DI 20101: DDS Jurisdiction
TN 4 (12-09)
A. Initial cases
|
Type Claim |
Situation |
Jurisdiction |
Reference |
|---|---|---|---|
|
DIB, DWB, CDB |
Claimant living |
DDS in the State of actual residence |
|
|
CDB, DWB |
Filed after death |
SSA |
Title II Claim Filed After Death (Chart), DI 23510.025 |
|
DIB |
Filed after death |
DDS in the State of residence at death, or SSA, if filed more than three months after death |
Title II Claim Filed After Death (Chart), DI 23510.025 |
|
DIB |
Death within waiting period |
SSA |
Title II Claim Filed After Death (Chart), DI 23510.025 |
|
DIB, DWB, CDB |
Claimant dies after filing |
DDS in the place of residence at time of receipt |
Title II Claim Dies After Filing (Chart), DI 23510.020 |
|
CDB |
AOD after age 22 or more than 7 years after CDB termination |
SSA. See P.L. 108-203 for an exception due to SGA cessation- Then DDS has jurisdiction. |
|
|
DIB, DWB |
AOD after DLI/PP |
SSA or DDS in the State of residence - see reference |
|
|
DIB, DWB |
EOD after DLI or PP (returned to DDS) |
DDS in the State of residence |
|
|
DIB |
Application prior to date first insured |
DDS in the State of residence |
|
|
Title XVI |
Claimant dies after filing |
SSA or DDS in the State of residence |
Title XVI Claimant Dies After Filing (Chart), DI 23510.035 |
|
Title XVI |
Non-disability alert |
SSA |
|
|
Title XVI |
Receiving DIB, CDB or DWB |
SSA |
DI 20101.001C and Collateral Estoppel, DI 27515.000 |
|
Title II or XVI |
Work issue cases - current onset and no possible closed period or TWP |
SSA |
Initial and Subsequent Work Issue Cases, DI 24001.005 |
|
Title II or XVI |
Engaging in SGA - current onset and no possible closed period or TWP |
SSA |
Initial and Subsequent Work Issue Cases, DI 24001.005 |
|
Title II or XVI |
Work activity is not SGA |
DDS in the State of residence |
Initial and Subsequent Work Issue Cases, DI 24001.005 |
|
Title II or XVI |
FO reversal of technical/SGA Denial |
DDS in the State of residence |
|
|
Title II or XVI |
SGA ceased |
DDS in the State of residence |
Initial and Subsequent Work Issue Cases, DI 24001.005 |
|
Title II |
Engaging in SGA–possible closed period |
DDS in the State of residence |
Initial and Subsequent Work Issue Cases, DI 24001.005 |
|
Title II or XVI |
Engaging in SGA–visual impairment alleged |
DDS in the State of residence |
Jurisdiction of Blindness Cases, DI 26001.010 |
|
DIB |
Totalization |
SSA |
Disability Determination Services (DDS) Review and Development of Totalization Claims, DI 23550.001. |
|
DIB, DWB, CDB |
Foreign claim |
SSA |
|
|
Title II or XVI |
U.S. possession |
SSA |
|
|
Title II or XVI |
Northern Mariana Islands |
Federal Disability Examiner |
|
|
Title II or XVI |
Career railroad or railroad annuitants |
GLPSC-DPB |
B. Subsequent claims
|
Type Claim |
Situation |
Jurisdiction |
Reference |
|---|---|---|---|
|
DIB, DWB or CDB |
Receiving DIB, DWB, or CDB |
SSA or DDS in the State of residence |
|
|
SSI |
Receiving DIB, DWB, CDB |
SSA or DDS in the State of residence |
DI 20101.001C and Collateral Estoppel DI 27515.000 |
|
DIB, DWB, CDB |
Receiving SSI |
SSA or DDS in the State of residence |
DI 20101.001B.4. and Collateral Estoppel DI 27515.000 |
|
DIB, DWB |
Prior denial after DLI/PP |
SSA |
|
|
CDB |
AOD more than 7 years after CDB termination |
SSA. See P.L. 108-203 for an exception due to SGA cessation- Then DDS has jurisdiction. |
|
|
Title II or XVI |
Hearing pending |
SSA |
|
|
Title II or XVI |
AC review pending |
DDS in the State of residence |
|
|
Title II or XVI |
Court action pending-common issue |
SSA |
|
|
Title II or XVI |
Court action pending on same type of claim – no common issue |
DDS in the State of residence |
|
|
Title II or XVI |
Hearing pending on other type claim–common issue |
ALJ |
|
|
Title II or XVI |
Hearing pending on other type claim–claimant or ALJ objects to joining claims or no common issue |
DDS in the State of residence |
C. Reconsideration cases
|
Type Claim |
Situation |
Jurisdiction |
Reference |
|---|---|---|---|
|
Title II or XVI |
Reconsideration requested |
DDS in state of residence |
|
|
Title II or XVI |
Claimant leaves state of initial decision |
DDS in state of residence |
|
|
Title II or XVI |
Claimant leaves state before determination completed |
Transfer to state of current residence |
|
|
Title II or XVI |
Claimant refuses to provide reconsideration evidence |
DDS in the state of current residence |
|
|
Title II or XVI |
Two different DDS prepared different decisions |
DDS in state of current residence |
|
|
Title II or XVI |
FO reconsideration reversal of prior SGA denial |
DDS in the state of residence |
|
|
Title II |
Foreign claim |
SSA (OIO) |
|
|
Title II or XVI |
U.S. possessions |
SSA |
|
|
Title II or XVI |
Career railroad or railroad survivor annuitants |
GLPSC-DPB |
|
|
Title II |
End Stage Renal Disease (ESRD) |
SSA |
Processing Reconsideration, Hearings, and Appeals Medicare ESRD Cases MQGE Cases, DI 45005.001 |
|
Title II or XVI |
Changed Identity |
SSA |
|
|
Title II |
Emergency Clause |
SSA |
|
|
Title II or XVI |
Informal remand of hearing |
DDS which made the unfavorable decision, or SSA (OIO) if it was a foreign claim. (Transfer should be considered on a case-by-case basis with service to the claimant as the top priority). |
Appeals Council (AC) Requests for Development, DI 29501.050A |
D. Reopening cases
|
Type Claim |
Situation |
Jurisdiction |
Reference |
|---|---|---|---|
|
Title II or XVI |
Reopening issue raised during development of a current claim |
DDS handling current claim |
|
|
Title II or XVI |
Reopening issue raised by new and material evidence without new application |
DDS in State of residence |
|
|
Title II or XVI |
Two different DDS prepared conflicting decisions |
DDS in State of residence |
|
|
DIB or DWB |
EOD after DLI/PP (returned to DDS) |
DDS in the State of residence |
E. Continuing Disability Review cases
|
Type Claim |
Situation |
Jurisdiction |
Reference |
|---|---|---|---|
|
Title II or XVI |
CDR |
DDS in the State of actual residence |
|
|
Title II or XVI |
Claimant moves |
Transfer to State of residence |
|
|
Title II |
Foreign claims |
SSA |
|
|
Title II |
Residence in U.S. possessions |
SSA (OIO) |
|
|
Title II |
Career railroad or railroad annuitant case |
SSA |
|
|
Title II |
End Stage Renal Disease (ESRD) |
SSA |
Processing Medicare End-Stage Renal Disease Reconsideration Cases, DI 45005.001 and End Stage Renal Disease (ESRD) Medicare Cases, Including MQGE Cases DI 45001.000 through DI 45010.000 |
|
Title II or XVI |
Changed Identity |
SSA |
|
|
Title II |
Emergency Clause |
SSA |
|
|
Title II or Title II part of a concurrent case |
SGA case |
SSA |
Initial and Subsequent Work Issue Cases, SSA-821-BK (Work Activity Report – Employee), & SSA-820-F4 (Work Activity Report – Self Employed Person). DI 24001.005, DI 10510.025, DI 10505.035, and OS 15025.001 |
|
Title XVI or Title XVI part of a concurrent case |
1619 status |
DDS in the State of residence |
Section 1619 Medical CDRs DI 40540.000 |
NOTE: Claims for Medicare based on ESRD are SSA jurisdiction. The processing center segment of the POMS, DI 45001.000 through DI 45010.000 provides additional information. Section 1619 CDRs are SSA jurisdiction. (See Section 1619 Medical CDRs, DI 40540.001).
F. Claimant moves
|
Type Claim |
Situation |
Jurisdiction |
Reference |
|---|---|---|---|
|
Title II , XVI and Concurrent |
Moves to foreign country (temporary-less than 6 months) |
DDS |
|
|
Title II |
Moves to foreign country (permanent-6 months or more) |
OCO/OIO |
|
|
Title II |
Moves from foreign country |
DDS in the State of actual residence |
|
|
Title II or XVI |
Moves to another State |
Transfer to the DDS in the State of residence |
|
|
Title II or XVI |
Moves to or from Puerto Rico, Guam, American Samoa, Virgin Islands |
DDS in the state of residence, or FO - see reference |
|
|
Title II or XVI |
DQB return and claimant moves (any level claim) |
DDS which received return |
DI 20101.010B.5 and |
|
Title II or XVI |
Reconsideration - claimant moves to another State |
DDS in the State of current residence |
|
|
Title II or XVI |
Reconsideration - claimant moves to or from Puerto Rico, Guam, or American Samoa |
DDS - see reference |
|
|
Title II or XVI |
CDR – claimant moves |
Transfer to the DDS in the state of residence |
G. Work issues
|
Type Claim |
Situation |
Jurisdiction |
Reference |
|---|---|---|---|
|
Title II or XVI |
Work issue cases |
SSA |
Initial and Subsequent Work Issue Cases |
|
Title II or XVI |
Engaging in SGA |
SSA |
Initial and Subsequent Work Issue Cases |
|
Title II or XVI |
Work activity is not SGA |
DDS in the State of residence |
Initial and Subsequent Work Issue Cases |
|
Title II or XVI |
Engaging in SGA - current onset and no possible closed period |
SSA |
Initial and Subsequent Work Issue Cases |
|
Title II or XVI |
SGA ceased after AOD |
DDS in the State of residence |
Initial and Subsequent Work Issue Cases |
|
Title II |
Engaging in SGA, possible closed period or TWP |
DDS in the State of residence |
Initial and Subsequent Work Issue Cases |
|
Title II or XVI |
Engaging in SGA, visual impairment alleged |
DDS in the State of residence |
Jurisdiction of Blindness |
|
Title II or XVI |
FO reconsideration reversal of prior SGA denial |
DDS in the State of residence |
|
|
Title XVI or Title XVI part of concurrent |
Section 1619 case (previously work issue) |
DDS in the State of residence |
Section 1619 Medical CDRs, DI 40540.000 |
H. Special Cases
|
Type Claim |
Situation |
Jurisdiction |
Reference |
|---|---|---|---|
|
Title II |
End Stage Renal Disease (ESRD) |
SSA |
Initial End-Stage Renal Disease Medicare Cases, DI 11052.001 and Processing ESRD Claims, DI 45001.005. |
|
Title II |
Career railroad or railroad annuitant |
SSA |
|
|
DMC |
Disabled minor child (DMC) age 15 1/2 - 18 to entitle parent |
DDS in the state of residence |
Disability Determination Necessary for a Child Age 15 1/2 to Age 18 to Entitle Parent DI 11020.060C and Disabled Minor Child (DMC), DI 23505.001 |
|
MQGE |
Medicare for Qualified Government Employment (MQGE) |
DDS in the state of residence |
MQGE - Background, DI 23540.001 Routing, DI 23540.015 |
|
Title II |
Changed identity |
SSA |
|
|
Title II |
Emergency clause |
SSA |