TN 1 (01-11)
DI 40105.020 Onset of Disabled Widow(er)’s Benefits (DWB) Later Than Age 62 Years 7 Months in Waiting Period Cases/ Age 63 in No Waiting Period Cases
A. Waiting period applies – onset established
When a waiting period applies and an onset for disabled widow(er)’s benefits (DWB) is established at or after age 59 1/2 but before age 62 years and 7 months, a technical denial is not proper.
An award of aged widow(er)'s benefits is necessary with a disability determination for Medicare only.
In cases where a waiting period does not apply, the applicable ages are age 60 and 63.
B. Processing instructions
In situations where the claimant’s alleged onset date (AOD) is after age 62 years and 7 months (63 in no waiting period cases), deny the claim using the “X3” reg-basis code.
A substantive determination of onset is made when the claimant’s AOD is prior to age 62 1/2 (63), but an onset after applicable age is established.
The PCs Disability Examiner (DE) or Disability Processing Specialist (DPS) must prepare an amended or revised Form SSA-831 (Disability Determination and Transmittal) using reg-basis code “X3.”
C. Preparing the SSA-831 – claimant’s AOD is after age 62 and 7 months or age 63 in no waiting period cases
Complete the special entries for the SSA-831 as follows:
Item 16: Enter “none established”
Item 19: Check block A
Item 20: Make no entry
Item 22: Enter “X3”
Item 27: Fully rationalize the basis for the determination. If additional space is necessary, check the second block and continue the rationale on an SSA-4268
Route the claim to the Claims Authorizer (CA)/Claims Technical Examiner (CTE) with an attached Form SSA-559 (Claims Folder/Material Transmittal) instructing the CA/CTE to process the “X3” denial through the Modernized Claims System (MCS), and process the award for aged widow(er)’s benefits if it has not already been processed.
In the event that the Disability Determination Services (DDS) has established an onset later than the AOD, the DDS should have prepared and released the personalized disability notice (PDN). If they did not do so, the DE/DPS must release the PDN and include paragraph 402 below.
402 AOD before Age 62 Years 7 Months But Onset Cannot Be Established Before Age 62 Years 7 Months or Later – Less Than 29 Months of Past and/or Future Disability Entitlement Prior to Age 65
We have determined that you are not entitled to Medicare coverage for the disabled. However, you may be entitled to Medicare at age 65, whether or not you are disabled. A person must be disabled for (1) months before his/her Medicare coverage begins. Because your condition was not disabling on any date through (2) , your Medicare coverage could not begin until you reach age 65.
Show “29” for Disabled Widow(er)’s Claims.
Date claimant is age 62 and 7 months for waiting period cases; age 63 for no waiting period cases. (MM/DD/YY)