TN 27 (04-09)

DI 13010.001 Work Activity and Work Incentives

The definition of disability requires that an individual be medically disabled, and unable to perform substantial gainful activity (SGA). After we find that a beneficiary is disabled, we have an obligation to periodically evaluate the impairment(s) to determine whether the disability continues or ceases. This evaluation process is a Continuing Disability Review (CDR). We periodically perform CDRs to determine if a beneficiary meets the medical definition of disability. If a beneficiary is working, we will perform a work CDR to investigate work activity and determine if he or she is able to engage in SGA.

See Also:

DI 13005.001 – Field Office Role in Medical Issue Cases

A. General overview of the field office work CDR process

For a list of the events that may trigger a work CDR, see DI 13010.010.

1. FO Interviewing process

The field office (FO) will develop and evaluate all work activity, using work incentives (DI 13010.001B in this section) as appropriate, to determine if disability continues or ceases:

  1. Explain pertinent work incentives, and the effect of work incentives to a beneficiary who works, or asks about returning to work.

  2. Explain to a concurrent (Title II and Title XVI) beneficiary the effect of how returning to work while on Supplemental Security Income (SSI), and how work incentives may affect that entitlement.

  3. Make sure the beneficiary understands that the work review may result in a cessation of benefits, and that he or she does have the opportunity to submit any new evidence that may make a difference on this decision.

  4. If applicable, establish a work report in eWork.

  5. If you decide that a beneficiary has engaged in SGA, explain the basis for the determination to the beneficiary.

  6. Enter the correct systems inputs to effectuate the determination

  7. eWork will prepare a SSA-899 (Continuing Disability Review) or a SSA-833-U5 (Cessation or Continuance Determination) when appropriate.

  8. eWork will provide the rationale on a SSA-4268-U4 (Explanation of Determination).

2. Disability ceases

We determine that disability ceases when:

  • medical improvement in the individual's impairment(s), or certain exceptions to medical improvement apply; and,

  • physical and/or mental impairment(s) and the vocational profile (i.e., age, education and work experience), if appropriate, does not prevent an individual from engaging in SGA (where relevant); or

  • the individual demonstrates by working, the ability to engage in SGA- subject to the trial work period (TWP) and extended period of eligibility (EPE) provisions.

When determining that disability ceases or benefits are not payable because of SGA, provide the beneficiary with due process before stopping benefits in the following cases:

  • during the (EPE), or

  • during the initial reinstatement period (IRP) in expedited reinstatement (EXR) cases.

NOTE: The SGA tests are not applicable to post-adjudicative determinations in Title XVI cases, therefore, handle work activity according to the policy principles found in SI 02302.010.

References:

DI 13010.185 - Due Process –SGA Cessation /Adverse Reopening

DI 13010.010 - Events that Issue a Work Issue CDR

DI 13010.025 - FO Responsibility in Work Issue CDRs

SI 02302.010 - 1619 Policy Principles

B. Policy - Work incentives and the FO role

Congress has passed numerous amendments to the Social Security Act with the intent to provide beneficiaries with disabilities incentives to return to work. When conducting a work CDR, consider how using one or more work incentives would affect Title II and Title XVI benefits, and explain any applicable work incentives to the beneficiary.

While work related CDRs apply only to Title II disability beneficiaries, it is important to identify the applicability of these provisions for concurrent beneficiaries to make sure you take appropriate action when you are considering Title XVI entitlement. Since the use of a work incentive might help a beneficiary retain entitlement to Supplemental Security Income (SSI), prompt identification and implementation are essential.

Currently available work incentives include:

Title II

POMS Reference

Trial Work Period (TWP)

DI 13010.035

Re-entitlement Period (Extended Period of Eligibility)- (EPE)

DI 13010.210

Extended Medicare Coverage

DI 28055.001B

CDR protection based on work activity

DI 13010.012

  

Title XVI

POMS Reference

Plan to Achieve Self Support (PASS)

SI 00870.001

Property Essential to Self-Support (PESS)

SI 01130.500

Blind Work Expenses (BWE)

SI 00820.535

Special Benefits for SSI Recipients Who Perform SGA, Despite Severe Medical Impairment (Section 1619(a))

SI 02302.001

Medicaid Eligibility for SSI Individuals Who Work Despite Severe Medical Impairment (Section 1619(b))

SI 02302.030

Student Earned Income Exclusion

SI 00820.510

  

Title II and Title XVI

POMS Reference

Impairment Related Work Expenses (IRWE)

DI 10520.001, SI 00820.540

Subsidy and

Special Conditions*

DI 10505.010

Continued Payments to Individuals Participating in a VR or Similar Program (Section 301)

DI 14510.003

Expedited Reinstatement

DI 13050.001

Ticket to Work program, including medical CDR protection

DI 55001.001

DI 55025.001

* For Title XVI, subsidy and special conditions apply in initial claims only.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0413010001
DI 13010.001 - Work Activity and Work Incentives - 12/05/2013
Batch run: 12/05/2013
Rev:12/05/2013