DI 28075.020 Reestablishing Title XVI Eligibility Following Suspension or Termination for Nondisability Reasons
When a person's prior title XVI eligibility was suspended because of a nondisability reason, and it is found when payment reinstatement is requested that nondisability suspension no longer applies, a CDR will be necessary only if an event which raises a continuing disability issue occurred after the last medical determination.
When an individual requesting a reinstatement is found otherwise eligible (i.e., the nondisability event no longer applies), the FO is authorized to resume payment even though a continuing disability issue arose during ineligibility.
NOTE: The DDS will also receive cases where the payments previously suspended for WU were reinstated, but in which a continuing disability issue is still outstanding.
The individual will be under a disability for title XVI purposes if the conversion recipient meets the Federal definition of disability or the individual has, since 12/73, continued to be disabled as defined by the State plan.
In situations where an SSA-833-U3 cessation was previously processed, the conversion recipient will be found eligible again only if the Federal criteria are met.
B. Procedure - Prior Suspension Involved
If prior suspension is involved:
If no medical issue exists, or there is sufficient medical evidence to prepare a continuance or clear cut cessation and the FO has not determined that the previously established disability ceased because of SGA, then prepare an SSA-832-U3. If no CDR is necessary and the individual is not in payment status, then forward the folder to the FO for reinstatement.
C. Procedure - Reinstatement After Termination
If an individual is reinstated after termination, proceed as follows:
1. New Application Needed
In situations where eligibility was previously terminated for a nondisability reason, proceed as follows:
Develop medical/vocational evidence as usual. (NOTE: Determine whether the individual has worked or undergone rehabilitation or other training since termination.)
Prepare Form SSA-831-U3 (Disability Determination and Transmittal).
2. No Application Needed
In situations where the FO, in the course of development, makes a retroactive SGA cessation and finds current eligibility exists, proceed as follows:
NOTE: The policy of reinstating title XVI payments without requiring a new application is an administrative expedient which protects benefits from being lost in the retroactive period.