TN 4 (09-21)

DI 28080.005 Due Process Pre-determination Notification for Title II Continuing Disability Review (CDR) Cases

A. When Should the Disability Determination Services (DDS) Prepare a Pre-determination Notice?

1. Certain Title II Medical-Vocational Cessations

Prepare a pre-determination notice when the determination is a non-medical cessation and we do not require statutory benefit continuation (SBC) election language.

We require a pre-determination notice for Title II-only DDS cessations for:

  • Cessation based on failure to follow prescribed treatment (FTFPT);

  • Cessation because prior favorable determination obtained by fraud or similar fault (FSF); and

  • Medicare Qualified Government Employee (MQGE).

NOTE: Prepare and release a pre-determination notice prior to processing the SSA-833, Cessation or Continuance of Disability or Blindness Determination and Transmittal.

See DI 27525.001 Due Process Notification for Adverse Reopenings.

2. Certain Title II Medical Adverse Reopenings

Like CDRs, Title II medical adverse reopening cases usually require SBC election language in the notice of the revised determination. Some adverse reopenings, however, require a pre-determination due process notice instead of SBC language. Those reopenings include:

  • Revising a previously established onset to a later onset;

  • Revision to a denial for whereabouts unknown, when the case is not a CDR;

  • Revision to a denial for FTFPT; and

  • Revision to a denial for FSF.

 

B. When Should the DDS not Prepare a Pre-determination Notice?

Do not prepare a pre-determination notice if the individual has the right to elect statutory benefit continuation (SBC). SBC election applies in the following examples:

1. Title II Medical and Medical-Vocational Cessations

Most Title II medical and medical-vocational cessations (i.e., medical improvement) cases require that the cessation determination notice inform the individual of the right to elect SBC on appeal.

See Also:

DI 28095.105 Title II Medical Cessation Notices Chart

2. Title II Medical Adverse Reopenings

Title II medical adverse reopening cases that require SBC election language in the notice of the revised determination include revision from:

  • Allowance to denial;

  • Allowance to a closed period of disability;

  • Continuance to cessation; or,

  • Cessation to an earlier cessation date.

 

3. Individual Requested Termination of Benefits

We require SBC language even when the field office (FO) obtains a signed statement or an SSA-795, Statement of Claimant or Other Person, from the individual requesting that we stop his or her benefits and the DDS determines from the evidence that the disability ceased (see DI 28080.005C.1. in this section).

4. Cessation Notice Requires SBC Election Language

For medical cessation cases that require SBC election language in the cessation notice, combine the pre-determination and cessation determination information into a single notice. Prepare and process SBC cessation (i.e., medical cessation) notices in accordance with NL 00705.358.

C. Process an Individual's Report Stating that he or she is no Longer Disabled

A direct report from an individual informing the FO that he or she is working or is no longer disabled does not serve as a basis for immediate cessation and termination of benefits without the issuance of a proper pre-determination notice.

The adjudicator will prepare a pre-determination notice, unless the individual signed a statement requesting that SSA stop benefits at the time he or she made the report of no longer being disabled. If the individual signed such a statement, process these cases in accordance with DI 28080.005C.1. and DI 28080.005C.2. in this section.

1. Individual Receives Title II Only

a. FO Actions

  • Obtain a signed statement or an SSA-795 from the individual reporting that he or she is no longer disabled and he or she requests that SSA stop his or her benefits.

  • File this statement in the official case folder. For instructions on faxing documents into the certified electronic folder, see DI 81010.090C.

b. DDS Actions

  • If the FO provided the signed SSA-795 in DI 28080.005C.1.a., the adjudicator will process the cessation without sending a pre-determination notice; and

  • The adjudicator will send a final cessation notice explaining the determination and appeal rights, including SBC election language, for these cases.

NOTE:In order for this due process exception to apply, the individual's signed request to stop benefits, in addition to his or her report of medical improvement or report of work activity must be in the official case folder.

2. Individual Receives Title XVI Only or Concurrent Title II/Title XVI

When processing determinations for a common issue concurrent for Title II/Title XVI case, the due process requirements for Title XVI also apply to the Title II. See DI 28080.030.

Goldberg/Kelly automatic payment continuation applies for Title XVI and current Title II/Title XVI cessations based on failure to follow prescribed treatment and fraud or similar fault.

The adjudicator will prepare a final cessation notice (rather than a pre-determination notice) before terminating Title XVI only or concurrent Title II/Title XVI disability benefits or payments, except where there has been confirmation of the individual's death.

 


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428080005
DI 28080.005 - Due Process Pre-determination Notification for Title II Continuing Disability Review (CDR) Cases - 04/04/2012
Batch run: 09/15/2021
Rev:04/04/2012