DI 12027.060 Title II Statutory Benefit Continuation When the Appeals Council Remands a Medical Cessation Case to the Hearing Level

A. Title II-only medical cessation cases

An individual can receive statutory benefit continuation (SBC) when the Appeals Council (AC) (or federal court by way of AC remand orders) remands a medical cessation case to administrative law judges (ALJs) at the hearing level for further action.

The SBC procedures covered in this section apply to Title II only disability cessation cases remanded by the AC or federal court to the hearing level. See DI 12027.065 for SBC policy on Title XVI only or concurrent Title XVI and Title II disability cessation cases.

IMPORTANT:

SBC does not apply while the case is pending at the AC or federal court level. See DI 12027.001 for more information on SBC eligibility.

1. SBC elected at the prior ALJ level

When the individual elected SBC in their prior ALJ hearing request, reinstate SBC without a new election statement retroactive to the first month of non-payment resulting from the now vacated ALJ decision. Follow procedures in DI 12027.060C, in this section.

NOTE:

For individuals who previously elected SBC, the hearing office's notice informs the individual to contact the Social Security Administration (SSA) if they do not want to receive SBC while awaiting a new decision. See FO responsibilities in DI 12027.060B below.

2. SBC not elected at the prior ALJ level

If SBC was not elected at the prior level, the individual retains the opportunity to elect SBC, if desired, pending a new ALJ decision. Payments start as of the month the AC remanded the case to the ALJ. Process the individual's election following standard election procedures in DI 12027.010 and DI 12027.008B.2.a for late elections.

B. Notification to the field office (FO) of the AC remand

When the AC remands a medical cessation case to the hearing level, the case transfer generates the Electronic Disability Collect System (EDCS) action item, "Case Remanded - Potential Benefit Continuation". Upon receipt of the Title II only case, the hearing office notifies the individual and the servicing FO of the remand. Office responsibilities are explained in the table below.

Office Responsibilities

Hearing Office	Field Office
1. Notifies the individual about their remanded case and option to elect or decline SBC pending the new ALJ decision. The notice instructs the individual to contact the FO to elect SBC.	1. Upon receipt of the Assistance Request or email, the FO follows procedures in DI 12027.060A and DI 12027.060C, in this section. For more information on Assistance Requests in EDCS, see DI 81020.100.
2. Notifies the FO of the remand order and the SBC issue through an Assistance Request in eView, or for Electronic Disability Collect System (EDCS) exclusions, by email to the servicing FO's email address. The email message will include the individual's social security number (SSN), name, date of the vacated ALJ hearing decision, along with the hearing office's requested action. Use the Detailed Office/Organization Resource System (DOORS) to identify the servicing office email address.	2. If the individual did not elect SBC at the prior hearing request and contacts the FO to elect SBC after the AC remand, the FO follows standard election procedures in DI 12027.010. For late elections, follow DI 12027.008B.2.a. The FO makes the good cause determination for a late SBC election. If the individual elected SBC in the prior hearing request, follow the reinstatement procedures in DI 12027.060C below, unless the individual has already contacted the agency about not wanting to receive benefits while waiting for a new decision.
3. Ensures the remand order is in eView for certified electronic folders (CEFs). For paper folders, store an electronic copy in Electronic Non-Medical (ENM) and a paper copy in the folder.	3. Closes out the assistance request, ensures all necessary SBC actions have been taken, and stores the SBC election statement electronically in the CEF or in the Evidence Portal (EP) for EDCS exclusions.

Hearing Office

Field Office

1. Notifies the individual about their remanded case and option to elect or decline SBC pending the new ALJ decision. The notice instructs the individual to contact the FO to elect SBC.

1. Upon receipt of the Assistance Request or email, the FO follows procedures in DI 12027.060A and DI 12027.060C, in this section.

For more information on Assistance Requests in EDCS, see DI 81020.100.

2. Notifies the FO of the remand order and the SBC issue through an Assistance Request in eView, or for Electronic Disability Collect System (EDCS) exclusions, by email to the servicing FO's email address. The email message will include the individual's social security number (SSN), name, date of the vacated ALJ hearing decision, along with the hearing office's requested action.

Use the Detailed Office/Organization Resource System (DOORS) to identify the servicing office email address.

2. If the individual did not elect SBC at the prior hearing request and contacts the FO to elect SBC after the AC remand, the FO follows standard election procedures in DI 12027.010. For late elections, follow DI 12027.008B.2.a. The FO makes the good cause determination for a late SBC election.

If the individual elected SBC in the prior hearing request, follow the reinstatement procedures in DI 12027.060C below, unless the individual has already contacted the agency about not wanting to receive benefits while waiting for a new decision.

3. Ensures the remand order is in eView for certified electronic folders (CEFs). For paper folders, store an electronic copy in Electronic Non-Medical (ENM) and a paper copy in the folder.

3. Closes out the assistance request, ensures all necessary SBC actions have been taken, and stores the SBC election statement electronically in the CEF or in the Evidence Portal (EP) for EDCS exclusions.

C. FO procedures to reinstate Title II SBC payments

1. SBC Reinstatement

To reinstate SBC when the AC remands a medical cessation case to the ALJ hearing level:

a.

Obtain the query Master Beneficiary Record (MBR) to verify status.
b.

Initiate SBC for the current month via Critical Payment System (CPS).
c.

Do not withhold any benefits for possible representative fees.
d.

Input type of payment (TPT) code C34.
e.

Show the date of the AC remand as the date of the appeal request in remarks.
f.

If the individual previously elected SBC with the hearing appeal, SBC payments are retroactively due as of the first month of non-payment resulting from the now vacated ALJ decision. Following standard office procedures, request assistance from the processing center (PC) to reinstate SBC payments for the retroactive months and ongoing months (minus the current month paid via CPS).
g.

If the individual did not previously request SBC, but now requests SBC with the remanded appeal, and is eligible to receive the continued benefits, initiate SBC payments as of the month of the AC remand order.
h.

For auxiliaries on the record, follow DI 12027.007B.2 and if SBC is elected, reinstate benefits. Do not hold off from reinstating the number holder's benefits while you resolve auxiliary benefits. Reinstatement of benefits may require assistance from the PC. Follow standard office procedures for requesting assistance from the PC.

NOTE:

SBC payments are not overpayments until the medical cessation decision is final. The medical cessation decision becomes final when the individual does not request further review within the appeal period (and does not have good cause for a late appeal) or has exhausted all levels of appeal. For more information see GN 02201.009C.

2. Development for suspension, deduction, or termination events

When unrelated events arise that may require development for suspension, deduction, or termination of benefits after the AC remand, the steps we take depend on whether the individual previously elected SBC.

a.
If the individual previously elected SBC with the hearing-level appeal:
- •
  
  Reinstate SBC payments first, then develop for the possible suspension, deduction, or termination event(s).
- •
  
  After completing development of the event, if an adverse payment adjustment is needed, we must provide advance notice to the individual and appointed representative, if any, before making the adjustment. See GN 03001.015 and GN 03001.005 for Title II advance notice requirements.
- •
  
  If the event involves substantial gainful activity (SGA), follow DI 12027.050.
b.
If the individual did not previously elect SBC, but elects SBC after the AC remands the case to the ALJ hearing level, proceed as follows:
- •
  
  Develop the suspension, deduction, or termination event first to determine if the individual is eligible to receive SBC payments.
- •
  
  Notify the individual of any applicable payment adjustment and initiate SBC, if eligible.
- •
  
  If the event involves SGA, follow DI 12027.050.

D. Terminating SBC benefits following an unfavorable ALJ hearing decision

For unfavorable ALJ decisions, SBC ends the month before the month of the ALJ decision or dismissal date. SBC terminates automatically for certain case types as explained in DI 12027.020C.2. For cases that do not terminate automatically, the FO must enter a Post Entitlement Online System (POS) input to terminate SBC benefits.

The hearing office will add the following language to the decision transmittal: "Further action necessary by claims processing component. The individual in this medical cessation case appears to have had disability payments/benefits continued through the hearing level. The ALJ's decision/dismissal of (date) is less than fully favorable; disability ceased on (date). Please terminate continued disability payments/benefits immediately."

For electronic cases, the transmittal information will be viewable in eView's "Case Data" tab under "ALJ Disposition" in the "Transmittal Data" subsection. For paper cases, the hearing office will send a copy of the decision/dismissal and transmittal to the FO via desktop fax.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412027060

DI 12027.060 - Title II Statutory Benefit Continuation When the Appeals Council Remands a Medical Cessation Case to the Hearing Level - 05/20/2018
Batch run: 09/04/2025
Rev:05/20/2018

Program Operations Manual System (POMS)