CASE REVIEW GUIDE
| DOCUMENT AGENCY RECORDS |
ITEM TO REVIEW | ACTION/VERIFICATION |
|---|---|---|
| Initial/Additional Claim | Effective date/date filed Employer(s) - Separation date - Reason for separation Eligibility issues - school - Able & Available Referral/work refusal Disqualifying income - pension - vacation - severance Alien Status Dependents Out-of-State employment Benefit Rights Interview Requalifying wages |
Matches monetary Matches employer/claimant statement: - Separation date - Reason for separation Factfinding statement addressing: - school - Able & Available - Referral/work refusal Verification statements from income source INS verification Verification/documentation Issue addressed Matches claimant questionnaire Earnings verification |
| Monetary Determination |
Number of employers for all listed employers Weeks of work Effective date Base period Weekly benefit amount Maximum benefit amount Matches payment history |
Employer wage verifications and wages - Weeks of work Matches initial claim Correct period for effective date Calculate properly under law Calculate properly under law |
| Monetary Redetermination |
Additional employers Increase/decrease in Weekly Benefit Amount |
Wage verification(s) from added employer(s) Supplemental check(s) issued Overpayment determinations |
| ESARs Printout; ES-511; ERP |
Active registration date Referral dates Employers not on monetary Wage restriction |
Job Service registration Employer verification of result of referral Wage & separation statement Claimant statement on employment Claimant statement on restriction & availability determination |
| Benefit History Printout |
Effective date Weekly Benefit Amount Monthly Benefit Amount Balance Wages/deductions |
Matches monetary Matches monetary redetermination Wage & separation verifications obtained for all employers/weeks Deductions calculated properly |
| Overpayment Printout |
Dollar amounts Weeks affected Balance |
Matches OP determination Notification of errors in calculations to appropriate administrative unit |
| Supplemental Check Printout |
Number of checks issued dollar amount | Matches monetary redetermination |
| Key Week Certification |
Eligibility issues - A&A - School - Return to work - Wages - Separation Work Search contacts Late filing Claimant signature |
Claimant statements/determinations - A&A - Training institution verification - Employer verification - Wage verification - Separation verification Work Search verification(s) Claimant statement-determination Match QC claimant questionnaire - Investigation if discrepancy |
| Nonmonetary Determinations |
Present for all issues detected in above document review | Verification or new factfinding obtained on all issues affecting key week Afforded due process |
| Appeals Decisions |
Fact-finding and Conclusion/outcome | Implementation of conclusion/outcome - Overpayment established - Weeks previously disqualified paid |
| DCI | Coded correctly | Matches information on documentation |
| PROCESS | ITEM TO REVIEW | ACTION/VERIFICATION |
|---|---|---|
| Claimant Interview |
Advised of interview Authorization to Release In-Person interview Questionnaire dated & signed by claimant/ investigator All items completed Potential issues recognized - Alien Status - School Availability - Transportation - Wage demands - Hours/days - Type of work - Child care - Physical limitation - Special licenses Work/referral refusal Wages Separation(s) |
Claimant call-in letter sent
Signed and dated by claimant Explanation if exception Claimant identification Explanation if exception Explanation if exception Match against Agency records -Statements taken on discrepancies -Factfinding statements from employers/ claimants/third parties Nonmonetary issued Wage/separation verification obtained from employer(s) |
| Coding | Claimant codes | Matches information on documentation |
| Employer Interviews |
All forms completed, dated, signed Wages for base period Employer(s) amend Wages for benefit year employer(s) Separation issues Other Incomes - Disability - Retirement - Training allowance - Severance Pay - Holiday pay - Bonuses Work Search contacts |
Explanation if exception Verification of base period wages - Compare with monetary; monetary if appropriate Verification of BY wages - Compare with payment history - Discrepancies resolved - Supplemental check(s) - Overpayment established Factfinding statements/rebuttals from claimant/all employers Nonmonetary determinations issued Verification statements obtained - Discrepancies resolved - Supplemental check(s) - Overpayment established Verification statements obtained Claimant rebuttal obtained Determination issued |
| Coding | Coded correctly | Matches information on documentation |
| Other Income Verifications |
SSI OASI Workers Compensation Educational training allowances Residuals |
Verification statement obtained
from income source - Discrepancies resolved - Supplemental Check(s) - Overpayment established |
| Coding | Coded correctly | Matches information on documentation |
| Other Verifications |
Local Office work
search policy Union registration Job Service registration policy Private Employment Agency verification(s) Educational training allowances Dependency |
Verification statements
obtained Rebuttal statement(s) obtained Nonmonetary determination(s) issued |
| Coding | Coded correctly | Matches information on documentation |
| Findings & Conclusions |
Narrative Summary - Pertinent facts of investigation - Explanation of non- English Speaking - Proper/improper payment - Basis for decision - Explanation of unusual delays |
Supported by documentation in
file
Signature of interpreter Nonmonetary determination(s) Overpayment/underpayment actions Formal actions by other SESA units - Appeals - Fraud |