POMS Reference

GN 01050: Assembly, Jurisdiction and Routing of Claims

TN 1 (06-86)

A. General

The DO will send new monthly benefit claims, to the processing center in which the previously adjudicated, cross-referred claim is being maintained, unless either claim is payable from the Disability Insurance Trust Fund or the new claim requires a disability determination. In this connection, it will be necessary to ascertain whether GN 01050.055 A. or B. would require the cross-referred claim to be maintained in the INTPSC.

For routing of new disability claims, see DI 11010.000ff., DI 11020.000ff., DI 11025.000ff. and DI 11010.255. When a new claim involves a foreign address, the DO will forward the claim to INTPSC (see C below).

When a claimant files for both RIB and spouse's benefits but is not insured for RIB, the claims will generally be processed together. Do not prepare an SSA-3293. Check item 4(b) on the SSA-3601 transmittal form and route the claims together to the PSC servicing the spouse's claim. When a claimant files for both RIB an spouse's benefits but the RIB precludes spouse's benefit entitlement, do not prepare an SSA-3601 or SSA-3428-U2 for the spouse's claim. Include paragraph RM 40 on the SSA-3687-U2 for the RIB claim and forward the claims together under transmittal form SSA-3293 to the PSC servicing the RIB claim.

When a husband and wife are each entitled to a primary benefit, one of which is a DIB, each of their respective claims is handled by the appropriate processing center (a servicing PSC, or INTPSC) whether developed simultaneously or one subsequent to the other. The DIB is reviewed if necessary and then maintained (i.e., filed and serviced for post-entitlement actions) by ODO or in those cases where the individual applying for benefits on the social security number resides outside the United States or used a foreign mailing address, the DIB is reviewed if necessary and maintained by INTPSC. The RIB claim is reviewed if necessary and maintained by the appropriate servicing PSC. If either spouse is also entitled to an additional amount as a spouse (i.e., the auxiliary benefit is higher than the primary benefit), the additional amount from the other trust fund will generally be paid to the beneficiary involved in a separate check.

In all cases in which more than one processing center may be involved, include with each claim a microfiche print, an MBR or an RC showing any pertinent information (e.g., identification of the other processing center, SSN, DB, date of entitlement, PIA, amount of benefit, and payment status) about the claim filed on the other SSN. Also, all necessary proofs (photocopies or certifications, if necessary) should be in the file even though the original documents may be in the other file. Each file should be completed so that each can be adjudicated without later having to request the other file. When a supplemental SSA-1F6 or SSA-2F6 is filed, include a photocopy of the fully completed application with the respective claim.

Example:

A woman files for RIB and for wife's benefits on the SSN of her disabled husband. The DO will send her RIB claim with necessary proofs to the servicing PSC, while the claim for wife's benefits with necessary proofs will go to ODO. (If both are living abroad both files will be sent to INTPSC.)

B. Subsequent claims

The DO will forward all subsequent claims (claims based on an E/R on which there has been prior claims action) to the PSC servicing the prior claim on that E/R. This rule will be followed even if the claimant is also filing for an RIB on an SSN serviced by another PSC or if the claim is also cross-referred to a previously filed claim in another PSC.

The only exception to this is a subsequent claim filed by a survivor who is the sole entitled survivor on that SSN and is also entitled on his/her own SSN. When this occurs the WIB/CDB claim should be routed to the PSC servicing the RIB account for handling as set forth in GN 01050.075.

C. Claims involving foreign address or residence

A new claim with a foreign address or residence will be sent to INTPSC for review. If the claim is cross-referred to a previously adjudicated RSI claim INTPSC will cross-refer and/or obtain the prior or related folders, as necessary. If the previous claim is in ODO the new claim will be sent to INTPSC. Cross-referral will be handled in INTPSC in accordance with the procedure outlined in GN 01050.075.

D. New claims without foreign or disability involvement

New claims without foreign or disability involvement which are cross-referred to previously adjudicated claims will be forwarded by the DO to the PSC which services the previously adjudicated claim except when the two claims are both RIB claims (see the Claims Routing Guide in GN 01050.075).

In most cases, if RIB claims of a husband and wife are filed or developed simultaneously, and different processing centers are involved, each will be sent to the processing center having jurisdiction of that case. If, however, the wife is entitled to spouse's benefits, both cases will be sent to the PSC servicing the husband's claim. After PSC adjudicative action, the wife's RIB claim will be sent to the PSC servicing her claim in accordance with GN 01050.075 for payment and filing. Post-entitlement information pertaining to the wife should be sent to the PSC servicing her RIB claim.

E. Technical entitlement on one SSN and payment on another SSN

In instances involving one or more claimants who will be technically entitled on one SSN but paid on another SSN (e.g., children entitled on two SSN's involving the combining of family maximums) the following rules apply. If both claims are initial life or subsequent life claims or if both claims are initial death or subsequent death claims, send both claims to the processing center having jurisdiction of the SSN on which payment will be made. If one claim is a subsequent life claim and the other is a subsequent death claim, send the claims to the processing center having jurisdiction over the SSN for the life claim. If one of the claims is ODO-jurisdiction, cross-refer the claims, include a microfiche, MBR extract, or RC with information about the other claim, and route the claims separately.

F. Totalization claims

All claims for totalization benefits are under INTPSC's jurisdiction (see GN 01702.310).