NL 00705.170 Model Letter — Reconsideration Affirmation of Initial Medicare Coverage Only
Prepare on SSA-L976-U2
Social Security Notice of Reconsideration
Upon receipt of your request for reconsideration, we had your claim independently reviewed by a physician and disability examiner in the State agency which works with us in making disability determinations. All the evidence in your case has been thoroughly evaluated; this includes the medical evidence and the additional information received since the original decision. We find that the previous determination denying your claim was proper under the law.
A widow, widower, surviving divorced spouse, mother or father entitled to survivors benefits may be entitled to Medicare coverage if he or she meets certain age requirements and has a physical or mental impairment that is so severe as to ordinarily prevent a person from working. The disability must have lasted or be expected to last for a continuous period of at least 12 months. The person's disability must not start later than 7 years after the death of the spouse; or not later than 7 years after prior entitlement to mother's (or father's) or disabled widow(er) benefits ended.
If you believe that the reconsideration determination is not correct, you may request a hearing before an Administration Law Judge of the Office of Disability Adjudication and Review. If you want a hearing, you must request it not later than 60 days from the date you receive this notice. You may make your request through any Social Security office. Read the enclosed leaflet for a full explanation of your right to appeal.
If you have questions about your claim, you should get in touch with any Social Security office. Most questions can be handled by telephone or mail. If you visit an office, however, please take this letter with you.
SSA Publication No. 70-10282