BASIC (10-06)

DI 12027.015 Cases Excluded from Statutory Benefit Continuation (SBC)

The following are excluded from the SBC provisions.

  • Initial determination of a closed period of disability (except adverse reopenings/revisions from an allowance to a closed period of disability).

  • Substantial gainful activity (SGA) cessations.

  • Whereabouts unknown cessations under Title II. (Title XVI whereabouts unknown is a basis to suspend, but not to terminate Supplemental Security. Income (SSI) payments until the beneficiary is located.) See DI 13015.001 for procedure on processing these cases.

  • Failure to follow prescribed treatment cessations.

  • Termination of benefits based on failure to cooperate with the field office request for necessary information or evidence needed to complete the continuing disability review. See DI 13015.001C.

  • Disability determinations made on the basis that a prior favorable determination was obtained by fraud or similar fault.

  • Auxiliary filing a claim on the record of a primary beneficiary whose disability has already been ceased (whether SBC is involved with the primary beneficiary’s record or not).

  • Medicare Qualified Government Employee (MQGE).

  • Termination of continued payments under Section 301. See DI 14505.010G.

NOTE: The cessation and adverse reopening determinations/decisions in Title II cases excluded from SBC require a due process predetermination notice without benefit continuation language. See DI 28080.005.

Goldberg/Kelly procedures apply to Title XVI cessation/adverse reopening cases that are exclusions from SBC. See SI 02301.300.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412027015
DI 12027.015 - Cases Excluded from Statutory Benefit Continuation (SBC) - 06/26/2014
Batch run: 06/26/2014
Rev:06/26/2014