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.