DI 12027.015:
Cases Excluded from Statutory Benefit Continuation (SBC)
Effective Dates: 06/26/2014 - Present- Effective Dates: 07/13/2018 - Present
- BASIC (10-06)
- DI 12027.015 Cases Excluded from Statutory Benefit Continuation (SBC)
- The following are excluded from the SBC provisions.
- * Initial determination of a closed period of disability (except adverse reopenings/revisions from an allowance to a closed period of disability).
- * Substantial gainful activity (SGA) cessations.
- * Whereabouts unknown cessations under Title II. (Title XVI whereabouts unknown is a basis to suspend, but not to terminate Supplemental Security. Income (SSI) payments until the beneficiary is located.) See DI 13015.001 for procedure on processing these cases.
- * Failure to follow prescribed treatment cessations.
- * Termination of benefits based on failure to cooperate with the field office request for necessary information or evidence needed to complete the continuing disability review. See DI 13015.001C.
* Disability determinations made on the basis that a prior favorable determination was obtained by fraud or similar fault.- * Title II disability determinations made on the basis that a prior favorable determination was obtained by fraud or similar fault.
- * Auxiliary filing a claim on the record of a primary beneficiary whose disability has already been ceased (whether SBC is involved with the primary beneficiary’s record or not).
- * Medicare Qualified Government Employee (MQGE).
- * Termination of continued payments under Section 301. See DI 14505.010G.
- NOTE: The cessation and adverse reopening determinations/decisions in Title II cases excluded from SBC require a due process predetermination notice without benefit continuation language. See DI 28080.005.
- Goldberg/Kelly procedures apply to Title XVI cessation/adverse reopening cases that are exclusions from SBC. See SI 02301.300.
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