GN 01010.030: Identifying prior claims filing situations
Effective Dates: 01/28/2015 - Present
- TN 13 (11-11)
- GN 01010.030 Identifying prior claims filing situations
- A. Policy for identifying prior claims
- The adjudicator is responsible for identifying any prior claims filed when adjudicating an initial or subsequent claim. If the prior claim is archived, you must retrieve the claim to review it and to determine if the information is material to the new claim. This is necessary to:
- * Prevent multiple incorrect benefits or payments;
- * Detect unresolved overpayments for which the claimant is liable or uncollected Annual Earnings Test (AET) penalties the claimant is responsible on this or any other Social Security number (SSN);
- * Identify prior underpayments and determine eligibility for payment to new claimant(s);
- * Discover open applications based on an earlier filing;
- * Determine if the Res Judicata rule applies (e.g., technical denial code of 0S1 on the MBR) per GN 03101.160 and GN 04040.010; and
- * Identify related claim files that may contain evidence previously submitted to SSA.
NOTE: Query the evidence (EVID) screen and the Claims File Records Management System (CFRMS) for required evidence before attempting to retrieve prior claims file (see GN 00301.286 and MSOM EVID 001.001).
- B. Procedures for identifying prior claims
- 1. Detecting prior claims
- Use the following indicators to detect prior claims:
- * An affirmative answer to the prior filing question on the application;
- * Receipt of the message “prior claim” from the Processing Center Action Control System (PCACS) after input of an earnings request;
- * Information obtained from the claimant’s interview;
- * Number Holder (NH) name, SSN alerts or edits generated on the Modernized Claims System (MCS) application (APPL) screen;
- * Prior claims remarks from the earnings computation (EC) data remark (DRMK) screen;
- * Processing limitation remarks regarding possible dual-entitlement (DE) on the MCS Systems Menu (MENU) screen;
- * Information in the Claims File Records Management System (CFRMS), and;
- * Review of the Inquiry Response (I/R) screens or the Master Beneficiary Record (MBR) special message (SP MSG) fields.
- 2. Determining prior filing status
- If you determine that prior filing is involved, review the MCS records and the MBR to determine the status of the prior claim. If an SSN is unknown, access the ALPHA-Index query to locate the SSN. Use the numident query to verify that the SSN located belongs to the claimant. See MSOM QUERIES 003.003.
- 3. Subsequent claim status
- * If the prior filing was a DIB claim, assume that the DIB claim was a denial if:
- * DIB insured status is not met;
- * A certified earnings record shows no prior period of disability;
- * There is no MBR; or
- * There is no feedback from MCS showing a DIB award.
- * If the reply to an MBR or Supplemental Security Record (SSR) inquiry is Not in File (NIF) and enough time has elapsed for the prior claim to update to the MBR or SSR, process the new claim as an initial claim.
- * If the field office (FO) cannot confirm the prior entitlement and suspicion exists that the claimant may be currently entitled on another SSN, contact the processing center (PC) for further development. See GN 01070.200 for more information.
- C. References
- * GN 01070.200 Field Office (FO) use of DOTEL for Claims Actions
- * GN 01010.040 Overpayment on a Prior Claim
- * GN 01010.042 Prior Uncollected Annual Earnings Test (AET) Penalties
- * GN 00204.025 Open Applications
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