TN 13 (11-11)

GN 01010.475 Abatements

A. Definition of abatement

Abatement is a decision of disposing an application without making a determination about the claimant's entitlement. Since there is no decision to award or disallow, an abated claim does not have appeal rights.

B. Abatement criteria

Consider abatement of a claim only in the following situations:

1. Improper applicant

The person filing an application on the claimant's behalf is not a “proper applicant” as defined in GN 00204.003 and we are unable to obtain a valid application from the claimant; or

2. Death of claimant during the claims process

  • The non-disabled claimant or disabled child dies in or before the first month of entitlement (MOET) or before effectuation of the claim to benefits or a lump-sum death payment (LSDP), see GN 00204.005 Claimant Dies Before Filing/Effectuation;

  • The disability (DIB) or disabled widow (DWB) claimant dies during the waiting period based on the alleged onset date AND the Disability Determination Services (DDS) does not make a disability decision before the time of death.

  • There is no possibility of an earlier onset date, no reason to question the alleged onset date, or there is no existing prior DIB freeze.

EXCEPTION: If auxiliary claimants are also pending in Modernized claims system (MCS) (e.g., terminal illness (TERI) claim where auxiliary development was not deferred, see DI 11010.315) do not abate the auxiliaries; and

  • There is no entitlement to Medicare.

NOTE: If the case does not meet the above requirements, a decision of abatement is not proper and you must either award or disallow the claim.

C. Special considerations on abatements

  • Do not abate the claim if the claimant dies in the month of Medicare entitlement. You must process an award.

  • Consider DIB freeze whenever possible (i.e., number holder (NH) is disabled for at least five full calendar months but dies in the first month of entitlement), the primary insurance amount (PIA) for future survivor beneficiaries may be affected. For more detailed information about when DIB freeze applies see DI 11010.075 and RS 00605.220.

EXCEPTION: If this NH had been entitled to retirement (RIB) prior to the year of DIB onset, a freeze award would not be proper even if the first DIB month of entitlement (MOET) is in a different year than the year of onset since the RIB eligibility year is earlier than both of these dates. In this circumstance, abatement for the DIB would be the proper action.

  • If a person with a conditional month of election (MOEL) dies before the final determination of excess earnings, follow the instructions in GN 00204.030. Process the abatement only after you determine that the first month of entitlement would be after the month of death.

  • An application for a representative payee (SSA-11BK) is not a claim for benefits; do not attempt to dispose of it by abatement if we select a different person other than the applicant as payee for the beneficiary. See GN 00503.130 for more information.

  • If the DIB determination has been made but the claim has not been effectuated when notification is received that the NH died before the first month of entitlement (MOET) (i.e., in the waiting period), refer the disability claim to a disability examiner to investigate possible earlier onset. If no earlier onset date is possible, the examiner should either annotate the electronic folder with the remark "Death in Waiting Period - No possible earlier onset" or correct the SSA-831 and the disability claim should be abated. Refer to RS 00615.320 for the effect of an abated DIB application and RIB LIM.

Note: Unlike advance file claims processed via MCS earning computation (EC) process, no notices are generated for advance file claims in the Development Holding File (DHF) until after the current operating month (COM) equals the MOEL and the award (e.g., automated 101 (A101)) has been processed and updated to the Master Beneficiary Record (MBR).

D. Procedure for abatements

Denial codes 67, 68 and 96 are the only reason codes applicable for an abatement action. Do NOT use any other code to abate the claim.

1. Processing abatements

For MCS EC processing, input the code “07” (ABATEMENT) in the DEC STAT line of the decision (DECI) screen and show the appropriate reason (i.e., code 67, 68 or 96) on the Benefit Continuity Factor (BECF) screen.

Since there is no initial determination and no adjudicative approval is required, an abatement action processed via MCS EC will not update the MBR for the individual involved. NOTE: You cannot process abatement actions via manual adjustment, credit and award process (MADCAP) or manual adjustment credit and award data entry (MACADE).

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