PROGRAM OPERATIONS MANUAL SYSTEMPart DI – Disability InsuranceChapter 235 – Specific Case InstructionsSubchapter 10 – Death CasesTransmittal No. 3, 04/02/2020
Refers readers to other references about Title II claims with death in the waiting period.
Summary of Changes
DI 23510.001 Cases Involving Death - Title II and Title XVI
In our Procedure on Death after filing a title II application and death in the waiting period included two cross references.
Since the Social Security Amendments of 1965, the disability impairment(s) preventing an individual from engaging in any substantial gainful activity (SGA) must be expected to result in death, or must have lasted or be expected to last for at least 12 continuous months from the date of onset.
Consider an impairment likely to result in death if:
Based on established medical knowledge, and under the particular circumstances in the case, it is found to be terminal; or
It actually results in death.
Disability may be established for an individual who has an incapacitating impairment that is expected to cause death before it has lasted 12 months. However, for Title II claims that require a waiting period, if a claimant’s death follows so quickly after the onset of disability, and an onset earlier than alleged is not possible, return the claim to the field office for a technical denial.
Address the following primary issues in death claims:
application before or after death;
any onset issues;
impairment duration; and
the waiting period.
These issues are addressed in the following sections. For other development or information to secure relating to the claimant’s cause of death, see DI 23510.005.
All Title II claims in which onset is alleged at least five full months before the month of death require a disability determination. When a Title II claimant dies before a disability determination is made, prepare a disability determination.
For denial cases in which the impairment did not last 12 months nor was it the cause of death, complete the claim in the usual manner with the exceptions as outlined in the chart, DI 23510.020, Death after Filing – Title II (Chart).
This situation applies only to disability insurance benefit (DIB) and disabled widow(er) benefit (DWB) claims. There is no waiting period for childhood disability benefit (CDB) claimants or for a DIB or DWB claimant who had a prior period of disability (e.g., previous closed period).
For DIB claims see, DI 10105.075 A. When the Five Month Waiting Period is not Required
For DWB claims see, DI 10110.001 G.1. Requirements for Disabled Widow(er)'s Benefits (DWB)
If the DDS determines there is no possibility of establishing an earlier onset date (e.g., substantial gainful activity (SGA) stopped at the AOD due to a traumatic impairment), then process the case as a no determination case according to instruction on Death After Filing for Title II as outlined in DI 23510.020. For electronic disability insurance benefit (eDib) cases also see, DI 81020.127, Processing “No Determination” Claims.
Pay disability insurance benefits (and dependent's benefits based on a worker's entitlement to disability benefits) to the disabled worker's survivors if an application for benefits was filed within three months following the month of the worker's death. The FO has jurisdiction on CDB or DWB claims filed after death.
Do not prepare a determination for deceased DWB or CDB claims, or for cases in which the application was filed more than 3 months after the worker’s death (see DI 23510.025, Title II Claim Filed After Death (Chart).
If the field office (FO) sends a case to the DDS in which the AOD is less than five months before the month of death and there is no possibility of an earlier onset, return the case to the FO unadjudicated. Follow the procedures on Title II Claim Filed After Death as outlined in DI 23510.025 for cases involving:
an established onset date (EOD) same as the AOD, and the AOD is more than five months prior to the date of death;
an EOD after the AOD (whether the EOD is more or less than five full months before death);
closed period; or
a severe impairment that did not last 12 months and was not the cause of death.
The FO has jurisdiction if there is no surviving eligible payee and the decedent either:
did not incur unpaid medical expenses,
did incur expenses but SSA does not make Medicaid eligibility determinations for the State, or
did incur medical expenses and SSA makes Medicaid eligibility determinations for the State but the State welfare agency did not request a determination for Medicaid purposes.
If these conditions are met, and the folder is already in the DDS when the FO receives notice of the claimant's death, the FO contacts the DDS and requests that development be stopped and the folder returned to the FO. For eDib cases, see the instructions on Processing Field Office (FO) Determinations in DI 81010.140 and instructions on Field Office Determinations in DI 81020.075.
If the FO learns that the decedent incurred unpaid medical expenses and the State is one in which SSA makes Medicaid eligibility determinations, and if the State agency requests a determination for Medicaid purposes, the FO returns the case to the DDS for a disability determination.
For cases involving an Interim Assistance Reimbursement (IAR), the FO may need to send the case to the DDS for a disability determination as noted in DI 23510.001E.2. in this section.
SI 02101.004, Underpayment Due – Individual Deceased – IAR Involved
SI 02101.006, SSA Underpayment Due – Individual Deceased – Surviving
DI 23510.035, Death After Filing - Title XVI (Chart)
SI 01730.060, Medicaid Information by Regions - Exhibits
When a claimant dies after the date of filing but prior to initial adjudication, eligibility may be established, provided the requirements for disability are otherwise met (i.e., severity and duration of impairment), and:
The claimant is survived by an eligible spouse;
The claimant is survived by an “ineligible” spouse (see SI 02101.006, SSI Underpayment Due – Individual Deceased – Surviving Spouse Not Member of an Eligible Couple); or
Interim assistance payments have been advanced by a State under an agreement (see SI 02101.004, SSI Underpayment Due – Individual Deceased – IAR Involved).
For example, if the impairment could have been expected to last 12 months, even though the claimant died from an unrelated cause, disability may be established. Similarly, if the claimant dies due to the alleged impairment and other eligibility factors are met, disability may be established. In such cases, eligibility for benefits terminates in the month after the month of death.
In some cases, even though there is no surviving spouse, but there are unpaid medical expenses, a disability determination may be required for Medicaid eligibility purposes, provided SSA is under agreement to make Medicaid eligibility determinations for the State and the State welfare agency requests a determination. Complete the case according to the instructions in the charts in DI 23510.035 Death after Filing - Title XVI (Chart).
Agency policy states that a proper applicant or other representative may sign the Form SSA-827 (Authorization to Disclose Information to the Social Security Administration) and must specify the basis for the authority. However, sources may not always recognize a proper applicant’s authority without additional documentation. The requisite documentation may vary from state to state, facility to facility, and even the type of records being requested (e.g., mental health, drug and alcohol treatment).
Standards and compliance issues related to the Health Insurance Portability and Accountability Act of 1996 (HIPAA - Public Law 104-191 ), as well as, the Health Information Technology for Economic and Clinical Health (HITECH ) Act are overseen by the Department of Health and Human Services. However, each state may enact confidentiality laws that are more strict.
The DDS may request FO assistance in obtaining additional documentation as needed. For example:
A copy of the death certificate; and
An affidavit or court order indicating the signatory’s authority.
GN 00204.003, Proper Applicant
DI 11005.055, Completing the Authorization to Disclose Information to the Social Security Administration (SSA) Form SSA-827
DI 23510.005, Notice of Death Received in the Field Office (FO) – Title II and Title XVI