TN 16 (05-93)

DI 40505.100 Medical Improvement Expected (MIE) Cases With Work Activity

See DI 55025.010 for medical CDR processing instructions for beneficiaries with Tickets to Work.

These are medical CDRs initiated because of events other than a medical alert.

Most such issues may be raised in the FO or PC. If raised in FO, the FO will secure SSA-454 BK and other CDR information and forward development to PC for folder association and CDR action. (If folder already in FO, they will forward it with SSA-454-BK directly to DDS.)

If PC cannot take final action, folder will be sent to FO or to DDS, depending on development needed.

A. Policy

1. CDR necessary

Return to work in a MIE case may indicate medical recovery. A medical CDR will be initiated.

2. Current MIE criteria

For purposes of this section, current MIE criteria apply - DI 26525.025. A case diaried under old criteria is not subject to an immediate medical CDR if it does not meet current MIE criteria.

3. Clear-cut cessation may result

  1. A clear-cut cessation results if a beneficiary with a MIE diary returns to work and meets certain other conditions - DI 28030.035.

  2. Title XVI cases are not ceased for work activity (DI 40540.001), but a clear-cut cessation applies if all the criteria are met.

  3. Either the PC or DDS may prepare a clear-cut cessation.

NOTE: A medical CDR is not conducted in title II - only MIP or MINE cases during the TWP, unless medical recovery is alleged.

B. Procedure

1. Folder review; MIE diary appropriate?

Determine if diary appropriate - DI 26525.015. Do not screen per DI 40505.001C; work activity may require investigation regardless of the medical issue.

2. MIE diary not appropriate

a. Establish correct diary:

Cancel the MIE diary with an SSA-3500, and establish a MIP or MINE diary as appropriate - DI 26525.001.

b. Title II:

Take action on title II work activity. For information on the processing center’s responsibilities in work continuing disability reviews, please refer to DI 13010.023.

c. Title XVI:

Alert FO of earnings, if it is not clear whether the earnings have been reported.

3. MIE diary appropriate clearcut case

a. Determination

Prepare a clear-cut cessation determination if all the criteria are met.

b. Cessation notice:

Prepare notice with benefit continuation language.

c. Processing:

  • Release the notice.

  • Forward folder to FO for appeals period. Tell FO to handle as a medical cessation: benefit continuation rights apply.

4. MIE diary appropriate; not a clearcut case

If report of work is detailed, but does not meet the clear-cut provisions:

  1. Establish TWP months, and CDIO, on SSA-3500-U2. (If DDS does not establish a medical cessation, a TWP will apply.)

  2. Explain issue on SSA-847-U3, or on SSA-5526-U3 if CDR interview not done; forward folder to DDS or FO for CDR.

5. MIE diary appropriate; work needs investigation

If the report of work lacks the detail necessary for an evaluation:

  1. Establish CDIO on SSA-3500-U2

  2. Forward case to FO by SSA-5526-U3 for development and CDR interview; explain what information is needed.

  3. If title XVI involved, request income and resources (I&R) decision and any necessary I&R adjustment.

  4. Tell FO to forward case to DDS for a medical determination when FO actions are complete.