TN 2 (05-10)

DI 27025.001 Cases Requiring a Personalized Disability Notice Explanation

A. Background

When a partially favorable Title II or Title XVI reconsideration disability determination is prepared, the law requires that the determination notice contain a personalized explanation of the case written in plain language, including a discussion of the evidence, and reason(s) for the determination.

Personalized notices should be:

  • brief;

  • informal;

  • non-technical; and

  • understandable to all claimants.

When a personalized explanation is prepared that explains why the claimant is no longer entitled to disability benefits (e.g., disability cessations, adverse reopenings), it is not necessary to repeat the information in the determination notice.

B. Cases that Require a Personalized Disability Notice

The following cases require a personalized disability notice:

  • Reconsideration Title II and Title XVI medical and medical/vocational denials;

  • Reconsideration Title II and Title XVI substantial gainful activity (SGA) denials;

  • Reconsideration Title II and Title XVI closed period and unfavorable onset date allowances except:

    • Closed period allowances where the onset and cessation dates are the same as those alleged;

    • Title XVI cases where the alleged onset date is prior to the application date but set as the date of application;

    • Disabled Widow(er) Beneficiary or Childhood Disability Beneficiary claims where the onset date is set later than alleged onset date, but allows payment or entitlement to Medicare for the disabled at the earliest date based on retroactivity of the application, the number holder's date of death, or first month of entitlement;

    • Disability Insurance Beneficiary (DIB) claims in which the alleged onset date is earlier than the date insured status is first met, and the onset date is set as of the date insured status is met; and

    • DIB claims in which the period of disability ends due to attainment of full retirement age. In these cases, the disability benefits are converted to retirement benefits.

NOTE: A personalized notice is not necessary when a claimant files a disability claim alleging a visual impairment and the DDS makes a fully favorable determination based on another impairment, since the determination is not unfavorable or partially favorable.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427025001
DI 27025.001 - Cases Requiring a Personalized Disability Notice Explanation - 05/06/2010
Batch run: 05/06/2010
Rev:05/06/2010