POMS Reference

DI 12010: Hearings Level Review - Initial Claims

TN 3 (07-10)

A. Policy when favorable decision is received

Effectuate ALJ and Attorney Advisor decisions immediately upon receipt of the folder or the electronic alert.

NOTE: The ALJ decision will not be effectuated if the field office (FO) or processing center (PC) is informed that the Appeals Council (AC) is reviewing the decision under its authority in 20 CFR 404.969 and 416.1469. Also see DI 42010.205 (Interim Benefits in Cases of Delayed Final Decisions – Title II), and SI 02007.001 (Interim Benefits in Cases of Delayed Final Decisions – SSI), for instructions on paying interim disability benefits when the ALJ’s decision has not been issued or effectuated within 110 days after the date of the ALJ decision because the AC has taken own motion review.

B. Process – Office of Disability Adjudication and Review (ODAR)

1. Medical diagnosis and regulation basis coding

The hearing office (HO) provides the diagnosis and regulation basis coding for all favorable Title II, Title XVI and concurrent Title II and Title XVI hearing decisions rendered. The diagnosis and regulation basis coding is input to the Case Processing and Management System (CPMS). This information will assist the FO and the PC in effectuating the ALJ decisions.

2. Notice of decision

The HO sends a notice of the decision to the claimant and if applicable, his or her representative. The notice can be viewed in eView if the case is linked or in the Online Retrieval System (ORS) for paper cases.

3. Routing of decision

a. For paper cases

Title II

The HO forwards Title II favorable decisions to the PC for effectuation.

Title XVI

The HO forwards Title XVI favorable decisions to the FO for effectuation. See DI 12010.040 and SI 04030.070 for development and effectuation procedures.

Concurrent Title II/ Title XVI

The HO separates the Title II and Title XVI claim folder(s) and routes or transmits them per DI 12010.035B.3.a. and DI 12010.035B.3.b. in this section.

NOTE: Follow the protest procedures in GN 03103.260 for Title II if the FO believes that the hearing decision is clearly contrary to or conflicts with the law and regulations.

b. For electronic cases

CPMS routes the case to the appropriate office.

C. References

MSOM OHA 001.011 – Hearing/Appeal Query Response.

GN 03103.250 - PC Effectuation of ALJ Decisions .