TN 47 (08-96)
DI 42586.070 Post-DDS Readjudication Considerations -- Stieberger
A. Policy — general
1. Fully favorable determinations
If the class member is disabled throughout the DEVELOPMENT PERIOD, and he/ she remains disabled, the DDS prepares a fully favorable allowance/ continuation determination. The determination is fully favorable for Stieberger reopening purposes, even though the onset is later than the original AOD.
Payment is made for the PAYMENT PERIOD, and, if all factors of eligibility continue to be met, from the end of the PAYMENT PERIOD through the present.
2. Partially favorable determinations
Partially favorable determinations include closed periods and onset dates established later than the earliest possible Stieberger ONSET.
If the DDS cannot establish disability for part of the period developed, it will establish an actual onset when certain conditions are met (see DI 42586.055D.2). When the DDS establishes an actual onset, regular title II and title XVI rules are used to determine the first month of payment.
The DDS sends fully unfavorable decisions to the FO for retention during the appeals period. The DDS prepares and releases the notice to the class member and his/her representative.
Unfavorable and partially favorable Stieberger determinations are appealed to the ALJ level.
Tolerances have been established for developing work activity (see DI 42586.075) in title II and title XVI initial entitlement and in title II continuing eligibility determinations (See DI 12586.070) and for title XVI nonmedical factors of eligibility (See DI 12586.080).
Protective filing for auxiliaries is the earliest of:
the date of the earliest SSA-16 within the Stieberger period (10/1/81 - 9/2/92) on which the auxiliary was mentioned, or;
the date the Stieberger supplement was signed.
7. DDS adjusts onset
If the DDS cannot find the class member disabled for part of the DEVELOPMENT PERIOD and certain other conditions are met (see DI 42586.055D.2.), it establishes an actual rather than an administrative onset. When the DDS establishes an actual onset date (i.e., a date other than the Stieberger ONSET proposed by the FO on the summary sheet), regular rules will be used to determine the first month of payment.
8. Suspension, deduction, offset
Prisoner suspense months are excluded from the PAYMENT PERIOD. (See DI 42586.065C.).
Workers Compensation (See DI 52101.001); Windfall Offset (See GN 02610.005 - GN 02610.022) apply during the Stieberger PAYMENT PERIOD as do other non-prisoner suspension and deduction criteria.
9. Work activity
Work activity after 11/30/91 is developed (see DI 12586.070); work prior to 12/01/91 will not be counted for purposes of assessing trial work months or for purposes of imposing SGA suspensions or terminations. Any such work is meaningful only in assessing the Stieberger claim for allowance or denial; i.e., work activity before 12/01/91 does not count against a trial work period, etc. NOTE: This restriction does not apply to work performed while a person was on the rolls (e.g., based on a later claim) that was already counted as trial work or SGA.
Beneficiaries who are currently entitled based on subsequent claims may be affected as a result of counting trial work months which occur after 11/30/ 91.
10. Termination and reentitlement
Beneficiaries who are currently entitled based on subsequent claims may be adversely affected as a result of counting trial work months after 11/30/ 91. In order to avoid large retroactive overpayments, when development results in termination for SGA after the PAYMENT PERIOD ends, protect the filing date for a new claim as of the date of SSA's receipt of the request for Stieberger review.
In such cases, the FO prepares an SSA-833 cessation determination and returns the case to the DDS to establish a new period of disability. These are separate periods of entitlement, and separate periods of disability; PIAs and rates must be computed for each entitlement period separately.
If subsequent entitlement is not adversely affected by terminating the Stieberger entitlement, no protective filing is required.
Similarly, if the beneficiary's entitlement must be terminated because he/ she received a medical denial for a period when he/she lived outside New York State (see DI 32586.020), the period of disability and entitlement ends with the month of alleged onset in the non-New York State denial. If the beneficiary has been found to be currently disabled, a new period of disability and entitlement can be established as of the day after the date of the non-New York State decision.
B. Policy — systems annotation
If any of the above exceptions to normal entitlement rules apply, the Special Message field of the MBR must be annotated to show “Special Stieberger rules used.”