Basic (03-86)

DI 13095.140 Model Letters and Miscellaneous Paragraphs -- Title II

Cross refer to DI 13010.215A.

The title II model letters and paragraphs on the following pages are to be used as guides in preparing cessation, reinstatement, subsequent suspension, and termination notices in title II only and the title II portion of concurrent title II/XVI cases.

In title II only cases where a cessation, reinstatement, subsequent suspension, or termination notice is being prepared, use appeals paragraph.

In the title II part of a concurrent case where a cessation, subsequent suspension, or termination is being prepared, follow the instructions in NL 00703.000 regarding the lead-in, disclaimer and appeals paragraphs. The rationale, however, must be taken from an appropriate exhibit in this section.

In the title II part of a concurrent reinstatement notice (whether allowed or denied), use the appeals language found on the reverse of Form SSA-L8151-U2, Supplemental Security Income Notice of Change.

 

Exhibit 1. Model Letter--Cessation Notice, Title II--Trial Work Period Completed. Claimant Performing SGA.

 

A person's disability ends if he or she becomes able to do substantial gainful work. (At the present time earnings over $(          ) a month usually will be considered substantial and gainful.) Benefits will be paid for the month disability ends and 2 additional months. Not until a person has completed 9 months of trial work is a decision made as to whether he or she has become able to do substantial gainful work.

 

The evidence in your case shows that you completed your ninth month of trial work in (            ) and became able to do substantial gainful work in (            ). Therefore, your last check will be for the month of (            ).

 

OPTION: Impairment-related work expenses paragraph (Exhibit 6).

 

If you stop doing substantial gainful work again within 15 months after your trial work period ended, contact any Social Security office right away. Monthly benefit checks can be started again without a new disability application. In addition, Medicare protection can continue after you receive your last monthly benefit check. (You will be notified later when this coverage will end.) You will be billed every 3 months for your medical insurance premiums; please pay them promptly to avoid duplicate billing and loss of coverage for failure to pay on time.

 

To have your benefit checks started again and to receive this Medicare protection you must have a disabling condition. To decide if you have a disabling condition we will do a medical review of your case. You may be asked to help us in obtaining additional evidence to make this decision. If you refuse to help us in getting this evidence your checks and Medicare protection may stop.

 

You will be notified later if we owe you any back benefits or you are overpaid any benefits.

 

 

Exhibit 2--Model Letter--Reinstatement Notice, Title II--Benefits Previously Suspended Because of SGA--Work Stopped or Earnings Dropped Below SGA Level--15-Month Reinstatement Period Not Ended

 

Disability benefits can be started again because you are no longer doing substantial gainful work. Your benefit checks (will be) (have been) started beginning for the month of (            ). They will continue as long as you have a disabling condition and do not do substantial gainful work.

 

IF YOU GO BACK TO WORK OR IF YOU ARE CURRENTLY WORKING AND THERE IS A CHANGE IN YOUR WORK STATUS OR IN THE AMOUNT OF YOUR EARNINGS, YOU MUST LET US KNOW RIGHT AWAY.

 

If you have Medicare and are disabled, that protection continues without change except that if you were billed every 3 months for your insurance premiums they will now be deducted monthly from your check beginning with the month of (            ).

 

 

Exhibit 3--Model Letter--Reinstatement Denial Notice, Title II--Benefits Previously Suspended Because of SGA--Reinstatement Requested--15-Month Reinstatement Period Not Ended

 

You requested that your disability benefits be started again because you stopped doing substantial gainful work. A review of the evidence in your case shows that the work you (are doing is) (did in (            ) was) substantial gainful work. At the present time earnings over $(          ) a month usually are considered substantial and gainful. Therefore, we cannot start your benefits again.

 

 

Exhibit 4--Model Letter--Reinstatement Denial Notice, Title II--Benefits Previously Suspended Because of SGA--Reinstatement Requested--15-Month Reinstatement Period Expired

 

You requested that your disability benefits be started again because you are no longer doing substantial gainful work. A review of the evidence in your case shows that while you are no longer doing substantial gainful activity, the time limit for having disability benefits started again has passed. Benefits can be restarted only if a person stops doing substantial gainful work within 15 months after the end of the trial work period. Your trial work period ended (            ) and you stopped doing substantial gainful activity in (           ). Since this is more than 15 months after the end of your trial work period, we cannot start your benefits again.

 

If you believe that you are still disabled you should contact any social security office about filing a new application. Most questions can be handled by telephone. However, if you visit an office, please take this notice with you.

 

Exhibit 5--Model Letter--Subsequent Suspension Because of SGA--Title II--Benefits Previously Reinstated--Returned to SGA

 

Your benefits were started again, after your trial work period ended, because your earnings either stopped or dropped below the amount generally considered substantial and gainful. Since your earnings are again above the substantial gainful work level (now usually $(          ) a month), beginning (            ), your checks (will be) (have been) stopped.

 

OPTION: Impairment-related work expenses paragraph (see Exhibit 6).

 

If you stop working again or if your earnings drop below the amount considered substantial and gainful, you should contact any social security office about starting your checks again or, if necessary, filing a new application.

 

You will be notified later IF we owe you any back benefits or you are overpaid any benefits.

 

Exhibit 6--Miscellaneous Paragraphs (Title II)

 

Explanation of 15-Month Reinstatement Period

 

If you stop doing substantial gainful work again within 15-months after your trial work period ended contact any Social Security office right away. Monthly benefit checks can be started again without a new disability application. In addition, Medicare protection can continue after you receive your lat monthly benefit check. (You will be notified later when this coverage will end.) You will be billed every 3 months for your medical insurance premiums; please pay them promptly to avoid duplicate billing or loss of coverage for failure to pay on time.

 

To have your benefit checks started again and to receive Medicare protection you must have a disabling condition. To decide if you have a disabling condition we will do a medical review of your case. You may be asked to help us in obtaining additional evidence to make this decision. If you refuse to help us in getting this evidence your checks and Medicare protection may stop.

 

NOTE: In the case of a deemed widow or disabled worker who for some reason is not receiving cash benefits, this paragraph should be revised to advise the claimant to get in touch with any Social Security office in order that his or her status as a disabled person may be reestablished.

 

Explanation of Reinstatement of Benefits

 

Disability can be started again because you are no longer doing substantial gainful work. Your benefit checks (will be) (have been) started beginning with the month of (            ). They will continue as long as you have the disabling condition and do not do substantial gainful work.

 

Medicare Coverage During 15-Month Reinstatement Period (Claimant in suspense)

 

If you have Medicare and have a disabling condition, that protection can continue after you receive your last monthly benefit check. (You will be notified later when this coverage actually will end.) You will be billed every 3 months for your medical insurance premiums; please pay them promptly to avoid duplicate billing and loss of coverage for failure to pay on time.

 

Impairment-Related Work Expenses Not Allowed as Claimed

 

Although you reported impairment-related work expenses, the items you mentioned do not meet the guidelines for exclusion from earnings. Therefore, we cannot allow them.

 

Impairment-Related Work Expenses Insufficient to Reduce Earnings Below SGA

 

Although you reported impairment-related work expenses which we allowed, they are not enough to reduce your earnings below the monthly amount generally considered to be substantial gainful work. At the present time, earnings over $(          ) a month usually are considered substantial and gainful.

 

NOTE: Delete this last sentence if SGA is defined elsewhere in the same notice.

 

Further Notification for Overpayment/Underpayment

 

You will be notified later IF we owe you any back benefits or you are overpaid any benefits.