Effective Dates: 12/14/2023 - Present Previous | Next

TN 17 (12-23)

DI 42010.010 Development of Non-disability Issues

A. Policy

When we effectuate payment on a favorable hearing decision in a title II disability case, we defer development of non-disability issues unless the issue is critical to establishing entitlement.

B. Mandatory non-disability development

If an administrative law judge (ALJ) issues a favorable hearing decision, but the evidence of record shows that a claimant does not meet one or more non-disability factors of entitlement, do not process the claim or initiate development. Prepare and email a protest memorandum and all supporting evidence to the Office of Appellate Operations (OAO) via the ^DCARO OAO Protest Cases mailbox. See DI 42010.065 for instructions on protesting a hearing decision.

Generally, do not process the claim if the evidence in file indicates that the claimant:

  1. 1. 

    Does not meet insured status on the established onset date; or

  2. 2. 

    Was working at substantial gainful activity levels on the onset date or during the waiting period (unless the ALJ specifically addresses these earnings in the hearing decision).

NOTE: 

The PC will effectuate an ALJ case even when the claimant does not meet insured status if they have issued a protest memorandum but not heard back from the Appeals Council after 40 days see DI 42010.065C.

C. Development issues

Upon receipt of a favorable Title II hearing decision, the Office of Disability Operations (ODO) or jurisdictional program service center (PSC) will immediately initiate all non-disability development either through the field office (FO), or directly, as appropriate.

1. Process involving suspense status

If evidence supporting certain non-disability factors of entitlement or eligibility is missing or incomplete, process the claim involving the appropriate suspense status and initiate development. Examples include:

  • •

    Citizenship and lawful presence

  • •

    Capability and representative payee (pay current benefits only see GN 00504.105)

  • •

    Prison and fugitive felons status

  • •

    Proof of death

Upon completion of development, update the claim to pay status and release any withheld benefits, or refer the protest issue to the hearing office if you conclude one or more factors of entitlement are unmet.

2. Process into pay status

a. Workers' compensation

If you cannot obtain workers' compensation proof within 10 business after the initial attempt to process ALJ decision, do not continue to try and obtain proof of workers' compensation payments prior to effectuating the ALJ decision. If we do not have proof of the actual amount of workers’ compensation payments received by the number holder, we can use the claimant's allegation or the state maximum weekly amount. For detailed instructions on workers’ compensation development, see DI 52140.010. For state maximum rates, see DI 52150.045.

b. Lag earnings

We only develop lag earnings prior to effectuating a hearing decision when lag earnings are needed to establish insured status. Defer development of lag earnings when lag earnings only affect benefit amounts.

c. Proof of age

Defer development for proof of age unless the issue is critical to entitlement. For processing claims when proof of age is in question, see DI 11010.055 .

D. Auxiliary claims

When an ALJ issues a favorable hearing decision, and auxiliary claims exist on the same earnings record, we process the primary and auxiliary claims together if possible. If development is incomplete for one or more auxiliary claims, process the primary claim to payment and initiate development of auxiliary claims. See GN 01010.140 for instructions on delayed claims.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0442010010
DI 42010.010 - Development of Non-disability Issues - 12/14/2023
Batch run: 12/14/2023
Rev:12/14/2023