Citations:

Social Security Act -- Section 223(g) and 1631(a)(7);

Regulations -- 20CFR 404.1597, 404.1597a, 416.995 and 416.996

BASIC (10-06)

DI 12027.001 Statutory Benefit Continuation (SBC)

Citations:

Social Security Act -- Sections 223(g) and 1631(a)(7) ;

Regulations -- 20 CFR 404.1597 , 404.1597a , 416.995 and 416.996

A. General – Statutory Benefit Continuation (SBC)

This subchapter contains the policy and field office (FO) instructions for processing SBC during an appeal under Title II and/or Title XVI of:

  • a medical cessation determination where the disabled individual’s physical or mental impairment(s) has ceased, never existed, or is no longer disabling, i.e., medically improved, or

  • a medical adverse reopening/revision determination.

Appealing the medical cessation (or medical adverse reopening/revision determination) is required to have the option of SBC.

  • A beneficiary that elects SBC is required to sign a specific statement (SSA-795) to that effect. See DI 12027.010B.4.

  • A beneficiary that declines SBC is required to sign a specific statement (SSA-795) to that effect. See DI 12027.010B.4.

The continued benefit provisions do not apply to an initial determination on an application for disability benefits or to a determination that an individual was disabled only for a specified period of time.

B. Policy – Statutory Benefit Continuation (SBC)

1. Medical Cessation

A beneficiary may elect or decline to continue receiving Title II social security disability benefits, Title XVI Supplemental Security Income (SSI) disability or blindness payments, and/or Medicare during a reconsideration or an Administrative Law Judge (ALJ) hearing appeal for a medical cessation determination.

2. Medical Adverse Reopening/Revision Determination

A beneficiary may elect or decline SBC of Title II social security disability benefits, Title XVI SSI disability or blindness payments, and/or Medicare during a reconsideration or an Administrative Law Judge (ALJ) hearing appeal of a medical adverse reopening/revision determination:

  • allowance to denial

  • allowance to closed period

  • continuance to medical cessation

  • revision to an earlier cessation date

  • revision to a later cessation date.

3. Appeals Council (AC) Court Remands

SBC also applies in cases remanded to the ALJ by the AC, when the appeal issue is a medical cessation (or medical adverse reopening/revision determination), including court remands not covered by Section 2(d) of P.L. 98-460.

  • See AC Remand Medical Cessation Cases - Title II, DI 12027.060

  • See AC Remand Medical Cessation Cases – Title XVI and Concurrent Title II/Title XVI, DI 12027.065

4. SBC provisions apply in each of the following situations:

  1. Title II - Medical improvement determination (after January 11, 1983)

  2. Title XVI - Medical improvement determination (after October, 1984)

  3. Title II and/or Title XVI - Medical adverse reopening/revision determination of:

    • allowance to denial

    • allowance to closed period

    • continuance to medical cessation

    • revision to an earlier cessation date

    • revision to a later cessation date

  4. Title XVI Age 18 Medical Redetermination - Medical Cessation That Uses the Disability Standard for Adult Applicants

  5. AC Remands to ALJ - When appeal issue is medical cessation (or medical adverse reopening/revision determination)

    • See Cases Excluded From Statutory Benefit Continuation (SBC), DI 12027.015.

    • See Benefit Continuation Revisions – Policy, DI 28001.070.