TN 6 (08-90)

DI 27515.055 New Claim Filed - Prior Title II or Title XVI Claim in Work Incentive Status

A. Introduction

The Act provides certain work incentives to assist and encourage disabled beneficiaries who attempt to return to work. Accordingly, a beneficiary or SSI recipient may file a disability claim under another title (or for another type of benefit under the same title) when there is/was intervening work activity covered under a work incentive provision.

B. Policy

1. Resolve work issue first

Work issues in a new disability claim are resolved first, under current procedures (DI 24001.001), without reference to the prior disability entitlement (i.e., if a claimant is currently engaging in SGA, the claim may be denied on that basis). Whether or not a claimant is currently receiving benefits (i.e., in current payment status) is not material in the evaluation of the work activity.

EXAMPLE : If a new application is filed for title II DIB by an individual engaging in SGA, the individual must not have engaged in SGA for a 12-month period prior to the beginning of the current SGA. If the 12-month duration requirement is not met, there is no possibility of either an open or closed period of disability for the new application regardless of whether or not the claimant continues to receive benefits under title XVI (or title II) (DI 13010.105).

2. Medical issue

Once work issues are resolved, medical issues (including possible medical improvement and impairment severity) should be considered in conjunction with the decision or determination made in the prior claim, under adoption rules.

NOTE : A claimant who completes a TWP and is eligible for an EPE is considered to have a disabling impairment until a formal determination is made (including notification and appeal rights) that the impairment(s) is no longer disabling.

3. Vocational Rehabilitation (VR) program

  1. when disability has been medically ceased, a claimant may continue to receive benefits because of participation in an approved VR program (section 301 payments).

  2. An independent disability determination must be made on any subsequent disability claim when the prior claim is in section 301 payment status.

  3. A closed period on the new claim may be appropriate.

C. Procedure

Follow these rules if an individual files a subsequent claim or a claim for another type of benefits under the same title:

If the individual continues to have a disabling impairment (see DI 28055.001) and...Then...

is in an extended period of eligibility (EPE) (including pre 07/87 title XVI 1619 EPE cases)

  • Adopt the prior determination/decision of continuing entitlement for EPE purposes to establish entitlement on the new claim.

  • Verify that:

is in an extended Medicare eligibility Period

  • Adopt the prior determination/decision of continuing entitlement for EPE/Medicare purposes to establish entitlement on the new claim.

  • Verify that :

is in 1619 Status (Effective: 7/1/87

  • Adopt the prior determination/decision of continuing entitlement for 1619 purposes to establish entitlement on the new claim.

  • Verify t