What this means
m21-4:7.14 explains an overview of VBMS deferrals. In plain terms, the official guidance says VBMS Deferral functionality allows a claims processor to return a claim to an earlier phase within the claims cycle to correct erroneous actions. It also addresses when the claims processor is assigned the claim for corrective action, and disagrees with the deferral, the claims processor will e-mail a brief narrative to the QRT supervisor and copy their supervisor within five business days of receipt of the deferral.
How this may help with a claim
Use m21-4:7.14 as an internal VA audit trail for an overview of VBMS deferrals, not as a promise of a particular result. Compare the actions recorded in your claim file or decision notice with this source-specific detail: VBMS Deferral functionality allows a claims processor to return a claim to an earlier phase within the claims cycle to correct erroneous actions. When the claims processor is assigned the claim for corrective action, and disagrees with the deferral, the claims processor will e-mail a brief narrative to the QRT supervisor and copy their supervisor within five business days of receipt of the deferral. If the record does not show the expected action, identify the missing step precisely when asking VA or an accredited representative to review the file.
What to review in your file
- Check the file against this official condition: VBMS Deferral functionality allows a claims processor to return a claim to an earlier phase within the claims cycle to correct erroneous actions.
- Confirm that the record or notice addresses this source point: When the claims processor is assigned the claim for corrective action, and disagrees with the deferral, the claims processor will e-mail a brief narrative to the QRT supervisor and copy their supervisor within five business days of receipt of the deferral.
- Document how this stated step or exception applies: Step — Action; 1 — The claims processor e-mails the QRT supervisor with the deferral disagreement narrative.; 2 — The QRT supervisor will assign a QRS to review the deferral disagreement.;
Important limits
m21-4:7.14 is primarily internal workflow guidance about an overview of VBMS deferrals. It can help identify what VA was expected to document, but it does not by itself create a claimant deadline, a freestanding entitlement, or a guaranteed remedy. The source also states: VBMS Deferral functionality allows a claims processor to return a claim to an earlier phase within the claims cycle to correct erroneous actions. The MITIGATE button should not be used to resolve accurate deferrals because claims processors must take the corrective actions outlined in all accurate deferrals.
Search terms when useful
Phrases that may help when searching your claim file or this library.
- An Overview of VBMS Deferrals
- m21-4:7.14
- VBMS Deferrals
- deferral reviews
- erroneous deferrals.
- 7.14.a. VBMS Deferrals
- VBMS Deferral functionality allows
- manual reference
Original VA guidance
The official VA text of this section
14. Overview of VBMS Deferrals
Introduction
This topic contains information on VBMS deferrals, including
- an overview of VBMS deferrals
- procedures for deferral reviews, and
- erroneous deferrals.
Change Date
November 12, 2019
7.14.a. An Overview of VBMS Deferrals
VBMS Deferral functionality allows a claims processor to return a claim to an earlier phase within the claims cycle to correct erroneous actions. Using the VBMS Deferral functionality is required for any situation in which a claim returns to a previous step in the process, which involves all relevant details to include:
- a manual reference
- most appropriate reason(s) for deferral, and
- relevant electronic claims folder document bookmarks.
When the claims processor is assigned the claim for corrective action, and disagrees with the deferral, the claims processor will e-mail a brief narrative to the QRT supervisor and copy their supervisor within five business days of receipt of the deferral. The narrative must identify why the claims processor disagrees with the deferral and provide a reference to support the disagreement.
7.14.b. Procedures for Deferral Reviews
Follow the steps in the table below for deferral review requests.
Scroll sideways to see the full table.
| Step | Action |
|---|---|
| 1 | The claims processor e-mails the QRT supervisor with the deferral disagreement narrative. |
| 2 | The QRT supervisor will assign a QRS to review the deferral disagreement. |
| 3 | The QRS will review all relevant documents and determine if the deferral is appropriate within two business days of receipt from the QRT supervisor. |
| 4 | The QRS will e-mail the results of the deferral review to the QRT supervisor and the claims processor’s supervisor. |
| 5 | The claims processor’s supervisor will notify the claims processor of the outcome of the deferral review and take the actions provided in the table below. Note: All actions must be completed within three business days following QRT review. |
7.14.c. Erroneous Deferrals
The MITIGATE button should not be used to resolve accurate deferrals because claims processors must take the corrective actions outlined in all accurate deferrals. The MITIGATE button should only be used to resolve erroneous deferrals.
Note: The MITIGATE button will resolve the entire deferral. Current functionality does not support the mitigation of a partially erroneous deferral. Failure to include a supporting reference in the initial deferral is not grounds for automatic mitigation (system mitigation). Also, avoidable versus unavoidable, or outside the scope of the employee is not grounds for system mitigation.