Basic (01-19)

DI 23010.045 Predetermination Notice Language for Failure to Follow Prescribed Treatment (FTFPT) Cessations and Adverse Reopenings

A. Title II, Title XVI, and concurrent claims

We are writing to you on behalf of the Social Security Administration in reference to your [disability insurance benefits / Supplemental Security Income disability payments / disability insurance benefits and Supplemental Security Income disability payments]. We may be required by law to determine that you are not entitled to the benefits you are currently receiving.

In order to get benefits, you must follow treatment prescribed by your medical source, if this treatment is expected to restore your ability to work. If you do not follow the prescribed treatment without a good reason, we will not find you disabled, or if you are already receiving benefits, we will stop paying you benefits.

The evidence now in your file indicates that you are failing, without good cause, to follow prescribed treatment, [tell what treatment—e.g., back surgery, eye surgery] that could be expected to restore your ability to work. If you have information or evidence about this prescribed treatment and why you are not following it, it is important that you let us know within 30 days.

If we do not hear from you within 30 days of the date of this notice, we will make a determination based on the evidence already on file, and your [claim will be denied/benefits will be ceased]. Such a determination may also result in the loss of future rights or a decrease in the amount of benefits payable.

If you have any questions, please write to [insert title and address of DDS] as soon as possible or call [name of contact and phone number].

B. Title XVI child disability claims

We are writing to you on behalf of the Social Security Administration in reference to [child’s name]’s Supplemental Security Income disability payments. We may be required by law to determine that [child’s name] is not entitled to [benefits/the benefits he or she is currently receiving].

A child is not eligible for these benefits if he or she fails, without good cause, to follow treatment prescribed by his or her own medical sources that can be expected to prevent his or her condition from being disabling.

The evidence now in [his or her] file indicates that [he or she] is failing, without good cause, to following prescribed treatment [tell what treatment—e.g., back surgery, eye surgery] that could be expected to restore [his or her] ability to function in an age-appropriate manner. If you have information or evidence about this prescribed treatment and why [he or she] is not following it, it is important that you let us know within 30 days.

If we do not hear from you within 30 days of the date of this notice, we will make a determination about your child’s entitlement based on the evidence already on file, and we may find [child’s name] not entitled and [his or her] benefits may be ceased. Such a determination may also result in the loss of future rights or a decrease in the amount of benefits payable.

If you have any questions, please write to [insert title and address of DDS] as soon as possible or call [name of contact] at [phone number].

C. Title XVI blindness claims

We are writing to you on behalf of the Social Security Administration in reference to your Supplemental Security Income blindness payments. We may be required by law to determine that you are not entitled to [benefits/the payments you are currently receiving].

A person is not eligible for these payments if he or she fails, without good cause, to follow treatment prescribed by his or her own medical sources that can be expected to restore his or her vision to the point where he or she is no longer blind as defined by law.

The evidence now in your file indicates that you are failing, without good cause, to follow prescribed treatment [tell what treatment—e.g., eye surgery] that could be expected to restore your eyesight. If you have information or evidence about this prescribed treatment and why you are not following it, it is important that you let us know within 30 days.

If we do not hear from you within 30 days of the date of this notice, we will make a determination based on the evidence already on file, and your benefits will be ceased. Such a determination may also result in the loss of future rights or a decrease in the amount of benefits .

If we find that your eligibility to Supplemental Security Income payments as a blind person ceased, you can receive payments for a 2-month period after your blindness eligibility ends.

If you have any questions, please write to [insert title and address of DDS] as soon as possible or call [name of contact] at [phone number].


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423010045
DI 23010.045 - Predetermination Notice Language for Failure to Follow Prescribed Treatment (FTFPT) Cessations and Adverse Reopenings - 01/03/2019
Batch run: 01/03/2019
Rev:01/03/2019