TN 45 (11-11)

GN 00205.190 Significance of Items on the Disability Applications

A. Introduction

If the number holder (NH) was previously entitled to a freeze or Disability Insurance benefits (DIB) that terminated within 60 months of the current disability's onset, no waiting period is required. We may exclude a prior period of disability from the elapsed years in establishing DIB insured status and in computing the DIB.

We may need evidence from an earlier DIB, Disabled Widow(er)’s benefits (DWB), or Childhood Disability benefits (CDB) claim to adjudicate the claim.

Prior entitlement to a reduced benefit (Retirement Insurance benefit (RIB) or Widow(er)’s Insurance benefit (WIB)) may cause a reduction in the DIB if the date of birth is prior to 1928 or the DIB onset was prior to 01/01/90.

Certain previously entitled applicants may request expedited reinstatement of disability benefits under title II and title XVI when their disabling impairment no longer permits them to perform substantial gainful activity. If we approve the request, the applicant may receive up to 6 months of provisional cash benefits while we conduct a medical review and determine if we can reinstate the applicant’s benefits. The applicant also may be eligible for Medicare or Medicaid coverage during the provisional benefit period. (For expedited reinstatement information, see DI 13050.001.)

B. Policy for completing the application

1. Military service (MS) or railroad retirement (RR) service questions

It may be possible to get evidence of disability from the Railroad Retirement Board (RRB) if the claimant filed a disability claim with RRB. Evidence may be available from a service department or from a Department of Veterans' Affairs (DVA) facility if the NH was in the armed forces. Both questions are leads to possible additional quarters of coverage (QC).

2. Disclosing medical evidence

Most medical sources require authorization from the claimant before releasing information to us.

3. Windfall Elimination Provision (WEP) question

The WEP question applies to NHs entitled to a pension or an annuity from non-covered employment and are eligible for RIB or DIB after December 1985. For more information, see RS 00605.360.

C. Procedure for completing the application

1. Date of onset

Consider eligibility for childhood disability benefits if the alleged date of onset is prior to age 22. (For information on CDB benefits, see RS 00203.080 - RS 00203.090.)

2. Question on nature of impairment

The type of impairment may indicate that the NH is eligible for worker's compensation (WC) payments and we must offset the DIB.

Develop for a representative payee if the nature of the impairment indicates the claimant needs one.

3. Question about WC or other Public Disability Benefits (PDB)

If the NH is receiving WC or other PDB provided for under Federal, State, or local laws or plans, the DIB and auxiliary benefits payable may be subject to offset.

Private companies or carriers may pay some WC/PDB benefits, but benefits are required under Federal, State, or local laws or plans (e.g., State temporary disability insurance benefits). Such benefits are not “private” benefits when deciding if we need to develop these benefits further.

On a paper application, if the NH indicates he or she has filed or intends to file for a “PDB” which is not VA, SSI, or welfare benefits (i.e., the “other” block is checked), have the NH complete an SSA-546 (Workers' Compensation/Public Disability Benefit Questionnaire).

If the NH filed for a private disability benefit (one paid under a private company's plan or paid under the terms of a private disability insurance policy purchased by the NH) do not have the NH complete the SSA-546.

In a Modernized Claims system (MCS) claim, the WC01 screen generates if the NH answers “yes” to the question, “have you filed for or do you intend to file for WC or PDB” on the DISB screen. This information will result in calculation of any applicable offset.

4. Question about children

List the names of all children including those not living with the NH. Encourage the NH to file for all children even though the NH may not want to handle their benefit payments. Document the whereabouts (if known) of any children not living with the NH.