TN 1 (09-09)

DI 27540.035 Concurrent Title II/Title XVI – Statutory Benefit Continuation Does Not Apply

A. Policy

Goldberg/Kelly automatic payment continuation governs the following types of reopenings and revisions:

  • Failure to follow prescribed treatment; and

  • Fraud or similar fault.

For information on the cases where the Disability Determination Services (DDS) sends a predetermination due process notice, see Policy – Due Process for Adverse Reopenings DI 27525.001C.

See Also:

  • DI 27525.010 - Providing Due Process in Adverse Reopenings Involving Title XVI and Concurrent Title II/Title XVI Cases.

  • DI 13015.015 - Benefit Continuation in Failure to Cooperate/Whereabouts Unknown Cases.

  • DI 28075.005 - Failure to Cooperate (FTC) and Whereabouts Unknown (WU) Cases

NOTE: Goldberg/Kelly procedures do not apply to Title XVI whereabouts unknown cases because WU (S06) is considered an administrative suspension and does not result in a loss of eligibility.

B. Reopening and revision is less than fully favorable

1. Allowance to closed period – Title II and Title XVI

  • Allowance to Closed Period – Title II – Reopening Notice 4 (NL 00705.216)

  • Allowance to Closed Period – Title XVI – Reopening Notice 5 (NL 00705.221)

2. Denial to partially favorable onset (not AOD) – Title II and Title XVI

  • Denial to Partially Favorable Onset (Not AOD) – Title II – Reopening Notice 6 (NL 00705.226)

  • Denial to Partially Favorable Onset (Not AOD) – Title XVI – Reopening Notice 7 (NL 00705.231)

3. Denial to closed period – Title II and Title XVI

  • Denial to Closed Period – Title II – Reopening Notice 8 (NL 00705.236)

  • Denial to Closed Period – Title XVI – Reopening Notice 9 (NL 00705.241)

4. Fully or partially favorable onset to a later onset

  • Fully Favorable or Partially Favorable Onset to a Later Onset – Title II – Reopening Notice 10 (NL 00705.246)

  • Fully Favorable or Partially Favorable Onset to a Later Onset – Title XVI – Reopening Notice 11 (NL 00705.251)

C. Reopening and revision is unfavorable

  • Allowance to Denial – Title II – Reopening Notice 1 (NL 00705.201)

  • Allowance to Denial – Title XVI – Reopening Notice 2 (NL 00705.206)

D. Basis change only – blind to disabled

  • Change in Basis – Blind to Disabled – Title II – Reopening Notice 13 (NL 00705.261)

  • Change in Basis – Blind to Disabled – Title XVI – Reopening Notice 14 (NL 00705.266)

E. No change in basis or end result – claimant aware or denial of request to reopen and revise

  • No Change in Basis or End Result – Claimant Aware or Denial of Request to Reopen – Title II – Reopening Notice 12 (NL 00705.256). Add disclaimer paragraph 842.

  • No Change in Basis or End Result – Claimant Aware or Denial of Request to Reopen – Title XVI – Reopening Notice 12 (NL 00705.256). Add disclaimer paragraph 841.

F. No change in basis or end result-claimant unaware

  • Title II – No DDS notice is required.

  • Title XVI – No DDS notice is required.

G. Reopening and revision is unfavorable – Notifying auxiliaries in separate households