BASIC (01-06)

DI 10135.010 Deemed DWB Entitlement When Actual Entitlement Precluded

A. Policy - Disabled Beneficiary Age 60 or Over

The following applies to a disabled beneficiary age 60 or over:

  • An individual who becomes entitled to D (widow's or widower's) benefits beginning at age 60-64, inclusive, and who would have met all requirements for entitlement to DWB if not age 60 or over, will, for HI purposes only, be deemed to be entitled to DWB for each month of D entitlement. Deemed entitlement will continue until the occurrence of an event terminating entitlement to DWB.

  • To establish deemed DWB before entitlement, the individual must submit a completed SSA-3368-BK “Disability Report-Adult”, marked prominently to show that it is being filed for purposes of HI entitlement.

    NOTE: Deemed DWB cases can be established in EDCS. Refer to DI 81010.020B for further instructions.

  • Although delay in submitting evidence of disability should be avoided, it will not result in loss of months of entitlement. The effective date of deemed DWB entitlement for a person entitled to D benefits depends on the date DWB could have begun, not on when evidence of disability is submitted.

    EXAMPLE 1:

    Mrs. Smith, born in 5/40, filed for and was awarded widow's benefits effective 6/00 the month her husband died. In 12/03, she filed evidence establishing that she was disabled beginning several years before her husband's death. She is deemed, for HI purposes, to be entitled to DWB beginning 6/00 and is entitled to HI beginning 6/02.

    NOTE: In some cases, a disabled widow or widower, eligible for a reduced RIB which would be greater than the reduced D benefit, will find it advantageous to restrict the scope of the application to D benefits only in the first possible month of entitlement so that D entitlement can be established for at least one month prior to the start of RIB entitlement. Once the D entitlement is established, and it is determined that the beneficiary would have met all the requirements for DWB if not age 60 or over, he or she may be deemed entitled to DWB for the purpose of HI entitlement. Even though D benefits are terminated when entitlement to reduced RIB begins, deemed DWB entitlement continues, enabling the beneficiary to become entitled to HI after 24 months.

    EXAMPLE 2:

    Mrs. Allen, a disabled individual, inquired at the DO about her benefit rights when her husband died in 10/00. She attained age 62 in 09/00, is fully insured, and wants reduced RIB; she could not meet the 20/40 requirement for DIB. Her husband's PIA was less than her own, and entitlement to a reduced RIB would preclude entitlement to D benefits (and to deemed entitlement to DWB). However, she can become entitled to HI only if she is deemed entitled to DWB for 24 months. Accordingly, Mrs. Allen makes clear on her application that she is filing only for D benefits for the month 10/00; her application for reduced RIB is limited to begin 11/00. Once she has been entitled to D benefits, she can then establish deemed entitlement to DWB, which will continue after her D benefits have been converted to reduced RIB. Beginning 10 /02, after 24 months of deemed entitlement to DWB, she can become entitled to HI. Of course, upon attaining age 65 in 10/03, Mrs. Allen becomes entitled to HI under the regular insured provision and her coverage continues without interruption.

B. Policy - Disabled Beneficiary Receives Mother's Benefits

1. Deciding Whether to Apply for DWB or E Benefits

  • A widow, aged 50-60 who is disabled and has an entitled child in her care cannot be simultaneously entitled to DWB and E benefits; she must choose one benefit or the other.

  • It is not necessary that a mother/widow give up E benefits or actually be entitled to DWB in order to be entitled to HI after the 24-month qualifying period. A mother/widow can, by filing a timely application for HI and submitting proof of her disability and proof of age, establish “deemed entitlement” to DWB for months in which a mother/widow is actually entitled to E benefits and eligible for DWB. Of course a mother/widow can file for DWB entitlement, to which terminates E benefits and establish HI after the 24-month qualifying period.

  • Generally, it will be advantageous to retain E benefits. When benefits of a widow and children entitled on the same SSN must be reduced for the family maximum, the total amount payable to a family may be somewhat less if the disabled widow is entitled to DWB rather than E benefits as any reduction in benefit amount occurs after adjustment for the family maximum.

  • The earlier a mother/widow applies for DWB, the greater the reduction in the amount of her W or D entitlement when E entitlement terminates.

    NOTE: The E beneficiaries are subject to child-in-care deductions and to termination when no child of the WE is entitled-disadvantages which do not apply to DWB.

  • When filing for HI only, the widow submits an SSA-3368-BK captioned, “Disability Report-Adult”.

2. Timely Filing and Documentation of Disability for DWB and E Benefits

  • Providing pertinent information is a necessary part of the application process and the decision on whether to file for DWB or for HI must be made entirely by the claimant.

  • Unless the application and proof of disability are filed timely, the deemed DWB entitlement of an E beneficiary cannot be established for a given month even though all other requirements are met for that month. See DI 10135.010B.3. and DI 10135.010B.4. concerning retroactivity of applications. See DI 81001.005–Certified Electronic Folder (CEF) Overview and GN 00301.285 for electronic folder organization and statements and other documentations. See also www.socialsecurity.gov/adultdisabilityreportpro for SSA-3368-BK, “Disability Report-Adult”.

3. Mother Beneficiaries Who Furnished Proof of Disability and Applied for HI Prior to 7/1/74

As a result of the 1972 Amendments a disabled widow entitled to E benefits who filed for HI and furnished proof of disability prior to 7/1/ 74 is deemed to have been filed timely for DWB. This is applicable in the earliest month in which the widow met all eligibility requirements to satisfy the 24-month qualifying period.

4. Mother Beneficiaries Applying for HI on or After 7/1/74

  • To receive HI coverage at the earliest possible time, widows entitled to E benefits (and who, had they filed an application, would be entitled to DWB), should file an application for HI within 1 year after the month in which they attain age 50; or if later, the month in which they first become eligible for DWB.

  • Individuals who are entitled to E benefits but are not disabled upon attaining age 50, should be encouraged to apply for HI within 1 year of becoming disabled. If the person files an application for HI only, the application has 1 year retroactivity and HI would begin with the 25th month of deemed entitlement to DWB.

EXAMPLE:

Mrs. Hall, born in 1944, has an entitled child in her care, and has been receiving E benefits since 9/94, when her husband died. At that time she had been severely disabled for many months, but did not file for DWB because of her eligibility for mother's benefits. On 5/24/99, she files an application for HI only and submits evidence of disability. If she meets all DWB eligibility requirements, for purposes of HI, she will be deemed entitled to DWB beginning 5/98, and will be entitled to HI beginning 5/00.

C. Policy - Disabled Beneficiary Receives Father's Benefits

1. Extending Medicare Coverage to Disabled Men

  • When father's benefits were extended to widowed men in 3/75 as a result of the Weinberger v. Wiesenfeld decision, it was held that, because the only issue before the Supreme Court was monthly benefit entitlement under section 202 (g) of the Social Security Act, Medicare entitlement was not available to disabled men who became entitled to father's benefits based on the decision.

  • Section 309 of the Social Security Amendments of 1983 (P.L. 98-21) amended the Social Security Act to provide Medicare coverage to disabled men entitled to father's benefits on the same basis that such coverage is available to disabled women entitled to mother's benefits.

    Thus, a disabled man entitled to father's benefits may be deemed entitled to DWB for those months in which he is actually entitled to father's benefits and eligible for DWB. After 24 months of such deemed DWB entitlement, Medicare entitlement begins.

  • The first month for which Medicare may be awarded to a disabled father beneficiary is 5 /83. The same considerations and application procedures applicable to mother beneficiaries (see DI 10135.010B.1.) apply as well to disabled father beneficiaries.

2. Retroactivity

  • Section 309 of P.L. 98-21 contained a special provision similar to that applicable to disabled mother beneficiaries who applied for Medicare entitlement prior to 7/1/74 (see DI 10135.010B.2.).

  • Under this special provision, disabled men entitled to father's benefits had 12 months from the effective date of the provision (5/1/83 - 4/30/84) in which to file for Medicare and, by submitting proof of their disability, they could establish deemed entitlement to DWB for up to 24 months prior to 5/83.

  • This enabled those men who elected to file for father's benefits rather than DWB to qualify for Medicare as of 5/83, the month the provision was effective or, if later, with the 25th month of deemed DWB entitlement.

  • Beginning with applications filed on 5/1/84 or later, however, the individual can establish no more than 12 months' deemed DWB retroactive entitlement, identical to the rule applicable to disabled mother's filing for Medicare on or after 7/1/74 (see DI 10135.010B.3.).

    For processing instructions see DI 11040.000.


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DI 10135.010 - Deemed DWB Entitlement When Actual Entitlement Precluded - 08/08/2012
Batch run: 08/08/2012
Rev:08/08/2012