Basic (05-01)

DI 28075.020 Reestablishing Title XVI Eligibility Following Suspension or Termination for Nondisability Reasons

A. Policy

When a person's prior title XVI eligibility was suspended because of a nondisability reason, and it is found when payment reinstatement is requested that nondisability suspension no longer applies, a CDR will be necessary only if an event which raises a continuing disability issue occurred after the last medical determination.

When an individual requesting a reinstatement is found otherwise eligible (i.e., the nondisability event no longer applies), the FO is authorized to resume payment even though a continuing disability issue arose during ineligibility.

NOTE: The DDS will also receive cases where the payments previously suspended for WU were reinstated, but in which a continuing disability issue is still outstanding.

The individual will be under a disability for title XVI purposes if the conversion recipient meets the Federal definition of disability or the individual has, since 12/73, continued to be disabled as defined by the State plan.

In situations where an SSA-833-U3 cessation was previously processed, the conversion recipient will be found eligible again only if the Federal criteria are met.

B. Procedure - Prior Suspension Involved

If prior suspension is involved:

  • Review the folder to verify that a medical issue exists.

If no medical issue exists, or there is sufficient medical evidence to prepare a continuance or clear cut cessation and the FO has not determined that the previously established disability ceased because of SGA, then prepare an SSA-832-U3. If no CDR is necessary and the individual is not in payment status, then forward the folder to the FO for reinstatement.

  • In all other cases, undertake medical development.

C. Procedure - Reinstatement After Termination

If an individual is reinstated after termination, proceed as follows:

1. New Application Needed

In situations where eligibility was previously terminated for a nondisability reason, proceed as follows:

  • Develop medical/vocational evidence as usual. (NOTE: Determine whether the individual has worked or undergone rehabilitation or other training since termination.)

  • Prepare Form SSA-831-U3 (Disability Determination and Transmittal).

  • Process conversion cases per DI 28075.010. Indicate on the SSA-831-U3 whether the individual has or has not continuously met the State plan.

2. No Application Needed

In situations where the FO, in the course of development, makes a retroactive SGA cessation and finds current eligibility exists, proceed as follows:

  • Process as though a timely application has been filed at the point at which work stopped or went below the SGA level.

  • Establish onset as instructed in DI 25501.000.

NOTE: The policy of reinstating title XVI payments without requiring a new application is an administrative expedient which protects benefits from being lost in the retroactive period.

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DI 28075.020 - Reestablishing Title XVI Eligibility Following Suspension or Termination for Nondisability Reasons - 06/06/2008
Batch run: 03/01/2022