TN 1 (12-18)

DI 40505.315 Handling Continuing Disability Reviews (CDRs) When the Social Security Administration (SSA) Did Not Effectuate the Cessation Determination

 

A. Operating policy for when the SSA did not effectuate the cessation determination

1. Uneffectuated medical cessations (UMC) and overdue medical cessations (OMC)

There is no time limit on correcting an error in processing a determination.

As a rule, if we notified an individual of a CDR cessation and he or she has not appealed, process the cessation. For special instructions concerning UMC cases and OMC cases, see DI 13015.265 for field office (FO) procedures and DI 28075.200 for DDS procedures.

UMC cases are Disability Determination Services (DDS) medical cessation determinations made before January01, 2006, and because of administrative error, we did not effectuate the determination at the time DDS made the determination.

OMC cases are DDS medical cessation determinations made on or afterJanuary 01, 2006. Due to an administrative error, we did not effectuate the determination for more than 2 months after the month of termination or date of the cessation notice, whichever is later.

2. Notice of action

Before we can process a cessation, we must have applied the medical improvement review standard (MIRS). For UMC cases, we must send a due process notice to the individual to explain the action that we are taking. However, for OMC cases, we do not need to send a due process notice before we stop checks because the individual has already received a cessation notice.

B. Procedure to process overdue medical cessation (OMC) and uneffectuated medical cessation (UMC) cases

1. OMC cases

Forward all OMC cases to the FO and request the FO to:

  • Send the notice per Payment Termination not Effectuated in DI 13010.197F, Special Situations in Work Continuing Disability Reviews; and

  • Process the case per Special Instructions for Processing UMC and OMC Cases in DI 13015.265B.

Process OMC appeals by following cessation procedures. If the individual wants to appeal, the FO considers whether good cause exists for late filing and if the individual requests, for benefit continuation.

2. UMC cases

If you discover a UMC case in the Processing Center (PC):

  • Obtain the UMC flag shown in DI 13015.265C;

  • Place it on top of the folder and forward it to the FO;

  • Request the FO to process the case per Special Instructions for Processing UMC and OMC Cases in DI 13015.265C.

Do not terminate benefits on any UMC case for which the DDS made the medical cessation determination prior to January 1, 2006.

The FO initiates a new CDR on all UMC cases. Do not attempt to identify cases where SSA has already terminated benefits. However, if we receive any type of protest (for example, Congressional contact or a request for waiver of the overpayment) on a UMC case that has been previously terminated, forward the case to the FO for processing per Special Instructions for Processing Overdue Medical Cessation and Uneffectuated Medical Cessation Cases in DI 13015.265.

If you receive a UMC case and the folder is:

  • In the PC, return it to the FO under cover of the flag shown in DI 13015.265C. Request the FO to process the case per Uneffectuated Medical Cessation Special Instructions for Processing Overdue Medical Cessation and Uneffectuated Medical Cessation Cases in DI 13015.265.

  • Not in the PC, send a modernized development worksheet (MDW) to the FO to indicate we did not process the termination action. Request the FO to process per Special Instructions for Processing Overdue Medical Cessation and Uneffectuated Medical Cessation Cases in DI 13015.265.

NOTE: These special UMC procedures do not apply after the DDS makes a new CDR determination. For example, if the new CDR determination (made after January 01, 2006) again results in a cessation determination, terminate benefits based on the new CDR cessation date and process any subsequent appeal. In addition, these instructions do not apply to OMC cases for which the DDS made the cessation determination on or after January 01, 2006.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0440505315
DI 40505.315 - Handling Continuing Disability Reviews (CDRs) When the Social Security Administration (SSA) Did Not Effectuate the Cessation Determination - 12/18/2018
Batch run: 12/18/2018
Rev:12/18/2018