TN 55 (08-96)

DI 12586.065 Favorable Title XVI Decisions -- Stieberger

Procedure

1. Update

To update the claim:

  1. Contact the class member or, if there is an SSA-1696 in file, the representative by sending an SSA-8009. Complete the first paragraph fill-ins based on the information provided by the DDS in the SSA-4268.

  2. Develop any work activity using the work activity tolerances in DI 12586.070.

  3. Develop the non-medical factors of eligibility using the special Stieberger tolerances in DI 12586.075 through DI 12586.090.

2. Actual Onsets and Closed Periods

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

  1. Actual Onset Cases

    • If the actual onset is later than the administrative onset (per the Worksheet summary), pay for the actual period of disability;

    • If the actual onset is earlier than the administrative onset (per the Worksheet summary), the DDS will show the actual onset on the SSA-831-U3. Pay for the PAYMENT PERIOD shown on the Worksheet.

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

    However, payment can not exceed the number of months in the period of disability, subject to the 48-month limit on payment for months prior to 12/ 91. 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 Begins Before 12/91 and 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 (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 1., above.

      • Terminate eligibility after the grace period;

    3. Closed Period Begins and Ends Before 12/91

      Payment can not exceed the number of months in the period of disability, 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 (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 (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 12586.045.D.

    EXAMPLE I: CLOSED PERIOD OVER 48 MONTHS

Situation:Application date= 12/1/83
 Date of onset= 12/1/83
 Medical cessation= 12/88
Processing:Actual payment months under regular title XVI rules would be 12/83 - 2/89, after adding grace period months (no waiting period). 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, pay starting 3/85, cease 12/88, and terminate 3/89.
  • EXAMPLE II: CLOSED PERIOD LESS THAN 48 MONTHS

Situation:Application date= 12/1/83
 Date of onset= 12/01/83
 Medical cessation= 12/85
Processing: