UMC cases are eCDR exclusions.
Adjudicate UMC determinations made before January 01, 2006 as if SSA never completed
the medical cessation determination. The FO will follow established policy and procedures
for initiating a new medical CDR and obtain a new Form SSA-454 (Continuing Disability
Review Report) and Form SSA-827 (Authorization to Disclose Information to the Social
Security Administration (SSA)). Using the flag shown in Exh #1 (Uneffectuated Medical
Cessation), the FO will send the new CDR case to the DDS for adjudication.
The DDS will follow established policies and procedures for adjudicating a new medical
CDR. The comparison point decision (CPD) will be the most recent favorable medical
decision. The previous cessation determination will have no bearing on the CPD. However,
consider any medical and/or other evidence in the file from the uneffectuated CDR
for the current evaluation. In all of these cases, the DDS has already found the individual
not disabled at some point in the past. If the individual is found not disabled for
more than 12 months, but is currently disabled, provide an explanation in the decisional
rationale. The reason for the explanation is so a future reviewer understands why
the individual was never ceased when they should have been, and benefits were never
stopped. Upon completion, return all UMC cases (including CONTINUANCE cases) to the
FO. Use the flag shown in Exh # 1, but reverse the To and From annotations.
Uneffectuated Medical Cessation
TO:DDSFROM: FODATE:
Disabled Individual: ____________________________
SSN: BIC:
This case is an uneffectuated medical cessation (UMC). The DDS made the cessation
prior to 01/01/2006. Per DI 13015.265 and DI 28075.200, SSA/DDS should set aside the
cessation determination and process a new CDR determination. Upon completion, return
ALL completed CDRs to the FO (including T2 and T16 continuance cases). Place this
flag on top of the folder. Reverse the To and From annotations.
FO Contact:
CR Name:
CR Phone Number:
Uneffectuated Medical Cessation --- Appeal
Disabled Individual:____________________________________
SSN: _______________________________________________
The DDS issued a medical cessation determination in this case prior to January 01,
2006. Subsequently, the disabled individual filed an appeal at the DDS (reconsideration),
Office of Disability Administrative Review (ODAR), or Appeals Council (AC). However,
due to administrative error(s), the FO did not send the appeal request/decision:
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•
To the appropriate office for processing, or
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•
Did not send it when received, or
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•
Did not effectuate the decision at the time it was made.
Special processing instructions in DI 13015.265 and DI 28075.200 provide that the
FO will initiate a new initial continuing disability review (CDR) for the cessation
determination DDS made prior to January 01, 2006 and the disabled individual did not
file an appeal.
[]Appeal Filed but not processed.
The individual filed an appeal but too much time has passed to process the appeal
without more recent medical and other relevant evidence. Accordingly, we will consolidate
the appeal with a new CDR. After the agency completes the new CDR and issues a new
or revised determination, we will give the individual the opportunity to continue
with an appeal.
By consolidating the appeal with a new CDR, we will handle all cases where we made
the cessation determination before January 01, 2006. We will handle these cases in
the same manner. We will suspend all actions relating to the pending appeal and make
a new or revised CDR determination.
[]Appeal Filed and processed.
We made an appeal decision, but due to administrative error(s), did not effectuate
it at the time. If we had effectuated the decision, the individual would be subject
to a retroactive termination. This retroactive termination could result in a large
overpayment assessment due to the agency delay in processing the appeal.
In the interest of preventing any adverse effect to all individuals in the UMC appeal
group and handling all UMC cases in the same manner, we will not process the unfavorable
appeal decision. We will make new CDR decision which we will give the individual the
opportunity to appeal.
Uneffectuated Medical Cessation Appeal Case
TO:FOFROM: DDS:
Disabled Individual: ____________________________
SSN: _______________________________________
This case is an uneffectuated medical cessation. The DDS made a cessation determination
prior to 01/01/2006. Per DI 28075.200D, DDS is returning this case to the FO for initiation
of a new CDR. Place this flag on top of the folder.
Comment:
DDS Contact:
Date:
Delete Explanation of Determination if the personalized information is included in
the body of the notice.)