If a DWB claimant is already or could become entitled to a DIB that exceeds the potential DWB PIA, a disability determination is not needed on the DWB claim.

Create a report of contact (RPOC) in the Modernized Claims System (MCS) DIB segment stating that a determination of disability on the DWB claim is not necessary if the DIB is allowed, due to the higher DIB payment.

NOTE: If a DIB and DWB claim are filed simultaneously and the periods to be adjudicated differ (e.g., the DIB insured status period and the DWB prescribed period differ), the field office (FO) should develop both claims. Accurately record all onset, date last insured, and prescribed period information on the SSA-3367 (Disability Report - Field Office) to advise the Disability Determination Services (DDS) that a determination of disability is necessary on both claims.

If, after comparing the potential benefits payable as a DWB and DIB, the DWB exceeds the claimant’s own DIB, the FO develops both claims completely.

If a current DIB beneficiary could become entitled to additional benefits due to DWB eligibility, the FO develops the DWB claim to completion.

If a claimant files DIB and DWB claims simultaneously, but is not insured for DIB, process the uninsured DIB denial and develop the DWB claim completely.

NOTE: If insured status depends on foreign work credit, see Totalization Benefits – General GN 01701.000, for additional information.

After December 1990, count each month in the period beginning with the first month of Supplemental Security Income (SSI) or federally administered State Supplementary Payment (SSP) eligibility toward both the 5-month waiting period for DWB payments and the 24-month qualifying period for Medicare coverage.

NOTE: When SSI is involved, code the Benefit Continuity Factors (BECF) screen in MCS for “windfall offset” to avoid releasing retroactive benefits until the SSI determination processes.

References:

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  DI 11015.020 – Crediting Months of SSI/SSP Toward the Disability Waiting Period and Medicare Qualifying Period for Disabled Widow(er)’s Benefits (DWB)

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  HI 00801.154 – SSI/SSP Credit for Disabled Widow(er)s

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  MSOM MCS 009.003 – Benefit Continuity Factors (BECF)

An individual eligible for SSI or SSP in the month before the DWB month of entitlement continues to be considered an SSI/SSP recipient for Medicaid purposes.

Medicaid continues:

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  as long as the individual remains eligible for SSI/SSP in the absence of the DWB; or

• •

  until he or she becomes entitled to Medicare Hospital Insurance (Part A) under Title XVIII.

An individual may be deemed disabled for DWB if he or she is eligible for SSI/SSP in the month that all non-disability requirements for DWB are met (e.g., prescribed period, marriage duration, widowed).

NOTE: Crediting SSI/SSP months toward deemed disability for DWB only applies to benefits payable January 1991 and later. For additional information, see Eligibility for Disabled Widow(er)’s Benefits (DWB) DI 10110.001.

An individual who filed for DWB prior to January 1991, and was denied only because of the more restrictive definition of disability used at the time, is deemed to have filed an application for DWB benefits for months after December 1990, if he or she was entitled to DIB for December 1990 or was eligible for SSI/SSP in January l991.