TN 31 (10-10)

DI 11015.005 Field Office (FO) Processing of an Initial Disabled Widow(er)’s Benefits (DWB) Claim

A. When the DWB applicant has never been entitled on the deceased number holder’s (NH) record

Do not defer development of the non-medical factors of entitlement for a DWB claim, as outlined in Requirements for Disabled Widow(er)'s Benefits (DWB) DI 10110.001.

If a widow(er) or surviving divorced spouse between the ages of 50 and 60 is filing for the first time on the deceased number holder’s (NH) record and alleges a disability:

  • Evaluate certified earnings records for both the deceased NH and the widow(er) to determine if it is in the widow(er)’s best interest to file for DWB (for information on development of a DWB claim when the widow(er)’s own disability insurance benefit (DIB) is larger than the potential DWB, see DI 11015.001B).

  • Obtain the appropriate application(s) and necessary proofs (e.g., age and relationship).

  • Prepare the certified electronic folder (CEF).

  • Transfer the CEF to the Disability Determination Services (DDS) for a medical determination.

  • Process the determination upon DDS case closure.

EXCEPTION: For non-CEF cases, follow processing instructions in Certified Electronic Folder (CEF) Exclusions and Limitations DI 81010.030 and Field Office (FO) Processing of a Disabled Widow(er)’s Claim for an Electronic Disability Collect System (EDCS) Exclusion Case DI 11015.015. After systems inputs to effectuate the claim, forward paper folders for allowances to the servicing Program Center (PC) (see the Claims Routing Guide GN 01050.075). Retain denied claims in the field office (FO) until an appeal is filed or the 6-month retention period expires.

References:

  • GN 01010.009 – Certified and Uncertified E/Rs

  • GN 00204.022 – Explore Entitlement on Another Earnings Record or to Another Class of Benefits

  • GN 00205.040 – RSDI Applications - Disability Question on Applications for Widow(er)'s Insurance Benefits (WIB)

  • RS 00207.007 - Field Office (FO) Processing of Initial Disabled Widow(er)'s Claims

  • DI 81010.000 – FO Procedures - Electronic Process

  • DI 81010.085 – Transferring Cases in Electronic Disability Collect System (EDCS)

B. When the DWB applicant was previously entitled on the deceased NH’s record

If the DWB applicant was previously entitled to mother’s or father’s benefits, DWB, or the lump sum death payment (LSDP) on the deceased NH’s record, follow procedures as described in DI 11015.005A (in this section), noting the following:

  • The claimant must submit proof of marriage if the prior entitlement was to the LSDP only.

  • The FO reviews the established record for the later of the NH’s date of death and the date the claimant’s previous entitlement terminated to calculate the prescribed period. To be eligible under the DWB provision, the widow(er)’s disability onset must have occurred prior to the end of the prescribed period.

NOTE: For information on re-entitlement when the prior DWB entitlement terminated because of the widow(er)’s remarriage, see How Remarriage Affects Widow(er)’s Benefits RS 00207.003.

1. Verify the NH’s date of death

Review the record (e.g., numident record (NUMI), master beneficiary record (MBR), or EVIDENCE (EVID) screen) for the date of the NH’s death, and record the information:

  • in a report of contact (RPOC), and

  • on the Modernized Claims System (MCS) Development Worksheet (DW01).

When the FO has no record of the NH’s death, request proof:

  • from the applicant, if readily available; or

  • if the applicant is unable to furnish it and the approximate date and place of death are known, obtain the evidence by certifying the public record or by other established procedures.

References:

2. Verify the date prior benefits terminated

When the claimant was previously entitled to mother's, father's, or DWB:

  • review the MBR to determine the date benefits terminated; and

  • record this information on an RPOC in MCS.

For additional information about terminating events, see Mother’s and Father’s Termination, RS 00208.030.

C. When the claimant can convert from mother’s or father’s benefits to DWB

If the widow(er) is entitled to mother’s or father’s benefits and becomes disabled, determine if it would be advantageous for the disabled widow(er) to elect DWB per RS 00207.005B. Additionally, review the widow(er)’s own earnings record to determine if he or she is insured for DIB, following instruction in DI 11015.001B.

NOTE: A mother or father beneficiary can be deemed to be entitled to DWB for health insurance (HI) purposes only, so he or she may wish to establish eligibility to DWB solely for HI purposes.

Follow processing instructions in DI 11015.005B (in this section), noting that it is not necessary to establish an MCS claim to create an EDCS case for the disabled widow(er). Create the MCS-Exclusion case in EDCS per DI 81010.020 and DI 81010.035B.

1. If disability is established

When the DDS makes a favorable determination, the FO completes the SSA-3601 Claims Routing form. Proceed as follows:

  • Complete the top portion of the 3601 in the usual manner, following instruction in GN 01020.255.

  • Check the “Action Required” block and include the message “DWB conversion case. Please see SSA-831 in CEF under SSN xxx-xx-xxx.”

  • Fax the 3601 to the Program Center (PC) of jurisdiction.

Upon receipt of notice that disability has been established, the program center (PC) prepares the widow(er)'s award effective with the first month for which the claimant is no longer entitled to mother's/father's benefits.

2. If disability is not established

When the DDS makes an unfavorable determination, the FO processes the disallowance via Manual Adjustment, Credit, and Award Direct Data Entry (MACADE). For complete MACADE processing instructions, see Disallowances, Abatements, and Withdrawals SM 00380.000.

References:

  • RS 00207.005 – Widow(er)’s Benefits – Conversion of Benefits – Policy

  • RS 00207.020 – Health Insurance (HI) for Disabled Widow(er)s

  • RS 00208.110 – Medicare – Requirements for Entitlement – Mothers/Fathers

D. When the DWB files a simultaneous LSDP application

If the widow(er) alleging disability can also be entitled to the LSDP (which can be paid immediately), but the DWB claim will be delayed (e.g., outstanding disability development), process the two claims independently.

  1. Process the LSDP through MCS earnings computation (EC).

  2. Send a notice to the claimant that includes UTI CLOR05, advising that SSA will contact him or her later regarding the pending widow(er)’s claim (for complete paragraph information, see MCS Universal Text Identifiers (UTI) NL 00725.005).

  3. Enter the remark “LSDP - ONLY TRIGGERED ON (DATE)” on an RPOC in MCS.

References:

  • GN 01010.140 – FO Action on a Delayed Claim

  • RS 00207.007 – Field Office (FO) Processing of Initial Disabled Widow(er)'s Claims

  • DI 11015.025 – Field Office (FO) Action on a Disabled Widow(er)’s Benefit (DWB) Claim after Disability Determination Service (DDS) Completion

E. When the claimant has prior Supplemental Security Income (SSI) or federally administered State Supplemental Payment (SSP) eligibility

Prior SSI or SSP eligibility can affect both the 5-month waiting period and the 24-month Medicare qualifying period. If the DWB claimant had prior SSI or SSP eligibility, follow procedures as described in DI 11015.005A (in this section) noting the following:

  • Annotate the MCS development worksheet (DW01) with the issue “SSISSP” and the remark, “Prior SSI/SSP eligibility.”

  • Follow processing instructions in DI 11015.020 and DI 11015.025A prior to adjudicating an allowance.


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DI 11015.005 - Field Office (FO) Processing of an Initial Disabled Widow(er)'s Benefits (DWB) Claim - 09/08/2014
Batch run: 09/08/2014
Rev:09/08/2014