TN 2 (10-11)

DI 12025.001 Claimant Requests Reconsideration of a Substantial Gainful Activity (SGA) Cessation

A. Field office (FO) procedure for work-issue-only reconsideration requests

When a Title II claimant requests reconsideration of a cessation and work is the only issue, develop the work issue per DI 13010.145.

NOTE: If the initial determination was made outside of eWork, the reconsideration is an eWork exclusion. For instructions on processing eWork exclusion cases, see DI 13010.145D.

B. FO procedure for work- issue reconsideration requests when there is also a possible medical issue

In addition to processing the substantial gainful activity (SGA) (work issue) reconsideration according to DI 12025.001A in this section, when there is also a possible medical issue, follow these steps:

  1. Review the file to determine if there is a matured medical reexamination diary or indication of medical improvement. For information about medical improvement diaries, see DI 13005.005.

  2. Determine whether the claimant:

    • meets the criteria for one of the two separate medical continuing disability review (CDR) protections provided by the Ticket to Work and Work Incentives Improvement Act of 1999 or

    • is participating in an Office of Program Development and Research (OPDR) demonstration project. Consider the following:

      1. Section 111 of Public Law 106-170 , as discussed in DI 13010.012

        If the beneficiary has received Title II or concurrent Title II and Title XVI benefits for at least 24 months, he or she will not have a medical CDR triggered solely as a result of his or her work activity.

      2. Section 101 of Public Law 106-170 , as discussed in

        • DI 55001.001 Ticket to Work and Work Incentives Improvement Act of 1999 (P. L. 106-170) -- Overview

        • DI 55025.001 Determining Ticket Status, and

        • DI 55025.010 Processing the Medical CDR for Beneficiaries with Tickets.

        If a beneficiary’s Ticket to Work is assigned and in use with an Employment Network (EN) or a State Vocational Rehabilitation (SVR) Agency, he or she will not be subject to medical CDRs. The Disability Control File (DCF) will show, “Assigned-In-Use” or “In Use SVR.”

  3. Obtain updated medical information by completing form SSA-454-BK (Continuing Disability Review Report) and using the procedures for eCDRs in the Electronic Disability Collect System, in DI 81010.225. Follow this procedure if the beneficiary has a matured medical diary on the DCF, and none of the medical CDR protections apply, nor is he or she a participant in an OPDR demonstration project that provides medical CDR protection.

  4. Obtain current SSA-827s (Authorization To Disclose Information to the Social Security Administration), as needed, for release of medical evidence.

  5. Send an interim notice. For model interim notice language for reconsideration reversal of an SGA cessation, see DI 12095.180.

  6. Send the folder(s) to the Disability Determination Services for resolution of the medical issue.

C. FO procedure when a claimant files a late request for reconsideration

When a claimant files his or her request for reconsideration late (i.e., more than 60 days after receipt of the initial determination) take the following actions:

  • Determine whether there is good cause for the late filing. For instructions regarding a good cause determination for late filing of a request for reconsideration, refer to GN 03101.020.

  • Prepare and send a notice, if you do not find good cause, following the instructions in DI 12005.015C.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412025001
DI 12025.001 - Claimant Requests Reconsideration of a Substantial Gainful Activity (SGA) Cessation - 06/29/2017