TN 1 (12-11)

DI 27525.010 Providing Due Process in Adverse Reopenings Involving Title XVI and Concurrent Title II and Title XVI Cases

A. Policy

Provide due process decision notices with benefit continuation language for title XVI and common issue concurrent title II and title XVI reopenings that are adverse to the claimant. The Disability Determination Services (DDS) does not provide a due process pre-determination notice for concurrent cases.

B. Title XVI and concurrent adverse reopenings

Statutory benefit continuation or Goldberg/Kelly provisions continue benefits for title XVI and concurrent reopenings. For reopenings governed by Goldberg/Kelly, see DI 27540.030.

Benefit continuation as provided under the Act (as amended by P.L. 98-460) requires the claimant to request benefit continuation. For reopenings governed by P.L. 98-460, see DI 27540.015.

C. Applying title XVI due process in common issue concurrent claims

When processing an adverse reopening determination on a common issue concurrent title II and title XVI claim, the due process requirements for title XVI also apply to the title II determination. A statutory hearing is the initial appeal step for both determinations. If the recipient’s request for appeal and SSA’s payment continuance is within 10 days of receipt of the due process notice, we will continue payments until the DDS issues an appeals decision. Alternatively, the recipient may waive payment continuance.

NOTE: In “common issue” claims, it is not necessary for the onset or ending dates in the two determinations to coincide. See DI 12045.005 Claims Under Different Titles – Common Issue – General.

D. When to apply title II due process in concurrent claims

Title II due process provisions apply when processing a title XVI determination of continuance concurrently with a title II adverse reopening determination. For example, this situation occurs when we reverse the title II claim to a denial because the recipient did not meet insured status requirements.

E. Beneficiary receiving title II benefits is ineligible for title XVI payments for a nondisability reason

1. Title XVI benefits suspended

Some concurrent title II and title XVI claims involve situations where title II payments continue but SSA suspended title XVI payments for a nondisability reason. DI 27525.010B applies in these cases. If the beneficiary requests an appeal within 10 days (or if good cause for late filing is shown), continue title II payments.

2. Title XVI benefits terminated – T31 status

When the title XVI claim is in title XVI benefits terminated (T31) status as of the date of the DDS action, process the case as a title II only and afford title II due process. Before preparing the revised determination, verify processing of a T31 action. If the response shows any status other than a termination, the case remains a dual entitlement and title XVI procedures apply.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427525010
DI 27525.010 - Providing Due Process in Adverse Reopenings Involving Title XVI and Concurrent Title II and Title XVI Cases - 12/06/2011
Batch run: 12/06/2011
Rev:12/06/2011