In some instances, after the receipt of an initial disability insurance benefit (DIB) allowance claim in the PC’s, an examiner may receive notice of the death of the number holder. Receipt of the notice of death may occur before or after payment effectuation. If the payment has been effectuated the case will be treated as a reopening.

NOTE: If the wage earner is in advanced file status, consider the payment effectuated.

When the death occurred in the waiting period, the examiner will review the determination (Form SSA-831 Disability Determination and Transmittal) for consideration of an earlier onset date or change in the entries. Whenever a beneficiary dies after effectuation of his or her claim, the examiner will take action to terminate benefits if the field office (FO) has not already taken the action.

When the examiner determines that an earlier onset is not possible and accepts the onset shown as correct, prepare a revised SSA-831 to process the denial. If the case is electronic, move the prior SSA-831 to the “Green Section” of the folder and create a barcode to scan the revised SSA-831 into the “Yellow Front” section of the electronic folder. In addition, instruct the module Claims Authorizer (CA) to include the sample standard paragraph shown below within the notice for Death within 5 Months of Onset. The CA must also create a barcode titled “T2 Notice of Disapproved Claim” and scan a copy of the notice into the “Red Section” of the electronic folder.

Complete the special entries for the SSA-831 as follows:

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  Item 5: Show “deceased” instead of address

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  Item 16: Enter “none established”

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  Item 19: Check block A

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  Item 22: Enter reg-basis code X3

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  Item 34: Enter “NH died MMDDYY, before being disabled 5 full calendar months and earlier onset cannot be established.”

Sample of Standard Paragraph - Death within 5 Months of Onset

A person who is disabled for at least five full calendar months may be eligible for disability benefits. (1) was not eligible for these benefits because (2) is given as the date the disability started and death occurred on (3). Therefore, the claim for disability benefits is denied.

Fill-ins:

1. 1. 

   Name of claimant

2. 2. 

   Alleged onset date (MM/DD/YY)

3. 3. 

   Date of death (MM/DD/YY)

NOTE: If death occurred before 1973, substitute “6” months for “5” months.

When there is a possibility of an earlier onset being established for the number holder (the evidence as to the cause of death considered along with other factors warrants further Disability Determination Services (DDS) review or development), return the folder to the DDS by Form SSA-847, but only after the survivor's benefits are paid by the PC. If the case is electronic, route the EF to the FO who will then route it to the DDS, since there is no electronic communication between the PCs and DDS.

When there are auxiliary claimants involved in the case, it is important to pay the survivors’ claim before further development of the DIB claim. In PSC/ODO, the examiner will place the notice of death and any other associated materials in “Orange Section” of the folder or will create a barcode and scan the materials into the “Orange Section” of the electronic folder.

Prepare Form SSA-567 (Notice for Subsequent Handling).

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  In the “Route to” column, show “Disability Processing Branch (DPB)” or in ODO to the Disability Examiner (DE).

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  In the “Reason” column, show “DIB claim requires processing” per DI 40115.010D.”

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  Prepare an SSA-559 Claims Folder/Material Transmittal, and transmit the folder to the appropriate PC, Attention: CA.

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  In the “Remarks” show “Please take necessary action on survivor claims; claimant died”

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  After all action, return folder to DPB per SSA-567 attached.

When there is a possibility of an earlier onset, the DE/DPS will send the case to DDS using Form SSA-847 (SSA Request for Case Action) for consideration of revision.

If the case is electronic, the DE/DPS will create a brief rationale explaining the reason an earlier onset is possible. The DE/DPS will then fax the rationale into the “Blue Section” of the EF and then contact the FO to process a Medical Reactivation per DI 81010.143. Contact to the FO can be made by Modernized Development Worksheet (MDW) or by phone. When the DDS establishes an earlier onset, they will prepare a revised SSA-831 and forward it to the FO for adjudication of the award.

If the DDS affirms the onset is within 5 months prior to death, they will return the case to DPB. DPB will prepare an SSA-831 and process it per DI 40105.010B.