TN 13 (11-11)

GN 01010.440 Disallowance for Lack of Insured Status

A. Policy on disallowances for lack of insured status

You should always use a certified Earning Record (E/R) to disallow or deny a claim for lack of insured status (see GN 01010.009) except for abandoned claims since you cannot request an earnings record without a social security number (SSN).

B. Procedure for disallowance for lack of insured status

Before disallowing or denying a title II claimant for lack of insured status (or lack of sufficient quarters of coverage (QCs) in deemed insured for hospital insurance (HI), consider the following:

1. Lag earnings and earnings Gaps

  • Complete all development for lag earnings (self employment income (SEI) and wages), military service (MS) or rail road (RR) employment if additional QCs based upon such earnings would result in establishing the claimant's entitlement (see RS 01404.005);

  • Resolve all earnings discrepancies and coverage issues; and

  • Resolve gaps in the earnings record in accordance with RS 01404.120.

2. The 4-month rule

Do not disallow a claim for lack of insured status if the number holder (NH) will obtain insured status within 4 months of the month of adjudication and the evidence of earnings for the qualifying quarter is available.

NOTE: you must wait until the first day of the new quarter to adjudicate the claim since any attempt to award a claim in which insured status is acquired after the current quarter will be processed as a disallowance by Modernized claims system (MCS) for lack of insured status.

a. Retirement (RIB) claims

If the evidence of earnings would give insured status more than 4 months after the month of adjudication, disallow the claim for lack of insured status. Indicate the first possible month of election (MOEL) plus the earliest and latest filing months that would permit entitlement for that month on the disallowance notice.

b. Disability (DIB) claims

DIB claims cannot be technically denied if there is evidence of reported earnings which would give insured status at any time within the calendar year without regard to the 4-month rule. See GN 00204.007 for additional information on the 4-month rule.

C. References

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GN 01010.440 - Disallowance for Lack of Insured Status - 12/12/2014
Batch run: 11/13/2017