TN 32 (07-16)

DI 11015.030 Field Office (FO) Technical Denials of Disabled Widow(er)’s Benefit (DWB)

A. Factors of entitlement not met

If the DWB claimant does not meet the non-medical factors of entitlement (for example, age or relationship), deny the claim.

For entitlement factors, see:

  • RS 00207.000 – Widow(er)’s Benefits Subchapter Table of Contents

  • DI 10110.001 – Requirements for Disabled Widow(er)’s Benefits (DWB)

B. Claimant engaged in substantial gainful activity (SGA)

If the DWB claimant is engaging in SGA, consider entitlement to a closed period of disability. If there is not a 12-month period of non-SGA immediately preceding the current SGA, follow existing procedures to deny the claim. The month the claimant began SGA must be within 14 months prior to the month of application.

Take the following actions:

  1. 1. 

    Document the work activity on the SSA-821-BK (Work Activity Report-Employee) or the SSA-820-BK (Work Activity Report-Self Employment) and your determination on the SSA-823-U3 (Report of SGA Determination). Store the SSA-820-BK, SSA-821-BK, and SSA-823-U3 documents in the certified electronic folder (CEF).

  2. 2. 

    Process the SGA denial in the Modernized Claims System (MCS).

  3. 3. 

    Complete the SSA-831-U3 denial via Electronic Disability Collect System (EDCS) “Claims Actions.”

  4. 4. 

    Create the personalized SGA denial notice in the Document Processing System (DPS).

NOTE: For non-CEF cases, complete the appropriate paper forms (e.g., SSA-821-BK, SSA-820-BK, SSA-823-U3, and SSA-831-U3) and file them in the modular disability folder (MDF).

For instructions on filing documents in the MDF see DI 70005.005.B.

For instructions on completing SSA-831-U3 (Disability Determination and Transmittal) for EDCS exclusion case, see DI 11010.205.

C. Prescribed period ends prior to the alleged onset date (AOD)

If the DWB claimant’s AOD is after the prescribed period and, you cannot establish a potential onset date (POD) prior to the end of the prescribed period, curtail POD development and deny the claim.

For information on curtailing POD development, see Curtailing Potential Onset Date Development DI 11005.065.

For information on determining the POD refer to the chart in DI 25501.220 (POD).

REMINDER: Do not rigidly compare the AOD to the date the prescribed period ends. You must determine if an earlier POD exists prior to denying the claim.

D. DDS establishes onset after the prescribed period

The disability determination services (DDS) may inadvertently prepare a favorable determination for a DWB claim for which the prescribed period requirement expired before the established onset date (EOD).

The field office (FO) returns these cases to the DDS to investigate the possibility of an earlier onset date. The DDS prepares a new determination and records it on a new SSA-831-U3.

Process the allowance or denial accordingly and release the appropriate notice.

See also:

  • DI 81010.140 – Processing Field Office (FO) Determinations

  • DI 81010.143 – Processing Medical Reactivations

  • DI 27501.005 – Reopening and Revising a Determination or Decision

  • DI 27505.001 – Conditions for Reopening a Final Determination or Decision

E. Res judicata in DWB claims

1. FO jurisdiction of DWB claim

When the claimant does not present new facts in a subsequent claim, deny DWB claims filed after a prior determination or decision that the claimant was not disabled on or before the last day of the prescribed period on the basis of res judicata.

For complete instructions on the applicability of res judicata, see Field Office (FO) Res Judicata Development and Processing DI 27516.001.

2. DDS jurisdiction

Send potential DWB res judicata denials to the DDS for a medical review if they do not meet the conditions for FO jurisdiction discussed in Res Judicata Development and Processing DI 27516.001-.

If the DDS determines that res judicata applies, the DDS notifies the FO by annotating the CEF at case closure with the message: “Res Judicata applicable to claim filed on (date of subsequent application).”

The FO completes MCS inputs described in DI 27516.001C.

To process the res judicata determination, see DI 11015.030E.1. in this section.

NOTE: For non-CEF cases, the DDS annotates the route slip used to return the folder to the FO as described in DI 11015.030E.2. of this section.

The FO is able to determine when to input an S1 denial from a basis code “S1” entered in item 35 of the DDS-prepared SSA-831-U3 on the subsequent claim.

F. DWB-Medicare only claim

The prescribed period for Medicare purposes extends to age 65 for DWB cases.

Deny the DWB-Medicare claim if:

  • at the POD the claimant is age 62 and 7 months and he or she was never previously entitled to any disability (Disabled Individual Benefits (DIB), Childhood Disability Benefits (CDB), or Disabled Widows Benefits (DWB)) or SSI benefits.

For claimants with prior Title II disability entitlement see HI 00801.152 and DI 11010.261.

For claimants with prior entitlement to SSI or federally administered State Supplementary Payments you may credit SSI/State Supplementary Payments (SSP) eligibility months to the qualifying period for Medicare entitlement, see DI 11015.020. or

  • the POD is within the prescribed period, but the claimant’s death occurs prior to adjudication and before expiration of the 24-month qualifying period for entitlement to Medicare.

NOTE: For instructions on coding technical denials in MCS, see Non Disability Disallowance, Abatement and Withdrawal Codes SM 00380.040.

See also:

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

  • DI 11005.050 – Prescribed Period and Controlling Date

G. Foreign earnings

Process an initial denial of claims for U.S. benefits when the number holder:

  • has at least six quarters of coverage (QC),

  • is not insured based on U.S. QCs alone, and

  • meets all other factors of entitlement.

For additional instructions, see Field Office Role in Processing Claims Filed Under a Totalization Agreement – General GN 01702.005.

H. When a DWB claim is an exception from FO authorization

For a list of exceptions to FO processing, see Excepting Disability Insurance Benefits (DIB), Disabled Widow(er) Benefits (DWB), Freeze, and Medicare Qualified Government Employee (MQGE) Claims from Field Office (FO) Authorization DI 11010.295.

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DI 11015.030 - Field Office (FO) Technical Denials of Disabled Widow(er)’s Benefit (DWB) - 10/29/2010
Batch run: 09/06/2019