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.
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:
Explain pertinent work incentives, and the effect of work incentives to a beneficiary who works, or asks about returning to work.
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.
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.
If applicable, establish a work report in eWork.
If you decide that a beneficiary has engaged in SGA, explain the basis for the determination to the beneficiary.
Enter the correct systems inputs to effectuate the determination
eWork will prepare a SSA-899 (Continuing Disability Review) or a SSA-833-U5 (Cessation or Continuance Determination) when appropriate.
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:
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.
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:
Trial Work Period (TWP)
Re-entitlement Period (Extended Period of Eligibility)- (EPE)
Extended Medicare Coverage
CDR protection based on work activity
| || |
Plan to Achieve Self Support (PASS)
Property Essential to Self-Support (PESS)
Blind Work Expenses (BWE)
Special Benefits for SSI Recipients Who Perform SGA, Despite Severe Medical Impairment (Section 1619(a))
Medicaid Eligibility for SSI Individuals Who Work Despite Severe Medical Impairment (Section 1619(b))
Student Earned Income Exclusion
| || |
Title II and Title XVI
Impairment Related Work Expenses (IRWE)
DI 10520.001, SI 00820.540
Continued Payments to Individuals Participating in a VR or Similar Program (Section 301)
Ticket to Work program, including medical CDR protection
* For Title XVI, subsidy and special conditions apply in initial claims only.