MCS 014.011 or MSOM T2PE 009.017.
D. Processing HI only claims, when qualified railroad retirement beneficiary (QRRB) involved
SSA will not establish an MBR for an individual who is uninsured under SSA coverage but who qualifies for Medicare under QRRB.
|
IF… |
THEN… |
|---|---|
|
Earnings record indicates Medicare and the only claimant is a QRRB NOTE: For information on QRRB, see HI 00801.011, HI 00801.012, and HI 00801.106 |
If you have taken a claim, or you have an electronically filed claim, send the claim to the RRB for processing. Send a printout of the application and a hardcopy of the EC determination from the Earnings Comp Print (DAPR) screen as a record of SSA’s certified earnings. MANCLR the MCS claim. Annotate the OF-41, Routing and Transmittal Slip, “QRRB - Filing for Medicare-only”, according to HI 00801.029C. Send claim to: Railroad Retirement BoardBureau of Retirement Claims Health Insurance Operations 844 North Rush Street Chicago, IL 60611 Notify claimant that since RRB has jurisdiction of the claim for HI-only coverage, we transferred the claim to RRB. |
|
A Medicare-only claim misrouted to a PC instead of RRB |
The PC will follow the instructions above to transfer the claim to the RRB. |