An individual who receives a medical cessation determination may elect to continue
receiving Title II disability payments while a request for reconsideration or for
a hearing before an Administrative Law Judge (ALJ) is pending. We call these payments
Statutory Benefit Continuation (SBC) payments.
When an individual appeals a medical cessation determination at the reconsideration
or ALJ hearing level, they have 15 calendar days (10 days plus 5 mailing days) from
the date of the medical cessation notice to elect SBC. Upon an individual's timely
request for SBC, disability payments continue while we make the reconsideration determination
or hearing decision. For more information on SBC election and processing, see DI 12027.010.
SBC payments stop after an ALJ issues a medical cessation decision even if the individual
continues the appeal process and requests Appeals Council (AC) review or review in
SBC payments are not overpayments until the medical cessation decision is final. The
medical cessation decision becomes final when the individual does not request further
review within the appeal period (and does not have good cause for a late appeal) or
has exhausted all levels of appeal. Therefore, we send an initial overpayment notice
to begin recovery of SBC
payments only if one of the following conditions is met:
At the reconsideration level: the individual does not appeal an unfavorable medical
cessation reconsideration decision to the ALJ hearing level, the 65-day (60 days plus
5 mailing days) appeal period has expired, and there is no good cause for a late request
for a hearing;
At the hearing level: the individual does not request AC review of an unfavorable
ALJ medical cessation decision, the 65-day (60 days plus 5 mailing days) appeal period
expires, and there is no good cause for a late request for AC review. In this situation,
the ALJ will return the folder (electronic file) to the appropriate office, after
the 65-day period for requesting AC review expires;
At the AC level: the AC denies a request for review, but the individual does not request
judicial review of the ALJ decision and the 65-day (60 days plus 5 mailing days) period
to do so expires, and there is no extension or good cause for late request for judicial
review. In this situation the AC will return the folder (electronic file) to the appropriate
office, after the 65-day period for requesting judicial review expires; or
At the federal court level: the individual requests judicial review and the court(s)
affirms the ALJ decision. The technician will receive the final court decision.
If the federal court remands the case and the AC then vacates the ALJ decision and
remands to the ALJ for another hearing and decision, please follow instructions in
DI 12027.060 (Title II cases) and DI 12027.065 (Title XVI and concurrent cases).
IMPORTANT: Before making any manual inputs to initiate recovery and issue an overpayment
notice related to SBC payments, technicians must review the individual's records to
appeal is not pending at the reconsideration, ALJ, AC, or federal court level (including
at the ALJ
level after an AC remand) and that all the appeal time periods have expired.