Identification Number:
DI 23510 TN 6
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Death Cases
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 235 – Specific Case Instructions
Subchapter 10 – Death Cases
Transmittal No. 6, 05/11/2020

Audience

PSC: CS, DE, DEC, DTE, IES, RECONR, SCPS, TSA, TST;
OCO-OEIO: CR, CTE, ERE, FCR, FDE, FDEC, RECONE;
OCO-ODO: CST, DE, DEC, DS, RECONE;
ODD-DDS: ADJ, DHU;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

ODP

Effective Date

Upon Receipt

Background

QAT no change to policy, minor change

Summary of Changes

DI 23510.020 Death after Filing – Title II (Chart)

Changed reference to Special Handling instructions from DI 81030.090 to .085

DI 23510.035 Death after Filing – Title XVI (Chart)

Changed reference to Special Handling instructions from DI 81030.090 to .085

DI 23510.020 Death after Filing – Title II (Chart)

Use this chart to determine required disability determination services (DDS) actions regarding Form SSA-831 (Disability Determination and Transmittal), notification, and any special routing instructions. For additional instructions related to these procedures, please see DI 23510.001 and DI 23510.010.

Situation Claim Type Determination DDS action

Alleged onset date (AOD) less than five full months before the month of death and no possibility of earlier onset (waiting period case). Also see, DI 23510.001C for additional instructions.

Disability insurance benefit (DIB) or disabled widow(er) benefit (DWB) (Initial or Reconsideration)

No Determination

(See, DI 81020.127 Processing “No Determination” Claims)

SSA-831 required

(Determined by current legacy system limitations) Complete only the following items not propagated by the system:

Items 30 & 31: Examiner signs and dates.

Item 34 (Remarks): Enter “Death in waiting period -- no possibility of earlier onset.”

Notification

No DDS-prepared notification is required.

SSA-831 not required

(Determined by current legacy system limitations) Process per the instructions in DI 81020.127

Established onset date (EOD) same as AOD

DIB, childhood disability beneficiary (CDB), DWB (Initial or Reconsideration)

Allowance

SSA-831

Complete as usual with the following exceptions:

Item 17 (Diary): Enter

  • NXP” for the diary type,

  • 0000” for the diary date (may be 4 or 6 characters depending on DDS legacy system), and

  • 7” for the diary reason.

Notification

No DDS-prepared notification is required.

EOD after AOD (whether the EOD is more than or less than five full months before the month of death);

or

 

Closed Period

DIB, CDB, or DWB (Initial or
Reconsideration)

Partially Favorable Allowance

SSA-831

Complete as usual with the following exceptions:

Item 17 (Diary): Enter

  • NXP” for the diary type,

  • 0000” for the diary date (may be 4 or 6 characters depending on DDS legacy system), and

  • 7” for the diary reason.

 

Item 29 (Ltr): Enter “PSC/DL”. (If the system is unable to generate the proper disability determination notice and a manual notice must be prepared.)

Notification

Prepare a personalized disability explanation in the third person.

Routing

Route case to the field office (FO) with a Special Handling flag (see, DI 81030.085 Certified Electronic Folder (CEF) Alerts, Flags, and Messages). Alert the FO via email to release the notice attachment when the case is processed.

For electronic disability insurance benefit (eDib) cases, see DI 81020.130 Electronic Case Closure.

Severe impairment did not last 12 months nor was it the cause of death

Or

Any fully unfavorable determination (excludes “death in the waiting period”)

DIB, CDB, or DWB (Initial or Reconsideration)

Denial

SSA-831

Complete as usual with the following exceptions:

Item 29 (Ltr): Enter “PSC/DL”. (If the system is unable to generate the proper disability determination notice and a manual notice must be prepared.)

Item 34: Enter an appropriate decision paragraph from DI 23510.030 Determination Paragraph, Disability Insurance Benefit (DIB) Claim filed after Death (Chart) for DIB cases. Make no entry for DWB or CDB cases.

Notification

Prepare a personalized disability explanation in the third person.

For DWB and CDB cases, the personalized disability explanation does not include a decision paragraph.

Routing

Route the case to the FO with a Special Handling flag (see, DI 81030.085 Certified Electronic Folder (CEF) Alerts, Flags, and Messages).

Alert the FO via email that the notice attachment should be released when the claim is processed.

For eDib cases, see DI 81020.130 Electronic Case Closure.

DI 23510.035 Death after Filing – Title XVI (Chart)

A. No surviving eligible spouse

Return the case to the field office (FO) unadjudicated if there is no surviving eligible spouse and:

  • there are no unpaid medical expenses; or

  • the disability determination services (DDS) does not make Medicaid eligibility determinations for the State.

If the FO later learns there is a surviving eligible spouse, the case will be returned to the DDS for a determination. For instructions regarding Medicaid only cases, see DI 23510.035D. in this section.

B. Surviving eligible spouse

If there is a surviving eligible spouse, the DDS must make a disability determination.

Use the appropriate chart for instructions about

  • completing Form SSA-831 (Disability Determination and Transmittal),

  • preparing the notification (if needed), and

  • routing the case.

1. Allowance

Use this chart for fully favorable allowance determinations:

SSA-831 Notification Special routing

Complete as usual with the following exceptions:

Item 17: Enter

  • NXP” for the diary type,

  • 0000” for the diary date (may be 4 or 6 characters depending on DDS legacy system), and

  • 7” for the diary reason.

Item 29 (Ltr./Par. No.): Leave blank

Item 34 (Remarks): If claimant filed for self enter, “Claimant deceased (date of death).”

No DDS prepared notification needed for fully favorable allowance.

Route the case to the FO with a Special Handling flag (see, DI 81030.085 Certified Electronic Folder (CEF) Alerts, Flags, and Messages).

Alert the FO via email or other electronic means that "SSI claimant deceased – claim allowed but not input – please input for underpayment due spouse."

For electronic disability insurance benefit (eDib) cases, see DI 81020.090 Certified Electronic Folder (CEF) Messages.

 

2. Partially favorable allowance

Use this chart for partially favorable allowance determinations:

SSA-831 Notification Special Routing

Complete as usual with the following exceptions:

Item 17: Enter

  • NXP” for the diary type,

  • 0000” for the diary date (may be 4 or 6 characters depending on DDS legacy system), and

  • 7” for the diary reason.

Item 29 (Ltr./Par. No.): Enter “DO D/L 1029, 1373”. (If the system is unable to generate the proper disability determination notice and a manual notice must be prepared.)

Item 34 (Remarks) If claimant filed for self enter, “Claimant deceased (date of death).”

DDS prepares a personalized disability explanation in the third person.

Alert the FO via email or other electronic means to release the notice attachment with the final notice prepared by the FO. For eDib cases see, DI 81020.130 Electronic Case Closure.

 

Do not prepare an interim notice SSA-1157-U2 (SI).

Route the case to the FO with a Special Handling flag (see, DI 81030.085 Certified Electronic Folder (CEF) Alerts, Flags, and Messages).

Alert the FO via email or other electronic means that "SSI claimant deceased – claim allowed but not input – please input for underpayment due spouse."

3. Denial

Use this chart for denial determinations:

SSA-831 Notification Special routing

Complete as usual with the following exceptions:

Ítem 29 (Ltr./Par No.): DDS D/L L444. (If the system is unable to generate the proper disability determination notice and a manual notice must be prepared.)

Item 34 (Remarks) If claimant filed for self enter, “Claimant deceased (date of death).”

DDS prepares a personalized disability explanation in the third person, and includes the appropriate decision paragraph per DI 23510.040, Determination Paragraph, Death after filing - Title XVI (Chart). The DDS releases the notice.

For eDib cases see, DI 81020.130 Electronic Case Closure.

Route the case to the FO with a Special Handling flag (see, DI 81030.085 Certified Electronic Folder (CEF) Alerts, Flags, and Messages).

Alert the FO via email or other electronic means that, "SSI claimant deceased – claim denied but not input."

For eDib cases, see DI 81020.090 Certified Electronic Folder (CEF) Messages.

C. Surviving ineligible spouse

The DDS may make a determination when the claimant is survived by an ineligible spouse. See DI 23510.001E.2 for instructions.

D. Medicaid only

The DDS makes Medicaid eligibility determinations in some States.

Use the appropriate chart for instructions about

  • completing Form SSA-831 (Disability Determination and Transmittal),

  • preparing the notification (if needed), and

  • routing the case.

1. Allowance

Use the chart below for fully favorable determinations:

SSA-831 Notification Special routing

Complete as usual with the following exceptions:

Item 17: Enter

  • NXP” for the diary type,

  • 0000” for the diary date (may be 4 or 6 characters depending on DDS legacy system), and

  • 7” for the diary reason.

Item 29 (Ltr./Par. No.): Leave blank

Item 34 (Remarks): If claimant filed for self, enter “Claimant deceased (date of death) – determination for Medicaid only”.

No DDS-prepared notification is needed for fully favorable allowances.

Route the case to the FO with a Special Handling flag (see, DI 81030.085 Certified Electronic Folder (CEF) Alerts, Flags, and Messages).

Alert the FO via email or other electronic means that, "SSI claimant deceased - claim allowed but not input - please notify welfare of Medicaid determination."

For eDib cases, see DI 81020.090 Certified Electronic Folder (CEF) Messages.

2. Partially favorable allowance

Use this chart for partially favorable allowance determinations:

SSA-831 Notification Special routing

Complete as usual with the following exceptions:

Item 17: Enter

  • NXP” for the diary type,

  • 0000” for the diary date (may be 4 or 6 characters depending on DDS legacy system), and

  • 7” for the diary reason.

Item 29 (Ltr./Par. No.): Enter “DO D/L 1029, 1373”. (If the system is unable to generate the proper disability determination notice and a manual notice must be prepared.)

Item 34 (Remarks): If claimant filed for self, enter, “Claimant deceased (date of death) – determination for Medicaid only.”

DDS prepares a personalized disability explanation in the third person.

Alert the FO to release the notice attachment with the final notice prepared by the FO.

For eDib cases, see DI 81020.130 Electronic Case Closure.

Do not prepare an interim notice SSA-1157-U2 (SI).

Route the case to the FO with a Special Handling flag (see, DI 81030.085 Certified Electronic Folder (CEF) Alerts, Flags, and Messages).

Alert the FO via email or other electronic means that, "SSI claimant deceased – claim allowed but not input – please notify welfare of Medicaid determination."

For eDib cases, see DI 81020.090 Certified Electronic Folder (CEF) Messages.

 

3. Denial

Use this chart for denial determinations:

SSA-831 Notification Special routing

Complete as usual with the following exceptions:

Item 29: Enter “DO D/L 1029, 1373”. (If the system is unable to generate the proper disability determination notice and a manual notice must be prepared.)

Item 34 (Remarks): If claimant filed for self enter, “Claimant deceased (date of death) – determination for Medicaid only.”

DDS prepares a personalized disability explanation in the third person, and includes the appropriate decision paragraph per DI 23510.040, Determination Paragraph, Death after filing - Title XVI (Chart).

Route the case to the FO with a Special Handling flag (see, DI 81030.085 Certified Electronic Folder (CEF) Alerts, Flags, and Messages).

Alert the FO via email or other electronic means that, "SSI claimant deceased – claim denied but not input – notify welfare of Medicaid determination."

For eDib cases, see DI 81020.090 Certified Electronic Folder (CEF) Messages.


DI 23510 TN 6 - Death Cases - 5/11/2020