PROGRAM OPERATIONS MANUAL SYSTEMPart DI – Disability InsuranceChapter 235 – Specific Case InstructionsSubchapter 10 – Death CasesTransmittal No. 5, 05/11/2020
QAT minor change no IRD needed no change to policy
Summary of Changes
DI 23510.010 Notice of Death Received in the Disability Determination Services (DDS) – Title II and Title XVI
Delete information about EDCS release 26.0 - no change to policy QAT
When the disability determination services (DDS) directly receives notice of the claimant's death, inform the field office (FO) via telephone, email, or other electronic means so the FO may take appropriate systems and survivor’s claims action. DDS must inform the FO of the reported date of death via telephone, email, or other electronic means so the FO may confirm if the reported date of death is correct. For electronic disability insurance benefit (eDib) cases, see DI 81020.090 Certified Electronic Folder (CEF) Messages.
The DDS develops the cause of death prior to adjudication unless an allowance is indicated based on medical evidence already in file. The DDS may request FO assistance to obtain the death certificate. The DDS may also request the FO’s assistance in obtaining signed SSA-827s from the deceased claimant’s administrator, executor, or trustee.
If it is a Title XVI only case, request the FO to determine whether a DDS disability/blindness determination is necessary, per DI 23510.001 Cases Involving Death – Title II and Title XVI.
If a disability determination is necessary, the DDS retains the case and follows these steps:
Prepare a determination;
Do not enter the disability determination data in NDDSS;
Input clearance data in NDDSS according to the instructions in DI 23510.035; and
Send the case to the servicing FO.
If no disability determination is necessary, cease development and return the case to the FO. (See, DI 81020.127 Processing “No Determination” Claims.)
Follow the appropriate procedures as outlined in:
DI 23510.020 - Death after Filing – Title II (Chart); or
DI 23510.035 - Death after Filing – Title XVI (Chart).
When a notice of death of an individual is received after an allowance or continuance determination has been released, notify the FO.
Notice of claimant's death after denial or cessation of disability benefits may raise a question as to whether the prior determination should be changed. When a claimant dies less than one year after denial or cessation of a period of disability, and survivors' benefits would be increased by an allowance, the DDS that made the original denial or cessation determination reviews the disability file and assumes jurisdiction over any further disability determination and possible reopening.
Documentary evidence of death should be in the form of a death certificate. The medical portions of the death certificate should show the cause leading directly to death and the conditions giving rise to that cause, with the underlying cause stated last. Ensure that a copy of the certificate is included in the medical evidence (2nd yellow) section of the case folder. See DI
81010.090 Faxing Documents in to the Certified Electronic Folder (CEF) Using Barcodes.
Further documentation may be needed if the death certificate does not contain enough information to conclude whether the prior determination should be changed. In such cases, obtain a copy of the hospital records showing medical findings and diagnoses. If the claimant did not die in the hospital or if hospital records are not available, it may be possible to obtain a medical report from the physician attending at death showing clinical findings and other pertinent information about the cause of death. Obtain any other medical or vocational evidence necessary for adjudication.
The receipt of evidence of the individual’s death does not necessarily warrant a revision of a previous determination. For example:
Death resulting from a traumatic event such as an automobile accident ordinarily would not warrant revision, while
Death resulting from a sudden coronary thrombosis may or may not have some bearing on whether the claimant was unable to engage in SGA during prior months.
Carefully evaluate the medical evidence obtained after death to determine whether the impairment allegedly causing disability may have been more severe than shown by the evidence developed during the individual’s lifetime. Examples of issues to consider include:
The findings and diagnoses made earlier may have been incomplete or incorrect;
The impairment may not have been definitively diagnosed; or
An additional impairment not previously disclosed may be found, e.g., an esophageal ulcer that was malignant.
The additional medical evidence, together with that previously in the file, may justify a finding that disability existed during the earlier period. This could apply to a prior denial or cessation even though the impairment did not appear to be severe previously.
DI 23510.020 - Death after Filing – Title II (Chart)
DI 23510.035 - Death after Filing – Title XVI (Chart)