Subchapter Preview:

NOTE: The audience for all sections and subchapters within this chapter is as follows: DO/BO/TSC: OS, RR; PSC: CRTA, DE, DEC, DTE, IES, RECONR; ODO: DE, DEC, DS, RECONE; INTPSC: CIES, ERE, FCR, FDE, RECONE; DDS: ADJ, DHU

TN 1 (12-10)

All employees responsible for case routing in the disability determination services (DDS) need a common understanding of terms that affect the routing of a case.

A. Claims with a common issue

Two or more “related claims” (see DI 32001.005J in this section) that have any overlapping period of time (common period of claimed disability), and the same deciding issue, whether medical or substantial gainful activity (SGA).

NOTE: It is not necessary that the onset dates or time periods are identical (see DI 12045.005).

B. Concurrent claims

Two or more disability claims in process for the same claimant, for different types of benefits or payments.

C. Critical cases

Title II claims identified by the field office (FO), Office of Disability Operations (ODO), or the DDS for priority processing because they involve terminal illness (TERI), dire financial need, or potential for adverse public relations. See also DI 23020.005 Critical Cases.

D. Dual entitlement

Status of a beneficiary who meets disability entitlement criteria for more than one disability benefit at the same time. A beneficiary with dual entitlement status may be ineligible for title XVI payments because of a non-disability reason.

E. Duplicate claims or applications

Two or more disability claims or applications, for the same claimant, and the same benefit, payment, or period of disability, filed either:

• before the release of the notice of an initial determination on the prior application; OR

• after the release of the notice of a favorable determination on the prior application with disability established as alleged.

F. International Program Service Center (INTPSC)

Operating component of the Social Security Administration (SSA) Office of International Operations (OIO) that handles program service center functions for foreign claims (PC-8).

G. “No determination” claim

A claim, processed through the DDS that does not require a disability determination.

H. Quality assurance (QA) review

A quality review, required by SSA regulations, to measure DDS performance and accuracy. Before effectuation, SSA selects a random sample of DDS determinations for QA review by the Office of Quality Performance (OQP); QA review evaluates decisional accuracy as well as documentation. See GN 04440.005 and DI 30005.005.

I. Preeffectuation review (PER)

A quality review of 50 percent of all favorable title II, title XVI, and concurrent DDS initial, and reconsideration determinations; required by the Social Security Act. The PER sample targets those determinations most likely to be incorrect, for identification and correction before they take effect. See DI 30005.005.

NOTE: Favorable title XVIII Medicare for Qualified Government Employment (MQGE) disability claims are also subject to PER review.

J. Related claims

Two or more disability claims filed under the same SSN.

See also:

• DI 32001.005A. in this section

• DI 27010.005 New Application with Reconsideration

• GN 01010.030 Identifying Prior Claims Filing Situations in the FO

K. Reopening

Agency review of a determination or decision that is otherwise final and binding under conditions specified by SSA regulations. See DI 27501.001.

L. Reopening and revision

When reopening is allowed, an amended determination that may be issued after a reopening review. See DI 27501.001.

M. Request for reconsideration

A written request for review of an initial or continuing disability determination. See DI 27001.001 and DI 29001.001

N. Return

A case sent back to the DDS by OQP or an ODO component for further action.

O. Subsequent claim

A disability claim filed for a claimant who was previously determined “not disabled”, under the same title of the Social Security Act, in a decision or determination that is now final and binding.

P. Unanswered inquiry

A congressional inquiry pending final response by ODO central office or assistant regional commissioner – management, operations, and support (ARC-MOS).