TN 18 (08-04)

RS 00301.147 Special Insured Status Requirements for Subsequent Periods of Disability - NH Over Age 31

A. Background

1. Before 1983 Amendments

Before the 1983 Amendments, a disabled worker who became entitled to a period of disability before age 31 under the special insured status requirements, and again became disabled at or after age 31, had to meet the “20/40” and fully insured status requirements. Many of these younger disabled NH's were denied since they had not worked long enough to earn the required additional QC's.

2. 1983 Amendments

The 1983 Amendments relax the rules for establishing insured status for the young disabled workers for subsequent periods of disability.

B. Policy—Basic Rules for Special Insured Status—NH Over Age 31

1. Applicability

The 1983 Amendments provisions apply only to disabled NH's who:

  1. Had a prior period of disability (PPD) established before age 31 and met only the special insured status requirements; and

  2. Do not currently meet 20/40 and fully insured status at onset.

2. Requirements For Special Insured Status

  1. Half of the quarters (QTR) after the QTR of age 21 up to and including the quarter of onset are QC's up to a maximum of 20 QCs out of 40 calendar quarters; and

  2. The person is fully insured.

  3. If the total number of elapsed QTRs is an odd number, drop one. Do not count any QTRs wholly or partially within a PPD except for the beginning and/or ending QTRs if they are QCs.

  4. If the number of elapsed QTRs is less than 12, the NH must have at least 6 QCs in the 12-QTR period ending with the QTR of onset. The qualifying period may be extended prior to age 21, and the QCs earned during that period may be used.

IMPORTANT: If the worker is an alien whose SSN was first assigned on or after January 1, 2004, then he/she must meet additional requirements under Section 211 of the Social Security Protection Act of 2004 (Public Law 108-203), to be insured and to establish entitlement based on his/her earnings. See RS 00301.102 for a full discussion of these requirements.

3. Effective Date

Under the 1983 Amendments benefits may first be paid or recomputed beginning in 5/83. However, the first possible month of entitlement may be earlier. These earlier months may be counted as part of 24-month Medicare requirement.

NOTE: The earliest Medicare month of entitlement using these new rules is 5/83.

C. Examples

1. Special Insured Status-Met

Mary Brown, DB 4/16/50, became disabled 5/16/75 at age 25. Her earnings record (ER) showed the following work pattern:

1970 NNNC

1973 CNNC

1971 NNCC

1974 NNCC

1972 CCCN

1975 NNNN

Since there were 16 QTRs elapsing after the QTR of age 21 attainment (the 2nd QTR of 1971) and up through her date of onset, Mary required 8 QCs to meet the special insured status earnings test. Mary had 8 QC's during that period and was entitled to a period of disability beginning 5/16/75. Her period of disability ceased 10/78 and terminated the last day of 12/78; benefits terminated 1/79.

Mary filed for DIB again in 6/83, alleging an onset of 11/2/82 and prior filing on her own SSN. An MBR establishes the dates of the PPD, and the ER shows the following:

1970 NNNC

1977 NNNN

1971 NNCC

1978 CCCC

1972 CCCN

1979 CNNN

1973 CNNC

1980 CNNN

1974 NNCC

1981 CNNN

1975 NNNN

1982 CCCN

1976 CNNN

1983 NNNN

There are 32 QTRs elapsing after the QTR of age 21 attainment up to and including the alleged onset date (11/2/82). (Excluded from this elapsed period is the 2nd QTR of 1975 through the 3rd QTR of 1978.) The last QTR of 1978 is a QC and is counted as part of the elapsed period.

Mary requires and has 16 QC's during this elapsed period, and meets the special insured status requirements for a second period of disability at onset.

2. Special Insured Status Met - Possible 20/40 Considered

John Jones, DB 7/16/40, became disabled 3/4/68, at age 28. His ER shows the following work pattern:

1961 NNNC

1965 NNNN

1962 NCCN

1966 CCNN

1963 NNCC

1967 CNCC

1964 CCNC

1968 NNNN

There are 26 QTRs elapsing after the QTR of age 21 attainment (the 3rd QTR of 1961) and the QTR of disability onset, John required 13 QC's to meet the special insured status earnings test. Since John had 13 QC's during this period, he was entitled to a period of disability. John's disability ceased 04/15/81. He was entitled to an EPE through the last day of 6/82; his benefits terminated 7/82. Since no benefits were paid after 6/81, the period of disability ceased on the last day of 6/81 (the last payment month). This quarter is a QC, however, and must be counted for any subsequent insured status.

John again files for DIB 6/83, alleging he became disabled 2/11/83. An MBR establishes the dates of the prior period of disability, and his ER reflects the following:

1961 NNNC

1969 NNNN

1977 NNNC

1962 NCCN

1970 NNCC

1978 NNNN

1963 NNCC

1971 NNNN

1979 NNNN

1964 CCNC

1972 NNNN

1980 CCCC

1965 NNNN

1973 NNNN

1981 CCCC

1966 CCNN

1974 NNNN

1982 CCNN

1967 CNCC

1975 NNNN

1983 NNNN

1968 NNNN

1976 NNNN

 

There are 33 QTRs elapsing after the QTR of attainment of age 21 up to and including the QTR of onset, excluding the PPD (the 1st QTR of 1968 through the last QTR of 1981). John requires and has 16 QC's to be entitled to a second period of disability beginning 2/11/83. (If John had an additional 2 QC'S in any quarter not part of the PPD, the provisions of the 1983 amendments would not apply since he would meet the 20/40 and fully insured tests).

3. Requirements Not Met

Frank Smith, DB 7/14/45, became disabled 12/13/70, at age 25. His ER shows the following work pattern:

1966 NNNN

1969 NNNC

1967 CNCN

1970 CCCN

1968 NNCC

 

There were 17 QTRs elapsing after the QTR of attainment of age 21 up to and including the QTR of onset, Frank required 8 QC's to be insured for DIB (since 17 is an odd number, it was reduced to 16). Frank was entitled to a period of disability as of 12/13/70. His period of disability ceased 9/78 and terminated the last day of 11/78; benefits terminated 12/78.

Frank files an SSA-16F6 on 6/14/83, alleging a new onset 2/11/83. His ER now shows the following:

1966 NNNN

1975 NNNN

 

1967 CNCN

1976 NCCN

 

1968 NNCC

1977 NNNN

 

1969 NNNC

1978 CNNN

 

1970 CCCN

1979 NNNN

 

1971 NNNN

1980 NNNN

 

1972 NNNN

1981 NNNN

 

1973 NNNN

1982 NNNN

 

1974 NNNN

1983 NNNN

 

There are 33 QTRs elapsing after the QTR of attainment of age 21 up to and including the QTR of onset (excluding the prior period of disability). Since this is an odd number, it is reduced to 32. Frank requires 16 QC's to meet insured status for a new period of disability but has only 8 QC's. His claim must be denied.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0300301147
RS 00301.147 - Special Insured Status Requirements for Subsequent Periods of Disability - NH Over Age 31 - 07/26/2012
Batch run: 07/26/2012
Rev:07/26/2012