TN 32 (04-26)
NL 00705.201 Reopening Notice 1 – Allowance to Denial – Title II
Disability
Allowance to Denial – Title
II
We are writing to you about (1) Social Security Disability Insurance (SSDI) benefits.
We recently looked at (2) disability claim again to make sure our decision was correct.
After reviewing all of the information carefully, we are changing our decision.
Based on our rules, we now find that (3) not disabled. Therefore, (4) claim is denied.
You will get another letter soon about when (5) payments (6) will stop.
Fill-ins:
(1)
your/claimant’s name (possessive)
(2)
your/his/her
(3)
you are/claimant's name
is
(4)
your/claimant's name
(possessive)
(5)
your/his/her
(6) or Medicare/null
The Decision
See the enclosed Explanation.
Attach
the Personalized Disability Explanation (PDE) language per DI 26530.020 and
DI 26530.055, including a list of the evidence, an explanation of what the evidence
shows, and the
detailed, personalized reasons for the determination. For additional guidance, see
Reopening of
Prior Determination DI 27536.015.
If concurrent claims are involved,
include:
This decision refers only to (1) SSDI benefits. You will get a separate letter about
(2) Supplemental Security Income (SSI) payments.
Fill-ins:
(1)
your/his/her
(2)
your/his/her
(Universal
text identifier (UTI)
4054)
Who Decided
(1)
Case
Fill-in:
(1)
Your/His/Her
If DDS disability determination:
Doctors and other trained staff looked at this case and made this decision. They work
for the State but used our rules.
If Federal disability determination:
Our doctors and other trained staff looked at this case and made this decision.
(UTI ALSC12)
If You Disagree With The Decision
(UTI ALS023 – modified to show the SSA-789 instead of the SSA-561)
NOTE: If the revision is due to a non-medical reason, such as work, show “SSA-561, called
“Request
for Reconsideration” instead of the SSA-789. Do not include the language for the DHO
hearing or
statutory benefit continuation.
If you do not agree with this decision, you have the right to appeal. A person who
did not make the first decision will decide the case. We will review the case and
look at any new facts you have. We will review the parts of the decision that you
think are wrong and correct any mistakes. We may also review the parts of our decision
that you think are right. We will make a decision that may or may not be in your favor.
-
•
You have 60 days to ask for an appeal.
-
•
The 60 days start the day after you receive this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
-
•
You must have a good reason if you wait more than 60 days to ask for an appeal.
-
•
You must ask for an appeal in writing. Please use our "Request for Reconsideration
- Disability Cessation" form, SSA-789. You can go to our website at https://www.ssa.gov/forms to locate this form. You can also contact us to request the form or if you need help
filling out the form.
Do not send the following caption and
paragraph below
(4059)
if there is a determination of fraud or similar fault since FSF precludes the payment
of statutory
benefit continuation (SBC).
Do not send the following caption and paragraph if the
revision is due to a non-medical reason, such as work or other reason that precludes
payment of SBC
(see DI 27540.025). However, a predetermination due process notice is needed.
(UTI
4059)
Appeal In 10 Days To Keep Getting Your
Benefits
You have only 10 days to ask us in writing to continue your benefits during your appeal.
The 10 days start the day after you get this letter.
-
•
To continue benefits, complete our SSA-792 Statutory Benefit Continuation Election
Statement form. Submit the form with your appeal request to your local Social Security
office within 10 days. You can go to our website at https://www.ssa.gov/forms to locate this form. You can also contact us to request the form or if you need help
filling out the form.
-
•
With this form, you can choose to continue or not continue getting benefits during
your appeal. If applicable, you can also choose to continue only Medicare and for
your family to keep getting their benefits if they are also receiving benefits on
your record.
-
•
We must receive your appeal request with the SSA-792 form within 10 days to continue
your benefits.
-
•
If you lose the appeal, you might have to pay back some or all of this money. If you
are receiving Medicare, you will not have to pay back Medicare.
(UTI ALSC23)
You May Not Have to Pay Back the Money You Get During Your Appeal
(UTI ALS099)
If you ask us to continue your benefits during your appeal, and your appeal is not
approved, we will start collecting the money you and your family received during your
appeal. You can request to not pay the money back by asking for a waiver. We may approve
your waiver if the overpayment was not your fault AND paying us back would mean that
you cannot afford to meet your daily living expenses, or it would be unfair for some
other reason. We may find you are not at fault for the overpayment of the benefits
you received during your appeal if all the following are true:
-
•
You asked for an appeal because you believe you still have a disability.
-
•
You provided the requested evidence.
-
•
You attended all requested examinations.
Do
not send the following caption and
paragraph
(4066) if the revision is due to a non-medical reason, such as
work.
How An Appeal Works
A Disability Hearing Officer (DHO) will decide (1) appeal. We will call this person
a DHO in the rest of our letter. The DHO will meet with you before making the decision
on (2) appeal. The meeting works like this:
-
•
The DHO will mail you a letter at least 20 days before the meeting to tell you its
date, time, and place.
-
•
You can look at (3) file before the meeting.
-
•
You can tell the DHO the reasons why you think (4) still disabled. You can give the
DHO more facts and you can bring people to say why (5) disabled.
-
•
You can have the DHO ask people to come to the meeting to speak about (6) disability
and bring important papers. You can question these people at the meeting.
-
•
You do not have to go to the meeting in person. If you do not want to go, you can
give the DHO more facts you may have. The DHO will decide your case using these facts
and what is now in your file. But if you go to the meeting, it may help the DHO decide
your case.
Fill-ins
(1) your/his/her
(2) your/his/her
(3) your/his/her
(4) you are/he is/she is
(5) you are/he is/she is
(6) your/his/her
(UTI REPC01/REP002)
If You Want Help With Your Appeal
You may choose to have a representative help you with your case. We will work with
this person just as we would work with you. If you decide to have a representative,
you should find one quickly so that person can start preparing your case.
Many representatives charge a fee only if you win your case. Others may represent
you for free. Generally, your representative cannot charge a fee unless we approve
it. Your local Social Security office can give you a list of groups that can help
you find a representative.
If you get a representative, you or that person must notify us in writing. You can
go to https://secure.ssa.gov/ssa1696/front-end/ to complete the form with your representative online, download the form SSA-1696
"Claimant's Appointment of Representative" at www.ssa.gov/forms, or contact us to request a form.
You can also log into your my Social Security account for information and online service options regarding your representation.
(UTI 4070)
If
(1)
Health Gets Worse
Fill-ins:
(1) Your/His/Her
If (1) health gets worse and you feel that (2) disabled again, please get in touch
with us. (3) may be able to get benefits again.
Fill-ins:
(1)
your/claimant’s name (possessive)
(2)
you are/he is/she is
(3)
You/claimant’s name
(UTI CTDO)
Suspect Social Security Fraud?
Please visit https://oig.ssa.gov/report or call the Inspector General's Fraud Hotline at (800) 269-0271. If you are a person
who is deaf or hard of hearing, call TTY (866) 501-2101.
Need More
Help?
-
1.
Visit www.ssa.gov for fast, simple, and secure online services.
-
2.
Call us at 1-800-772-1213, weekdays from 8:00 am to 7:00 pm. If you are deaf or hard
of hearing, call TTY 1-800-325-0778. Please mention this letter when you call.
-
3.
You may also call your local office at (1):
(2)
[Field Office Address
City, State,
ZIP]
Fill-ins (per
DOORS):
(1) Local field office public line phone number
(2) Local field office address
If you contact us, please refer to this letter. It will help us answer your questions.
How Are We Doing? Go to www.ssa.gov/feedback to tell us.
Enclosure:
Explanation
If limited English proficiency (LEP) flag exists OR preferred language is not English
OR Unknown
Multi-language insert