DI 12095.165 Model Letters Regarding Benefit/Payment Continuation

  1. Exhibit 1 - Benefit Continuation Model Letter A - (Pipeline Notice to Title II Beneficiary Whose Disability Determination Is Being Appealed)

  2. Exhibit 2 - Benefit Continuation Model Letter B - (Pipeline Notice to Auxiliary Title II Beneficiary Whose Benefits Are Dependent on Another Beneficiary's Appeal)

  3. Exhibit 3 - Payment Continuation Model Letter C - (Pipeline Notice to Title XVI Recipient Where Goldberg/Kelly Payments Are not Being Paid Because the Claimant Either Waived G/K Payments or Did Not File a Timely Appeal)

  4. Exhibit 4 - Benefit Continuation Model Letter D - (Pipeline Notice to Beneficiary/Recipient Who is Receiving Goldberg/Kelly Payments or Benefit Continuation Payments)

  5. Exhibit 5 - Benefit Continuation Model Letter E - (Pipeline Notice to Beneficiary/Recipient Who Was Receiving Goldberg/Kelly Payments Prior to the ALJ Decision and Appeals Council Dismissal)

  6. Exhibit 6 - Benefit Continuation Model Letter F - (Pipeline Notice to the Title II Beneficiary Entitled to EPE Whose Impairment Severity Determination Is Being Appealed)

  7. Exhibit 7 - Benefit Continuation Model Letter G - (Pipeline Notice to Auxiliary or Title II Beneficiary Entitled to EPE Whose Benefits Are Dependent on Another Beneficiary's Appeal)

  8. Exhibit 8 - Benefit Continuation Model Letter H - (Pipeline Notice to Title XVI Recipient Entitled to EPE Goldberg/Kelly Payments Not Being Paid Because Claimant Waived G/K Payments or Did Not File a Timely Appeal)

  9. Exhibit 9 - Benefit Continuation Model Letter I - (Pipeline Notice to Beneficiary/Recipient Who Is Receiving Extended Period of Eligibility Continuation)

  10. Exhibit 10 - Benefit Continuation Model Letter J - (Pipeline Notice to Beneficiary/Recipient Who Was Receiving EPE Continuation Under Goldberg /Kelly Prior to the ALJ Decision and Appeals Council Dismissal)

Exhibit 1

 

Benefit Continuation Model Letter A - (Pipeline Notice To The Title II Beneficiary Whose Disability Determination is Being Appealed) (Prepare on Form SSA-L951 U2/C2)

 

A change in the Social Security law allows disability benefits to be paid until an appeal of a decision that you are no longer disabled is decided by administrative law judge. Under this change, benefits can be paid to people whose benefits were stopped because they were found to be not disabled for medical reasons, if they are appealing the decision.

 

  • Contact any Social Security office within 10 days if you want benefits to be paid while you appeal.

     

If you want to receive benefits until a decision is made on your appeal, you must make a request in writing within 10 days after receiving this notice. Payments will start from the month that your benefits ended. If you were entitled or were about to become entitled to Medicare, you may also be entitled to Medicare. If you lose your appeal, you will be asked to pay the disability benefit back, but you will have the right to ask that you not be required to pay them back. You will not be asked to pay back any Medicare benefits you receive while the appeal is being decided. If you win the appeal, any money due you will be paid. If you cannot come within 10 days, be sure to contact us by phone. If you wait longer than 10 days, we will not pay you any benefits while you appeal unless you have a good reason for the delay.

 

The new law also changes the standards we use to decide whether a person's disability continues. Your claim must be reviewed again under these new standards by an agency of your State which helps us to decide if you are disabled. We expect our new rules to be ready in about 6 months. If you request benefits now we will pay you until that new decision is made. We will notify you when the new decision is made. You will have the right to appeal that decision if you think it is wrong and to request further continued benefits during that appeal.

 

If you have any questions about this notice, you may get in touch with any Social Security office. Most questions can be handled by telephone or mail. If you visit an office, please take this notice with you.

Exhibit 2

 

Benefit Continuation Model Letter B - (Pipeline Notices to Auxiliary Title II Beneficiary Whose Benefits Are Dependent on Another Beneficiary's Appeal) (Prepare on Form SSA-L951 U2/C2)

 

This notice is about the benefits you were receiving on the claim of: (Insert the name of the person on whose claim the appeal is filed).

 

A change in the Social Security law allows disability benefits to be paid until an administrative law judge decides the appeal of a decision that a person is not disabled. Under this change, benefits can be paid to people whose benefits were stopped because they or the person on whose claim they received benefits were found to be not disabled for medical reasons.

 

The person on whose claim you were receiving benefits has filed an appeal. You can have your benefits paid while the appeal is being decided if that person also choose to have your benefits paid.

 

  • Contact any Social Security office within 10 days if you want benefits to be paid during appeal.

     

If you want to receive benefits until a decision is made on the appeal, you must make a request in writing within 10 days after receiving this notice. The person on whose claim you receive benefits must also request that you receive benefits. Payments will start from the month that your benefits ended. If the appeal is lost, you will be asked to pay the benefits back, but you will have the right to ask that you not be require to pay them back. You wil not be asked to pay back any Medicare benefits you receive while the appeal is being decided. If the appeal is won, any money due you will be paid. If you cannot come within 10 days, be sure to contact us by phone. If you wait longer than 10 days, we will not pay you any benefits while the appeal is being decided unless you have a good reason for the delay.

 

The new law also changes the standards we use to decide whether a person's disability continues. The claim must be reviewed again under these new standards by a state agency which helps us decide disability. We expect our new rules to be ready in about 6 months. If you request benefits now we will pay you until that new decision is made. We will notify you when the new decision is made. You will have the right to appeal that decision if you think it is wrong and to request continued benefits if the person on whose claim you receive benefits also makes such a request.

 

If you have any questions about this notice, you may get in touch with any Social Security office. Most questions can be handled by telephone or mail. If you write, please refer to social security number of the person on whose claim you were paid. If you visit an office, please take this notice with you.

Exhibit 3

 

Payment Continuation Model Letter C - (Pipeline Notices to Title XVI Recipient Where Goldberg/Kelly Payments Are Not Being Paid, Because Claimant Waived G/K Payments or Did Not File a Timely Appeal) (Prepare on Form SSA-L8052 U2/C2)

 

A change in the Social Security law allows supplemental security income disability payments to be paid until an appeal of a decision that you are no longer disabled is decided by an administrative law judge. Under this change, payments can be paid to people whose payments were stopped because they were found to be not disabled for medical reasons.

 

  • Contact any Social Security office within 10 days if you want payments to be paid while you appeal.

     

If you want to receive payments until a decision is made on your appeal, you must make a request in writing within 10 days after receiving this notice. In addition, we will need information about non-disability factors such as your living arrangements, money you receive, and things you own. Payments will start no earlier than November 1984. If you lose your appeal, you will be asked to pay the disability payment back, but you will have the right to ask that you not be required to pay them back.

 

If you win the appeal, any money due you will be paid. If you cannot come in within 10 days, be sure to contact us by phone. If you wait longer than 10 days, we will not pay you any payments while you appeal unless you have a good reason for the delay.

 

(Insert paragraph 1152 (NL 00804.110) when SSA determines Medicaid eligibility).

 

The new law also changes the standards we use to decide whether a person's disability continues. Your claim must be reviewed again under these new standards by an agency of your State which helps us to decide if you are disabled. We expect our new rules to be ready in about 6 months. If you request payments now we will pay you until that new decision is made. We will notify you when the new decision is made. You will have the right to appeal that decision if you think it is wrong and request further continued payments during that appeal.

 

If you have any questions about this notice, you may get in touch with any Social Security office. Most questions can be handled by telephone or mail. If you write, please refer to your social security number in your letter. If you visit an office, please take this notice with you.

Exhibit 4

 

Benefit Continuation Model Letter D - (Pipeline Notice to Beneficiary/ Recipient Who Is Receiving Goldberg/Kelly Payments or Benefit Continuation Payments) (Prepare Title XVI Notice on Form SSA-L8052 U2/C2 and Title II Notice on Form SSA-L951 U2/C2)

 

A new law changes the standards we use to decide whether a person's disability continues. We expect that the new rules we will use to process cases under these new standards will be ready for use in about 6 months.

 

Your claim will be reviewed again by an agency of your State which helps us decide if you are disabled. Since you are receiving payments while you appeal, we will continue to pay you until a new decision is made on your claim.

 

We will notify you when a new decision is made using these new rules. You will have the right to appeal that decision if you think it is wrong and request further continued payments during that appeal.

 

If you have any questions about this notice, you may get in touch with any Social Security office. Most questions can be handled by telephone or mail. If you write, please refer to your social security number in your letter. If you visit an office, please take this notice with you.

Exhibit 5

 

Payment Continuation Model Letter E - (Pipeline Notice to Beneficiary/ Recipient Who Was Receiving Goldberg/Kelly Payments Prior To The ALJ Decision and Appeals Council Dismissal) (Prepare Title XVI Notice on Form SSA-L8052 U2/C2 and Title II Notice on Form SSA-L951 U2/C2

 

A new law changes the standards we use to decide whether a person's disability continues. We expect that the new rules we will use to process cases under these new standards will be ready for use in about 6 months.

 

Your claim will be reviewed again by an agency of your State which helps us decide if your are disabled.

 

Since you received payments until the administrative law judge decided your appeal, we will start those payments again from the month they ended. They will be paid until a new decision is made on your claim. We will notify you when a new decision is made using these new rules. You will have the right to appeal that decision if you think it is wrong and request further continued payment during that appeal. Please visit our office to tell us current information about your living arrangments, money you receive, and things you own.

 

(Insert paragraph 1152 (NL 00804.110) when SSA determines Medicaid eligibility.)

 

If you have any questions about this notice, you may get in touch with any Social Security office. Most questions can be handled by telephone or mail. If you write, please refer to your social security number in your letter. If you visit an office, please take this notice with you.

Exhibit 6

 

Benefit Continuation Model Letter F - (Pipeline Notice to the Title II Beneficiary Entitled to EPE Whose Impairment Severity Determination is Being Appealed) (Prepared on Form SSA-L951 U2/C2)

 

A change in the Social Security law allows the extended period of eligibility to be restarted until either an appeal of a decision that you are no longer disabled is decided either by an administrative law judge or your extended period ends. Under this change the right to restart the extended period of eligibility applies to people found to be not disabled for medical reasons, if they are appealing the decision.

 

  • Contact any Social Security office within 10 days if you want your extended period of eligibility to apply while you appeal.

     

If you want your extended period of eligibility to apply until either a decision is made on your appeal or your extended period ends, you must make a request in writing within 10 days after receiving this notice. We will start your extended period of eligibility again from the month it ended. If you were entitled to or were about to become entitled to Medicare, you may also be entitled to Medicare. If you lose your appeal, you will be asked to pay any disability benefits received back, but you will have the right to ask that you not be required to pay them back. You will not be asked to pay back any Medicare benefits you receive while the appeal is being decided. If you win the appeal, any money due you will be paid. If you cannot come in within 10 days, be sure to contact us by phone. If you wait longer than 10 days, we will not apply your extended period of eligibility while you appeal unless you have a good reason for the delay.

 

The new law also changes the standards we use to decide whether a person continues to have a disabling impairment. Your claim must be reviewed again under these new standards by an agency of your State which helps us to decide if you are disabled. We expect our new rules to be ready in about 6 months. If you request that your extended period of eligibility be continued, it will continue until either the new decision is made or your extended period ends. We will notify you when the new decision is made. You will have the right to appeal that decision if you think it is wrong and to request further continuation of your extended period of eligibility during that appeal.

 

If you have any questions about this notice, you may get in touch with any Social Security office. Most questions can be handled by telephone or mail. If you visit an office, please take this notice with you.

Exhibit 7

Benefit Continuation Model Letter G - (Pipeline Notice to Auxiliary of Title II Beneficiary Entitled to EPE Whose Benefits Are Dependent on Another Beneficiary's Appeal) (Prepare on Forms SSA-L951 U2/C2)

 

This notice is about the benefits you were receiving on the claim of (Insert the name of the person on whose claim the appeal is filed).

 

A change in the Social Security law allows disability benefits which come from having            's (Insert the name of the person on whose claim the appeal is filed) extended period of eligibility restarted to be paid until either an administrative law judge decides the appeal of a decision that       (Insert “his” or “her”) impairment is not disabling or the extended period ends. Under this change, benefits can be paid to people whose benefits were stopped because they or the person on whose claim they received benefits were found to be not disabled for medical reasons.

 

The person on whose claim you were receiving benefits has filed an appeal. You can have any benefits due you paid while the appeal is being decided if that person also chooses to have your benefits paid.

 

  • Contact any Social Security office within 10 days if you want to receive any benefits which may be due from the extended period of eligibility.

     

If you want to receive any benefits which come from having the extended period of eligibility restarted until either a decision is made on the appeal, or the extended period ends, you must make a request in writing within 10 days after receiving this notice. The person on whose claim you receive benefits must also request that you receive benefits. If you are due payments, they will start from the month that your benefits ended. If the appeal is lost, you will be asked to pay the benefits back, but you will have the right to ask that you not be required to pay them back. You will not be asked to pay back any Medicare benefits you receive while the appeal is being decided. If the appeal is won, any money due you will be paid. If you cannot come in within 10 days, be sure to contact us by phone. If you wait longer than 10 days, we will not pay you any benefits due while the appeal is being decided unless you have a good reason for the delay.

 

The law also changes the standards we use to decide whether a person continues to have a disabling impairment. The claim must be reviewed again under these new standards by a State agency which helps us decide disability. We expect our new rules to be ready in about 6 months. If you request benefits now we will pay you any money due until either that new decision is made or the extended period of eligibility ends. We will notify you when the new decision is made. You will have the right to appeal that decision if you think it is wrong and to request continued benefits if the person on whose claim you receive benefits also makes such a request.

 

If you have any questions about this notice, you may get in touch with any Social Security office. Most questions can be handled by telephone or mail. If you write please refer to the social security number of the person on whose claim you were paid. If you visit an office, please take this notice with you.

Exhibit 8

Payment Continuation Model Letter H - (Pipeline Notice to Title XVI Recipient Entitled to EPE (Goldberg/Kelly Payments Not Being Paid Because Claimant Waived G/K Payments or Did Not File a Timely Appeal)) (Prepare on Form SSA-L8052 U2/C2.)

 

A change in the Social Security law allows the extended period of eligibility to be restarted until either an appeal of a decision that you are no longer disabled is decided by an administrative law judge or your extended period ends. Under this change, the extended period of eligibility can be restarted for people who were found not to have a disabling impairment.

 

  • Contact any Social Security office within 10 days if you want your extended period of eligibility restarted while you appeal.

     

If you want your extended period of eligibility to restart until either a decision is made on your appeal or your extended period ends, you must make a request in writing within 10 days after receiving this notice. Your extended period of eligibility will restart no earlier than November 1984. If you lose your appeal, you will be asked to pay any disability payments back, but you will have the right to ask that you not be required to pay them back.

 

If you win the appeal, any money due you will be paid. If you cannot come in within 10 days, be sure to contact us by phone. If you wait longer than 10 days, we will not restart your extended period of eligibility appeal unless you have a good reason for the delay.

 

(Insert paragraph 0152 or 1152 (NL 00804.110) when SSA determines Medicaid eligibility.)

 

The new law also changes the standards we use to decide whether a person's disability continues. Your claim must be reviewed again under these new standards by an agency of your State which helps us to decide if you have a disabling impairment. We expect our new rules to be ready in about 6 months. If you request that your extended period of eligibility be restarted it will continue until either that new decision is made or your extended period ends. We will notify you when the new decision is made. You will have the right to appeal that decision if you think it is wrong and to request further continuation of your extended period of eligibility during that appeal.

 

If you have any questions about this notice, you may get in touch with any Social Security office. Most questions can be handled by telephone or mail. If you write, please refer to your social security number in your letter. If you visit an office, please take this notice with you.

Exhibit 9

Benefit Continuation Model Letter I - (Pipeline Notice to Beneficiary/ Recipient Who Is Receiving Extended Period of Eligibility Continuation (Prepare Title XVI Notice on Form SSA-L8052 U2/C2 and Title II Notice on Form SSA-L951 U2/C2.)

 

A new law changes the standards we use to decide whether a person has a disabling impairment. We expect that the new rules we will use to process cases under these new standards will be ready for use in about 6 months.

 

Your claim will be reviewed again by an agency of your State which helps us decide if you are disabled. Your extended period of eligibility will continue until either a new decision is made on your claim or your extended period ends. We will notify you when a new decision is made using these new rules. You will have the right to appeal that decision if you think it is wrong and request further extended period of eligibility continuation during that appeal.

 

(Insert paragraph 1152 (NL 00804.110) when SSA determines Medicaid eligibility.)

 

If you have any questions about this notice, you may get in touch with any Social Security office. Most questions can be handled by telephone or mail. If you write, please refer to your social security number in your letter. If you visit an office, please take this notice with you.

Exhibit 10

Payment Continuation Model Letter J - (Pipeline Notice to Beneficiary/ Recipient Who Was Receiving EPE Continuation Under Goldberg/Kelly Prior to the ALJ Decision and Appeals Council Dismissal) (Prepare Title XVI Notice on Form SSA-L8052 U2/C2 and Title II Notice on Form SSA-L951 U2/ C2.)

 

A new law changes the standards we use to decide whether a person continues to have a disabling impairment. We expect that the new rules we will use to process cases under these new standards will be ready for use in about 6 months.

 

Your claim will be reviewed again by an agency of your State which helps us decide if you are disabled.

 

Since you received continuation of your extended period of eligibility until the administrative law judge decided your appeal, we will start your extended period of eligibility again from the month it ended. Your extended period of eligibility will continue until either a new decision is made on your claim or your extended period ends. We will notify you when a new decision is made using these new rules. You will have the right to appeal that decision if you think it is wrong and request that your extended period of eligibility continue during that appeal.

 

(Insert paragraph 1152 (NL 00804.110) when SSA determines Medicaid eligibility.)

 

If you have any questions about this notice, you may get in touch with any Social Security office. Most questions can be handled by telephone or mail. If you write, please refer to your social security number in your letter. If you visit an office, please take this notice with you.


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http://policy.ssa.gov/poms.nsf/lnx/0412095165
DI 12095.165 - Model Letters Regarding Benefit/Payment Continuation - 09/06/2012
Batch run: 09/06/2012
Rev:09/06/2012