DI 11025.020 Disability Determination Needed to Establish Entitlement to Lump Sum Death Payment
If a fully or currently insured number holder (NH) dies on or after September 1, 1981, the provision of P.L. 97-35 (enacted August 13, 1981) redefines who can be paid the LSDP. The priority is:
The surviving spouse of the deceased who was living in the same household as the deceased at the time of death;
A person (other than a surviving divorced spouse) who is entitled to or was eligible for benefits as a widow(er), mother, or father on the deceased's record for the month the NH died;
A child of the NH who is entitled to or was eligible for benefits on the deceased's record for the month the NH died.
Under factors 2 and 3, a disability determination may be necessary to establish eligibility to benefits so a DWB or CDB can collect the LSDP. When the DWB or CDB does not wish to file for monthly benefits, the instructions in this section apply.
A. Taking and developing LSDP claims for DWB or CDB
Take, and develop, the LSDP claim in Modernized Claims System (MCS) as follows:
The LSDP screens should contain all the necessary information to determine eligibility. Do not take a CDB or DWB claim since they are not filing for monthly benefits.
Determine if the DWB or CDB meets all factors of entitlement for monthly benefits, except for filing an application.
Develop for evidence of age, relationship, or other factors of entitlement as if the LSDP applicant had also filed for monthly benefits.
For the DWB requirements, see RS 00207.001, Widow(er)’s Benefits Definitions and Requirements.
For the CDB requirements, see RS 00203.080, Childhood Disability Benefits (CDB)-General.
Deny the claim if the CDB or DWB does not meet a factor of entitlement.
The number holder (NH) died 5/30/2010. His widow, age 58, was not living with the NH at the time of his death. She alleges she is disabled. She does not wish to file for DWB, as she is receiving a Civil Service pension and Government Pension Offset (GPO) would reduce her DWB benefit to zero, and does not want Medicare entitlement. She does apply for the LSDP. You must determine whether the widow is disabled and otherwise eligible for DWB for the month of the NH’s death.
Same as example 1, except the widow is 49 at the time of the NH’s death. You would deny the claim, as she does not meet the basic eligibility factor of being at least 50.
The NH died 12/22/2009. His daughter, age 25, alleges disability at age 21 due to a serious car accident. She elects not to file for CDB but does file for the LSDP. To evaluate her eligibility for the LSDP, SSA must determine whether the disability began before age 22 and whether she is still under a disability at the time of her father’s death. She would also have to meet the other eligibility factors for CDB.
Same as example 3, except this time the car accident occurred at age 23. She stated she did not have a disabling condition before the car accident. Since she does not meet the basic eligibility factor that requires her disability to begin before age 22, deny her claim.
B. Obtaining a Disability Determination Services (DDS) decision if all non-disability requirements are met
The following additional instructions relate to these cases:
At present, these cases are Electronic Disability Collect System (EDCS) exclusions. Complete paper Forms SSA-3368 (Disability Report-Adult), SSA-827 (Authorization to Disclose Information to the Social Security Administration), and SSA-3367 (Disability Report-Field Office).
Prepare a modular disability folder (MDF). Show the NH’s SSN and the DWB or CDB’s name.
Transmit the paper folder to DDS using an SSA-831 (Disability Determination and Transmittal). Complete items 1-14 of the SSA-831. In item 11 remarks show “For LSDP only. NH’s date of death (date)”.
If you need help in completing these items see DI 11010.205, Completing the SSA-831.
C. Processing LSDP Allowance or Denial
1. Disability is denied, deny LSDP
To process the denial, take these actions:
DWB- In MCS on the DECD screen in the section titled: IS SPOUSE __, enter "3" to indicate not eligible;
If the denial code is not automatically generated, use disallowance code 47 for DWB, or 51 for CDB;
Process the case through EC.
2. Disability is established, LSDP can be paid
To process the allowance, take these actions:
DWB- In MCS on the DECD screen in the section titled: IS SPOUSE __, enter "2" to indicate eligible or entitled to survivor benefits for the month of death is the basis for allowance of the lump sum.
CDB- There is no special screen to indicate that the child is receiving the LSDP because they meet all the eligibility factors except for filing. Document the file that we established disability and that they meet all factors of entitlement for CDB except for actually filing a CDB claim.