TN 55 (08-96)

DI 12586.045 Payment Period and Onset -- Title II -- Stieberger

A. Introduction

The Stieberger DEVELOPMENT PERIOD and the onset date that the DDS will show on the SSA-831 are not necessarily related. Rather, the Stieberger onset will usually be an administrative onset, selected to permit payment in the first month of the Stieberger PAYMENT PERIOD (see C., below).

B. Policy -- Insured Status

For the purposes of Stieberger adjudication, a class member generally will be considered to have insured status as of the Stieberger onset as long as he/she was insured as of the AOD of the claim which resulted in entitlement to relief.

NOTE: If the 10(e)(5) exception requires that the DDS ask the FO to obtain prior folders (see DI 12586.035E), the DDS will also request that the FO determine when insured status was last met (see DI 12586.035).

C. Policy -- Payment Period

The Stieberger PAYMENT PERIOD (“payment period”) is usually the 48-month period prior to 12/91 (i.e., 12/87 through 11/91). Certain exclusions listed in D.1., below, may affect the title II PAYMENT PERIOD. If disability continues (and the factors of entitlement are met) payment of benefits may continue after the PAYMENT PERIOD.

The FO is responsible for computing the PAYMENT PERIOD and potential administrative onset date prior to sending the case to the DDS. The PAYMENT PERIOD will be computed using the DEVELOPMENT/PAYMENT PERIOD Worksheet (see DI 12586.095, Exhibit 10) or the PC program, if available in the FO.

D. Procedures

1. Computing Title II PAYMENT PERIOD

When computing the title II PAYMENT PERIOD, start with the 48-month period from 12/87 through 11/91, but go back further, as necessary, to exclude:

  • months the class member was already entitled to title II `A' (reduced or unreduced), `HA', CDB or DWB benefits;

  • months of potential entitlement to any type of benefit listed above, based on a pending claim;

  • months covered by a non-New York medical decision of denial (or cessation);

  • months, any part of which, the individual was incarcerated after conviction for commission of a felony or an offense in the nature of a felony.

IMPORTANT: No payment will be made for any months prior to the first month of potential entitlement on the earliest title II claim finally adjudicated in the Stieberger period; 10/1/81 through 7/2/ 92, inclusive.

2. Documentation

File the DEVELOPMENT/PAYMENT PERIOD worksheet on the right side of the DIB folder just beneath the SSA-831. Record the administrative onset shown on the summary sheet in the Remarks block of the SSA-831.

EXAMPLES:

  1. The earliest Stieberger claim was filed on 3/9/83 and had a 1/16/83 AOD. It was denied on 5/10/84 by the NY DDS on reconsideration. No subsequent claim or period of incarceration involved.

    The PAYMENT PERIOD is 12/87 through 11/91 (see C., above).

  2. Same facts as in a., except for incarceration from 7/31/90 until 4/ 1/93 due to a felony conviction. The PAYMENT PERIOD cannot include months of incarceration for a felony conviction, so count back 48 months beginning with 6 /90.

    The PAYMENT PERIOD is 7/86 through 6/90.

  3. The earliest claim in the Stieberger period was filed 5/14 /87, had a 12/10/86 AOD, and was denied at the ALJ level on 10/3/89. The class member became entitled to “A” benefits upon attainment of age 62 in 8/90.

    The PAYMENT PERIOD cannot include months of entitlement to `A' benefits, so 48 months back from 7/90 would be 8/86. Payment, however, cannot be made before 6/87 (i.e., the first possible month of entitlement on the earliest Stieberger claim).

    The PAYMENT PERIOD is 6/87 through 7/90. Benefits already paid for 8 /90 on will be adjusted, if necessary.

E. Policy -- Onset

1. General

The potential onset date shown on the worksheet summary is an administrative onset, selected to permit payment to start with the first month of the PAYMENT PERIOD. Unless the DDS must adjust the onset based on its development (see DI 12586.060, item 2.), the title II Stieberger ONSET is:

  • for CDB and no waiting period cases, the first day of the first month of the PAYMENT PERIOD (see F., below).

  • for all other cases, it is the first day of the fifth