TN 3 (04-12)

DI 28080.005 Due Process Pre-determination Notification for Title II Continuing Disability Review Claims

A. When should the Disability Determination Services (DDS) prepare a pre-determination notice?

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

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

B. When should the DDS not prepare a pre-determination notice?

Do not prepare a pre-determination notice if the beneficiary has the right to elect SBC. SBC election applies in the following examples.

1. Title II medical-vocational cessations

Most Title II medical-vocational cessations (i.e., medical improvement) claims require that the cessation determination notice inform the beneficiary 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 claims 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. Beneficiary signed statement

We still require SBC election language when the field office (FO) obtains a signed statement or an SSA-795, Statement of Claimant or Other Person, from the beneficiary 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.

5. Reference

DI 12027.015 Cases Excluded from Statutory Benefit Continuation (SBC)

C. Processing a beneficiary report stating that he or she is no longer disabled

A direct report from a beneficiary informing the FO that he or she works 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.

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

1. Beneficiary receives title II only

a. FO actions

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

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

b. DDS actions

  • Process the cessation without sending a pre-determination notice; and

  • Send a final cessation notice explaining the determination and appeal rights for these claims.

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

2. Beneficiary receives title XVI only or concurrent title II/title XVI

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 beneficiary's death.

To Link to this section - Use this URL:
DI 28080.005 - Due Process Pre-determination Notification for Title II Continuing Disability Review Claims - 04/04/2012
Batch run: 04/14/2014