TN 12 (08-22)

DI 23510.030 Decision Paragraph for a Disability Insurance Benefit (DIB) Claim Filed after Death (Table)

To determine the correct decision paragraph in the personalized disability explanation (PDE) by the regulation basis code, use this table:

Personalized Disability Explanation (PDE) Paragraphs

Regulation Basis Code
(Item 22 of the SSA-831)[1]

Basis for Determination

Decision Paragraph[2]

F1

Impairment not severe at time of death – Medical consideration alone

329 (NH's Name)

F2

Impairment not severe at time of death – Medical consideration alone

324 (NH's Name) (Date ER Last Met)

H1

Impairment severe at time of death – medical and vocational considerations: Capacity for Substantial Gainful Activity (SGA)—any relevant past work

330.2 (NH's Name)

H2

Impairment severe at time of death – medical and vocational considerations: Capacity for Substantial Gainful Activity (SGA)—any relevant past work

324(B) (NH's Name) (Date ER Last Met)

J1

Impairment severe at time of death – Medical and vocational considerations: Capacity for SGA—Other Than Relevant Past Work

330.2 (NH's Name)

J2

Impairment severe at time of death – Medical and vocational considerations: Capacity for SGA—Other Than Relevant Past Work

324(B) (NH's Name) (Date ER Last Met)

E1

Impairment no longer severe at time of death and did not prevent SGA for a period of at least 12 months

331.1(A) (NH's Name)

E2

Impairment no longer severe at time of death and did not prevent SGA for a period of at least 12 months

324(B) (NH's Name) (Date ER Last Met)

E3

Impairment is severe at time of adjudication/death but would not have been expected to last 12 months

331(E) (NH's Name)

E4

Impairment is severe at time of adjudication/death but would not have been expected to last 12 months

324(B) (NH's Name) (Date ER Last Met)

M5

Insufficient evidence provided

341(A) (NH's Name)

M6

Insufficient evidence provided

341(A) (NH's Name)

M3

Applicant does not want to continue development of claim: Wants determination made on evidence in file or does not indicate determination based on evidence in file

343(C) (NH's Name)

M4

Applicant does not want to continue development of claim: Wants determination made on evidence in file or does not indicate determination based on evidence in file

343(C) (NH's Name)

M7

Applicant does not want to continue development of claim: Does not want determination to be made on evidence in file

343(C) (NH's Name)

M8

Applicant does not want to continue development of claim: Does not want determination to be made on evidence in file

343(C) (NH's Name)

K1

Number Holder (NH) willfully failed to follow prescribed treatment

381A (NH's Name)

K2

Number Holder (NH) willfully failed to follow prescribed treatment

381A (NH's Name)

For a list of the PDE paragraphs in the table, see NL 00708.100. The list is in numerical order and contains text for each paragraph listed.

For additional information on PDE paragraphs in initial DIB after death denials, see DI 26530.030.

NOTE: The PDE paragraphs should be written in the third person.


Footnotes:

[1]

For information on the regulation basis codes, see DI 26510.045A.

[2]

The third element of the PDE.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423510030
DI 23510.030 - Decision Paragraph for a Disability Insurance Benefit (DIB) Claim Filed after Death (Table) - 08/12/2022
Batch run: 08/12/2022
Rev:08/12/2022