The 1965 amendments removed the requirement that the claimant’s condition is disabling
at the time the claimant files the application, and allowed for a closed period of
disability if the disability ceased no earlier than 12 months before the month of
the application file date.
The 1967 amendments provided for the extension of the 12-month requirement to 36 months
in situations where the claimant was physically or mentally incapable of filing the
claim in the 12-month period after his disability ceased. Since the number holder
(NH) was not under a disability during the 12-month retroactivity limitation for monthly
benefits, a denial of the disability insurance benefits (DIB) claim is appropriate.
Under this section, a closed period of disability freeze might be established.
Disability Determination Services (DDS) jurisdiction cases referred to the examiner
where the DDS does not determine whether the claimant’s failure to file a timely application
(within 12 months of disability cessation) was due to physical or mental incapacity
the Disability Examiner /Disability Processing Specialist (DE/DPS) will make the determination.
The field office may route the case directly to the Office of Disability Operations/Processing
Center-Disability Processing Branch (ODO/PC-DPB) in which the claimant filed after
12 months but within 36 months of the month of the alleged cessation.
If it is determined that the claimant's failure to file a timely application was not
due to physical or mental incapacity, prepare a determination of denial and personalized
letter to the claimant.
If it is determined that the claimant's failure to file a timely application was due
to physical or mental incapacity, route the case to the DDS using Form SSA-847 (SSA
Request for Case Action), for preparation of the determination.
If the case is electronic, the PCs DE/DPS will input a “No Determination” decision
code in MIDAS using the instructions in DI 81020.127 and route the claim to the appropriate DDS, using the instructions found in Electronic
Case Routing before Final Determination in DI 81020.125.