Deny the claim on duration.

Allow the claim for a closed period. Find that disability ended the month in which the claimant failed to follow the prescribed treatment without good cause.

Because title XVI blindness claims do not have a duration requirement, a statutorily blind individual is entitled to benefits as of the established onset date (EOD). See DI 25501.380 Establishing the Established Onset Date (EOD) of Statutory Blindness in Title II Disability Insurance Benefits (DIB) Claims.

If you determine that the claimant failed to follow prescribed treatment without good cause prior to the EOD, deny the claim.

If you determine that the claimant failed to follow prescribed treatment without good cause on or after the EOD and duration is met, find blindness ended the month in which the individual failed to follow prescribed treatment without good cause.

However, if further development is needed to make a FTFPT determination and the individual otherwise meets the criteria for title XVI blindness, the individual is entitled to benefits while we conduct the additional development. Prepare a favorable determination pending resolution of the FTFPT issue. Develop the claims per DI 23010.013 Development Procedures for a Failure to Follow Prescribed Treatment Determination.

If you find the individual failed to follow prescribed treatment without good cause:

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  Find that blindness ended the month in which you established the individual failed to follow prescribed treatment without good cause; and

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  Notify the beneficiary using a Notice of Planned Action. Use the notice language in DI 23010.045 Predetermination Notice Language for Failure to Follow Prescribed Treatment Cessations and Adverse Reopenings.

If, after CDR development, you make an FTFPT determination that a beneficiary has failed to follow prescribed treatment without good cause, you must send a predetermination notice to the beneficiary.

For the appropriate predetermination notice language, see DI 23010.045 Predetermination Notice Language for Failure to Follow Prescribed Treatment Cessations and Adverse Reopenings.

For title II CDR cessations based on FTFPT, this notice requirement is based on GN 03001.005 Notice Requirements for Title II Due Process Actions. For procedural simplicity, we extend this requirement to all title II CDR cessations based on FTFPT, see DI 40515.020A. This notice is not based upon statutory benefit continuation (SBC) provisions because these cases do not involve medical cessations. See DI 12027.015 Cases Excluded from Statutory Benefit Continuation (SBC).

For title XVI CDR cessations based on FTFPT, this notice requirement is based on Goldberg/Kelly (GK) procedures because they are non-medical group II deficiency cases, see DI 27540.030A. Send these notices to all relevant people listed in SI 02301.300E.2.

Give the individual 30 days to respond to the predetermination notice.

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  If the individual does not respond after 30 days, cease the claim.

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  If the individual responds and provides sufficient evidence of good cause, continue the benefits.

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  If the claimant responds but does not provide good cause for FTFPT, cease the claim.

The benefits cessation date for both situations is 30 days after you sent the predetermination notice.