TN 55 (08-96)

DI 12586.060 Favorable Title II Decisions -- Stieberger

Procedure

Follow the procedures below upon receipt of a favorable determination from the DDS. (Note: An auxiliary claimant on the record of a Stieberger class member is subject to the regular entitlement requirements and development rules.)

1. Updating

  1. Contact the class member, or if there is an SSA 1696-U4 in file, the representative, to develop any outstanding non-medical factors of entitlement. Develop work activity (if necessary) in accordance with the work activity tolerance procedures in DI 12586.070.

  2. If there are auxiliaries, use the Stieberger Folder Request Memo (DI 12586.095, Exhibit 11) with copies of the alert and queries attached, to request that the Stieberger Workgroup at P.O. Box 17369, Baltimore, MD 21298-0050 obtain the claims file(s). Protective filing for auxiliaries is the earliest of:

    • the date of the earliest SSA-16 within the Stieberger period (10/1/81 - 7/2/92, inclusive) on which the auxiliary was mentioned, or;

    • the date the Stieberger supplement was signed.

2. Actual Onsets and Closed Periods

If the DDS cannot find the class member disabled for the entire DEVELOPMENT PERIOD and certain conditions are met (see DI 12586.001, item 7.), it will establish an actual rather than an administrative onset.

  1. Actual Onset Cases - Actual onset must be prior to DLI. Regular rules regarding the waiting period apply. Months in the waiting period are not counted in the PAYMENT PERIOD.

    1. If the actual onset is later than the administrative onset shown on the Worksheet summary pay for the actual period of disability:

      • Annotate the Worksheet summary to show the actual onset established by the DDS;

      • Use regular rules to determine the month of entitlement;

      • Update for the actual period of entitlement, using the tolerances in DI 12586.070.

    2. If the actual onset is earlier than the administrative onset on the Worksheet summary, the DDS will show the actual onset on the SSA-831-U3. Pay for the Payment Period shown on the worksheet.

      • Annotate the Worksheet summary to show the actual onset established by the DDS;

      • Update for the period beginning with the administrative onset on the Worksheet summary using the tolerances in DI 12586.070.

  2. Closed Period Cases - Where the DDS establishes a closed period, the actual period of disability will be shown on the SSA-831-U3.

    However, payment cannot exceed the number of months in the period of disability, subject to the 48-month limit on payment for months prior to 12/ 91. Waiting period months are excluded from the PAYMENT PERIOD; grace period months (the two months of payment following the medical cessation month) are included in the PAYMENT PERIOD.

    1. Closed Period Begins 12/91 or Later

      • Annotate the Worksheet summary with the actual onset established by the DDS;

      • Use regular rules to determine dates of entitlement and termination;

      • Update for the actual period of entitlement, using the tolerances in DI 12586.070.

    2. Closed Period Ends After 12/91

      • Annotate the Worksheet summary with the actual onset established by the DDS;

      • Count the number of potential payment months prior to 12/91 (subtract any waiting period months; include any grace period months prior to 12/91);

      • If the number of months before 12/91 is 48 or more, begin payment based on the administrative onset on the Worksheet summary;

      • If the number of months before 12/91 is fewer than 48, begin and end payment based on the actual onset and cessation dates established by the DDS. See b.1., above;

      • Terminate eligibility after the grace period;

    3. Closed Period Ends Before 12/91 - Payment can not exceed the number of months in the period of disability and is subject to the 48-month limit on payment for months prior to 12/91.

      • Annotate the Worksheet summary with the actual onset established by the DDS;

      • Count the number of potential payment months (subtract any waiting period months; include any grace period months);

      • If the number of months is 48 or more, begin payment based on the administrative onset on the Worksheet summary;

      • If the number of months is less than 48, count the number of potential payment months (subtract any waiting period months; include any grace period months). Begin payment with the latest month that will allow this number of payment months before 12/91, considering all of the Stieberger PAYMENT PERIOD exclusions in DI 12586.045D.

    EXAMPLE I: CLOSED PERIOD OVER 48 MONTHS

Situation:Application date= 3/31/84
 Date of onset = 12/01/83
 Medical cessation= 12/88
Processing:Actual payment months under regular title II rules would be 5/ 84 - 2/89, after excluding waiting period months and including grace period months. This is more than the total of 48 months we can pay, prior to 12/91, under Stieberger rules. If no other PAYMENT PERIOD exclusions apply, we will pay with an MOE of 3/85, a cessation month of 12/88, and termination 3/89.
  • EXAMPLE II: CLOSED PERIOD LESS THAN 48 MONTHS

Situation:Application date= 3/31/84
 Date of onset= 12/01/83
 Medical cessation= 12/85
Processing:Actual payment months under regular title II rules would be 5/ 84 - 2/86, after excluding waiting period months and including grace period months. This totals 22 months, which does not exceed the 48 months Stieberger limit. If no other PAYMENT PERIOD exclusions apply, we will pay with an MOE of 5/84, a cessation month of 12/85, and termination 3/ 86.
 Do not begin payment before the “potential payment date” shown on the summary sheet.

3. Suspension, Deduction, Offset

Exclude prisoner suspense months from the PAYMENT PERIOD. (See DI 12586.045)

NOTE: The usual procedures regarding Workers Compensation (DI 52101.001); Windfall Offset (GN 02610.005 - GN 02610.022) apply during the Stieberger PAYMENT PERIOD, as do other non-prisoner suspension and deduction criteria.

4. Termination and Re-entitlement

a. Work Activity

Develop work activity after 11/30/91 using the instructions in DI 12586.070; work prior to 12/01/91 will not be counted for purposes of assessing trial work months or for purposes of imposing SGA suspensions or terminations (see DI 12586.001, item 11.).

Beneficiaries who are currently entitled based on subsequent claims may be affected as a result of counting trial work months which occur after 11/30/ 91. In order to avoid large retroactive overpayments, when development under DI 12586.055, item 5, results in termination for SGA after the PAYMENT PERIOD ends, protect the filing date for a new claim as of the date of SSA's receipt of the request for Stieberger review.

Prepare an SSA-833 cessation determination and return the case to the DDS to establish a new period of disability. When the folder is returned from the DDS, effectuate payments for the proper periods.

If subsequent entitlement is not affected by terminating the Stieberger entitlement, no protective filing is required.

b. Non-New York Denials

If the DDS must establish a closed period because of a later medical denial by a non-New York DDS, both disability and entitlement end with the AOD (or date of filing if the non-New York denial is a title XVI claim) in the non-New York claim. The entire period adjudicated in the non-New York determination is a non-entitlement period. If the class member is currently disabled, a new period of disability may be established no earlier than the day after the date of the non-New York decision.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412586060
DI 12586.060 - Favorable Title II Decisions -- Stieberger - 09/26/2008
Batch run: 01/27/2009
Rev:09/26/2008