If the DDS can not find the class member disabled for the entire DEVELOPMENT PERIOD
and certain conditions are met (see DI 12586.001, item 7.), it usually establishes an actual, rather than an administrative onset.
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a.
Actual Onset Cases
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•
If the actual onset is later than the administrative onset (per the Worksheet summary),
pay for the actual period of disability;
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•
If the actual onset is earlier than the administrative onset (per the Worksheet summary),
the DDS will show the actual onset on the SSA-831-U3. Pay for the PAYMENT PERIOD shown
on the Worksheet.
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b.
Closed Periods - Where the DDS establishes a closed period, the actual period of disability
will be shown on the SSA-831-U3.
However, payment can not exceed the number of months in the period of disability,
subject to the 48-month limit on payment for months prior to 12/ 91. Grace period
months (the two months of payment following the medical cessation month) are included
in the PAYMENT PERIOD.
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1.
Closed Period Begins 12/91 or Later
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•
Annotate the Worksheet summary with the actual onset established by the DDS;
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•
Use regular rules to determine dates of entitlement and termination;
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•
Update for the actual period of entitlement, using the tolerances in DI 12586.070.
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2.
Closed Period Begins Before 12/91 and Ends After 12/91
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•
Annotate the Worksheet summary with the actual onset established by the DDS;
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•
Count the number of potential payment months prior to 12/91 (include any grace period
months prior to 12/91);
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•
If the number of months before 12/91 is 48 or more, begin payment based on the administrative
onset on the Worksheet summary;
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•
If the number of months before 12/91 is fewer than 48, begin and end payment based
on the actual onset and cessation dates established by the DDS. See 1., above.
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•
Terminate eligibility after the grace period;
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3.
Closed Period Begins and Ends Before 12/91
Payment can not exceed the number of months in the period of disability, subject to
the 48-month limit on payment for months prior to 12/91.
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•
Annotate the Worksheet summary with the actual onset established by the DDS;
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•
Count the number of potential payment months (include any grace period months);
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•
If the number of months is 48 or more, begin payment based on the administrative onset
on the Worksheet summary;
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•
If the number of months is less than 48, count the number of potential payment months
(include any grace period months). Begin payment with the latest month that will allow
this number of payment months before 12/91, considering all of the Stieberger PAYMENT PERIOD exclusions in DI 12586.045.D.
EXAMPLE I: CLOSED PERIOD OVER 48 MONTHS
Situation: |
Application date= 12/1/83 |
|
Date of onset= 12/1/83 |
|
Medical cessation= 12/88 |
Processing: |
Actual payment months under regular title XVI rules would be 12/83 - 2/89, after adding
grace period months (no waiting period). This is more than the total of 48 months
we can pay, prior to 12/91, under Stieberger rules. If no other PAYMENT PERIOD exclusions apply, pay starting 3/85, cease 12/88,
and terminate 3/89.
|
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EXAMPLE II: CLOSED PERIOD LESS THAN 48 MONTHS
Situation: |
Application date= 12/1/83 |
|
Date of onset= 12/01/83 |
|
Medical cessation= 12/85 |
Processing: |
Actual payment months under regular title XVI rules would be 12 /83 - 2/86, after
adding grace period months (no waiting period). This totals 27 months, which does
not exceed the 48 months Stieberger limit. If no other PAYMENT PERIOD exclusions apply, pay starting 12/83, cease 12/85,
and terminate 3/86.
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|
Do not begin payment before the "potential payment date" shown on the summary sheet. |