TN 18 (09-07)

Citations:

20 CFR 404.1619 Quick Disability Determination process

20 CFR 416.1019 Quick Disability Determination process

A QDD case is an initial Electronic Disability Collect System (EDCS) case identified electronically via a predictive model as having a high degree of probability that the claimant is disabled and that evidence of the claimant’s allegations is expected to be easily and quickly obtained and the case can be processed quickly in the disability determination services (DDS).

A. Identifying QDD Cases

QDD cases are systems-identified when the FO transfers the EDCS segment of the case to the DDS. At the point of EDCS transfer:

1. Predictive Model software automatically scores the case to determine if it should be marked for QDD processing; and

2. An on-screen alert in EDCS notifies the claims representative (CR) that the case is a QDD case.

Cases that are fully-paper (all claims in the case are EDCS exclusions) are not considered for QDD. At least one of the claims must be established in EDCS in order for the predictive model to run to consider the case for QDD. However, the official folder may be either a Certified Electronic Folder (CEF) or a paper Modular Disability Folder (MDF).

NOTE: Do not inform the claimant that his or her case has been selected for QDD; however, if the claimant asks you, provide the information.

B. Screening for Possible QDD Cases at the Initial Interview

Because full non-medical development is required on all QDD cases, it is helpful to determine if a case might be scored as QDD before taking the claim. To identify a potential QDD case:

1. Conduct a pre-claim interview to identify the claimant’s alleged disabilities and determine if the case may be a likely allowance, based on Presumptive (PD) or Blindness (PB) criteria, Terminal Illness (TERI) case guidelines and CR experience;

2. Follow TERI guidelines to assist in determining whether to take a full application. (See: The Disability Interview Identifying Terminal Illness Cases DI 11005.601)

3. When screening results indicate QDD, PD/PB or TERI case characteristics may apply to the case, the FO will take a full application.

C. Processing QDD Claims

The following are basic instructions. Continue to follow local and regional instructions regarding faxing and mailing of 827's and medical records.

NOTE: Although a priority case, prior to transferring a claim to DDS the FO is responsible for Substantial Gainful Activity (SGA) development and documentation. For more information on SGA documentation, refer to DI 10505.035 Documenting Employment Cases Using Forms SSA-821 and SSA-823. For information on providing an accurate potential onset date (POD) refer to DI 25501.220 Potential Onset Date (POD) and DI 11005.045-Completing the SSA-3367 (Disability Report-Field Office).

1. Establish the appropriate application(s) for the claimant in Modernized Claims System (MCS)/ Modernized Supplemental Security Income Claims System (MSSICS);

2. Follow FO Procedures-Electronic Process (DI 81010.000) for instructions on Certified Electronic Folder (CEF) processing.

   NOTE: When completing the conditions section in EDCS, use the claimant’s own words. Complete information regarding alleged impairments, medical sources, tests, and medications is critical to correctly identify QDD cases. While standard abbreviations are acceptable (e.g. HBP, AIDS, ALS, PTSD, etc.), use caution when using abbreviations as the Predictive Model software requires complete information.

3. Create a barcode and fax a signed and dated SSA-827 to the certified electronic folder (CEF) prior to case transfer.

   NOTE: Most DDS/DPB/FDUs have the capability to reproduce the back of the SSA 827. Contact the RO to verify whether the disability adjudication component can reproduce the text on the back of the SSA 827. If the component processing the case can reproduce the back of the SSA 827, FOs will only need to fax the front of the signed and dated SSA-827, unless the claimant has written something on the back of the form. If so, then the back should be faxed. See POMS DI 11005.057 - Field Office Instructions for Obtaining Form SSA-827 for instructions for faxing SSA-827s into the CEF.

4. Fax claimant-provided medical evidence of record (MER) of 15 pages or less into the EF prior to case transfer and annotate on the MER barcode cover sheet “Faxed into the EF”, adding the date in MM/DD/YY format.

5. Verify in eView that all documents are available.

6. Flag the case as a PD/PB or TERI case, if applicable.

7. Transfer the case in EDCS.

8. Trigger MCS claims for non-medical completion (NMC) if they meet the requirement in DI 11010.030 - Procedure - MCS Non-Medical Completion; If NMC is not appropriate, tickle the DDSDEC for 20 days.

9. Start PD/PB payment, if appropriate based on DI 11055.230 Field Office (FO) Responsibilities in Presumptive Disability (PD) and Presumptive Blindness (PB) Cases and DI 11055.240 Field Office (FO) Procedures for Processing - Presumptive Disability (PD) and Presumptive Blindness (PB) Cases.

10. If a case is selected for QDD, EDCS presents the [This case has been marked as a Quick Disability Determination case] alert after the [Transfer] button is selected.

    NOTE: All claims within the case are flagged QDD. However, the QDD alert will only appear once. Consider this when coordinating with a claims representative in a different unit.

11. Attach any MER to the EDCS routing form, along with the SSA-827s and send to DDS by regular mail. Annotate on the EDCS routing form “Attached MER to be Scanned” if the MER was not faxed in the EF. The EDCS routing form identifies the case as QDD. Also annotate the SSA-3367 that MER is being mailed.

12. Return to MCS/MSSICS for cases that are QDD (after receiving the alert) and annotate as an issue on the DW01(s) that the case is a QDD case.

13. When the case is selected for QDD processing, the FO will complete all development.

    Do not defer development of any claim on a QDD case. Full applications and full development of non-medical factors are required for all QDD cases.

    In many instances, the claimant is no longer present when the EDCS case is transferred to the DDS. If a deferred application was taken and the case is subsequently identified as a QDD case, immediately re-contact the claimant and complete a full application and all necessary non-medical development as quickly as possible.

14. For non medical denials identified after one claim within a case is transferred, but the other claim remains in the FO, be sure to process the technical denial on MCS/MSSICS AND on EDCS.

15. For non medical denials identified on ALL claims for a QDD case that has been transferred and is pending in either a DDS or a DQB, telephone the DDS or DQB and ask them to remove the case from QDD and then return to FO to process as a non-medical denial.

D. Additional Requirements for Processing QDD Cases with an EDCS Exclusion

In concurrent claims, when one of the claims is an EDCS exclusion, follow the procedures in Certified Electronic Folder (CEF) Exclusions and Limitations (DI 81010.030). In addition, the FO will:

1. Complete all actions in DI 11005.603C. in this section;

2. Place signed, dated, and witnessed SSA-827s, along with any claimant-provided medical evidence, in the paper Modular Disability Folder (MDF); and

3. Attach an EDCS routing form to the front of the folder and forward it to the DDS after transferring the electronic portion of the claim.

E. FO Responsibilities While QDD Claim is at the DDS

• The DDS will contact FO management to resolve any issues the DDS encounters when receipting the QDD case (for example, case transferred to the incorrect DDS).

• Standard TERI follow-up procedures with the DDS are not required.

• Track cases regularly to avoid delayed payment in the event the non-medical completion (NMC) allowance did not trigger.

• Monitor the EDCS Actions Page for cases removed from the QDD process, as well as completed QDD cases. You will receive an alert stating, “Case Removed from QDD”.

• Enter date of removal on received line of DW01 and annotate remarks, if the case has been removed from QDD.

NOTE: Even after a case has been removed from QDD processing, you can view the current QDD status in eView by selecting the QDD indicator link.

F. Adjudication of QDD Allowances - Title II

1. Completed QDD cases appear on the EDCS Actions Page. The following action item appears, “DDS Determination Added” or “OQP Clearance - FO Adjudication Needed”. The EXP column beside the action item indicates “Y”.

   Follow Electronic Disability Collect System (EDCS) Actions Page (DI 81010.100) to clear action items.

2. When you cannot fully adjudicate a QDD claim through Earnings Computations, complete an A101/EF101 and route to the appropriate Processing Center (PC) for processing. Annotate the A101/EF101 in remarks that it is a QDD case. Critical case procedures should be used for telephone follow ups to the PSC or ODO until the claim is fully processed.

G. References

DI 10505.035, Documenting Employment Cases Using Forms SSA-821-BK (Work Activity Report-Employee) and SSA-823 (Report of SGA Determination- For SSA Use Only)

DI 11005.045, Completing the SSA-3367 (Disability Report- Field Office)

DI 11005.601, The Disability Interview Identifying Terminal Illness Cases

DI 11055.230, Field Office (FO) Responsibilities in Presumptive Disability (PD) and Presumptive Blindness (PB) Cases

DI 11055.240, Field Office (FO) Procedures for Processing Presumptive Disability (PD) and Presumptive Blindness (PB) Cases

DI 25501.220, Potential Onset Date (POD)

DI 81010.125, Receiving Medical Evidence in the Field Office (FO)

DI 81010.090, Faxing Documents into the Certified Electronic Folder (CEF) Using Barcodes