TN 60 (08-96)
DI 32586.045 Payment Period and Onset - Title II -- Stieberger
A. Policy -- general
The FO is responsible for computing the PAYMENT PERIOD prior to sending the case to the DDS. PAYMENT PERIODS must be calculated on a case-by-case basis (see DI 12586.045).
The Stieberger DEVELOPMENT PERIOD and the onset date that the DDS will show on the SSA-831 are not necessarily related. Unless an actual onset must be established, the onset in a Stieberger case will be established to permit payment in the first month of the PAYMENT PERIOD.
B. Policy -- insured status
If the DDS determines an individual was disabled during the DEVELOPMENT PERIOD, the individual generally will be considered to have insured status as of the established onset as long as s/he was insured as of the AOD. (See DI 32586.001, item 10).
those cases where the 10(e)(5) exception requires that the prior file(s) be requested and developed to the earliest possible retroactive date (see DI 32586.035C.), the DDS must be certain to ask the FO to determine when insured status was last met.
C. Policy -- payment period Title II
The Stieberger PAYMENT PERIOD (see DI 32586.001, item 7.) is generally the 48 months period prior to 12/91 (i.e., 12/87 through 11/ 91). However, if entitlement and disability continue, benefits may be paid after 11/91. Certain exclusions listed below may affect the title II PAYMENT PERIOD.
D. Process -- computing payment periods
The FO will use the procedures below when computing the title II PAYMENT PERIOD:
Count back 48 months prior to 12/91. In counting back, do not count:
months the class member was already entitled to title II `A' (reduced or unreduced), `HA', CDB or DWB benefits;
months of potential entitlement to any type of benefit listed above, based on a pending claim;
months covered by a non-New York medical denial (or cessation);
months, any part of which, the individual was incarcerated after conviction for commission of a felony or a crime in the nature of a felony.
IMPORTANT: In no case may payment be made for any months prior to the first month of potential entitlement on the earliest title II claim in the Stieberger period.
The earliest claim in the Stieberger period was filed on 3/9 /83. The AOD was 1/16/83. The NY DDS denied the claim at the reconsideration level on 5/10/84. No subsequent claims were ever filed, no period of incarceration.
The PAYMENT PERIOD is 12/87 through 11/91 (see C., above).
Same facts as in a., except the class member was incarcerated due to a felony conviction, from 7/31/90 until 4/1/93. The PAYMENT PERIOD cannot include months of incarceration for a felony conviction therefore begin counting back 48 months with 6/90.
MENT PERIOD is 7/86 through 6/90.
The date of filing of the earliest claim in the Stieberger period is 5/14/87. The AOD is 12/10/86. The claim was denied at the ALJ level on 10/3/89. The class member became entitle to `A' benefits upon attainment of age 62 in 8/90.
The PAYMENT PERIOD cannot include months of entitlement to `A' benefits, therefore begin counting back with 7/90. Forty-eight months would be 8/86, BUT, in no case is payment made for any month prior to the first possible month of entitlement on the earliest Stieberger claim. Since the AOD of the earliest Stieberger claim is 12/10/86, the first possible month of entitlement is 6/87.
The PAYMENT PERIOD is 6/87 through 7/90.
E. Policy -- documentation
The FO is responsible for computing the PAYMENT PERIOD and potential onset date prior to sending the case to the DDS. The information will be shown on the DEVELOPMENT/PAYMENT PERIOD Worksheet (DI 32586.095, Exhibit 3). The Worksheet will be prong filed on the right side of the DIB folder just beneath the SSA-831.
F. Policy -- onset
The onset date is established to permit payment to start with the first month of the PAYMENT PERIOD. Unless the DDS must adjust the onset based on its development (see DI 32586.050F.), the Stieberger onset in Title II cases is:
for CDB and no waiting period cases, the first day of the first month of the PAYMENT PERIOD
for all other cases, the onset date is the first day of the fifth month before the first month of the PAYMENT PERIOD.
NOTE: To ensure that payments begin no earlier than the start of the Stieberger PAYMENT PERIOD, in DWB and CDB claims it is usually necessary for the FO to establish an artificial date disability onset date (OS) to limit retroactivity.
If the actual OS would result in payments starting before the PAYMENT PERIOD, the FO will select a OS that will limit retroactivity to the start of the PAYMENT PERIOD. In doing this the FO will keep in mind that:
CDB applications based on a disabled worker's entitlement have a maximum retroactivity of 12 months. CDB applications based on retired or deceased worker's accounts have a maximum retroactivity of 6 months.
DWB applications have a maximum retroactivity of 6 months.
G. Policy -- non-New York denials
Periods adjudicated by a medical denial made while the class member was a non-New York State resident (see DI 32586.035 B.) may not be included in either the Stieberger DEVELOPMENT PERIOD or the Stieberger PAYMENT PERIOD. Both disability and entitlement end with the AOD of the non-New York claim (or DOF if the non-New York claim is title XVI). If the class member is once again disabled, a new period of disability is established after the period adjudicated by the non-New York decision ends. The DEVELOPMENT /PAYMENT PERIOD Worksheet will indicate what months are part of a period adjudicated by a non-New York State denial. It may be necessary to prepare two SSA-831-U3s, one for the closed period preceding the non-New York denial and one for the period after the close of the period adjudicated under the non-New York denial.
NOTE: Contact the Disability Programs Branch in the New York RO for assistance in such cases.