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DI 23510.035: Death after Filing – Title XVI (Chart)

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  • Effective Dates: 05/21/2014 - Present
  • Effective Dates: 07/20/2018 - Present
  • BASIC (09-08)
  • DI 23510.035 Death after Filing – Title XVI (Chart)
  • A. No surviving eligible spouse
  • Return the case to the field office (FO) unadjudicated if there is no surviving eligible spouse and:
  • * there are no unpaid medical expenses; or
  • * the disability determination services (DDS) does not make Medicaid eligibility determinations for the State.
  • If the FO later learns there is a surviving eligible spouse, the case will be returned to the DDS for a determination. For instructions regarding Medicaid only cases, see DI 23510.035C. in this section.
  • If the FO later learns there is a surviving eligible spouse, the case will be returned to the DDS for a determination. For instructions regarding Medicaid only cases, see DI 23510.035D. in this section.
  • B. Surviving eligible spouse
  • If there is a surviving eligible spouse, the DDS must make a disability determination.
  • Use the appropriate chart for instructions about
  • * completing Form SSA-831 (Disability Determination and Transmittal),
  • * preparing the notification (if needed), and
  • * routing the case.
  • 1. Allowance
  • Use this chart for fully favorable allowance determinations:
  • SSA-831
  • Notification
  • Special routing
  • Complete as usual with the following exceptions:
  • Item 17: Enter
  • * “NXP” for the diary type,
  • * “0000” for the diary date (may be 4 or 6 characters depending on DDS legacy system), and
  • * “7” for the diary reason.
  • Item 29 (Ltr./Par. No.): Leave blank
  • Item 34 (Remarks): If claimant filed for self enter, “Claimant deceased (date of death).”
  • No DDS prepared notification needed for fully favorable allowance.
  • Route the case to the FO with a Special Handling flag (see, DI 81030.090 Certified Electronic Folder (CEF) Alerts, Flags, and Messages).
  • Alert the FO via email or other electronic means that "SSI claimant deceased – claim allowed but not input – please input for underpayment due spouse."
  • For electronic disability insurance benefit (eDib) cases, see DI 81020.090 Certified Electronic Folder (CEF) Messages.
  • 2. Partially favorable allowance
  • Use this chart for partially favorable allowance determinations:
  • SSA-831
  • Notification
  • Special Routing
  • Complete as usual with the following exceptions:
  • Item 17: Enter
  • * “NXP” for the diary type,
  • * “0000” for the diary date (may be 4 or 6 characters depending on DDS legacy system), and
  • * “7” for the diary reason.
  • Item 29 (Ltr./Par. No.): Enter “DO D/L 1029, 1373”. (If the system is unable to generate the proper disability determination notice and a manual notice must be prepared.)
  • Item 34 (Remarks) If claimant filed for self enter, “Claimant deceased (date of death).”
  • DDS prepares a personalized disability explanation in the third person.
  • Alert the FO via email or other electronic means to release the notice attachment with the final notice prepared by the FO. For eDib cases see, DI 81020.130 Electronic Case Closure.
  • Do not prepare an interim notice SSA-1157-U2 (SI).
  • Route the case to the FO with a Special Handling flag (see, DI 81030.090 Certified Electronic Folder (CEF) Alerts, Flags, and Messages).
  • Alert the FO via email or other electronic means that "SSI claimant deceased – claim allowed but not input – please input for underpayment due spouse."
  • 3. Denial
  • Use this chart for denial determinations:
  • SSA-831
  • Notification
  • Special routing
  • Complete as usual with the following exceptions:
  • Ítem 29 (Ltr./Par No.): DDS D/L L444. (If the system is unable to generate the proper disability determination notice and a manual notice must be prepared.)
  • Item 34 (Remarks) If claimant filed for self enter, “Claimant deceased (date of death).”
  • DDS prepares a personalized disability explanation in the third person, and includes the appropriate decision paragraph per DI 23510.040, Determination Paragraph, Death after filing - Title XVI (Chart). The DDS releases the notice.
  • For eDib cases see, DI 81020.130 Electronic Case Closure.
  • Route the case to the FO with a Special Handling flag (see, DI 81030.090 Certified Electronic Folder (CEF) Alerts, Flags, and Messages).
  • Alert the FO via email or other electronic means that, "SSI claimant deceased – claim denied but not input."
  • For eDib cases, see DI 81020.090 Certified Electronic Folder (CEF) Messages.
  • C. Surviving ineligible spouse
  • The DDS may make a determination when the claimant is survived by an ineligible spouse. See DI 23510.001E.2 for instructions.
  • D. Medicaid only
  • The DDS makes Medicaid eligibility determinations in some States.
  • Use the appropriate chart for instructions about
  • * completing Form SSA-831 (Disability Determination and Transmittal),
  • * preparing the notification (if needed), and
  • * routing the case.
  • 1. Allowance
  • Use the chart below for fully favorable determinations:
  • SSA-831
  • Notification
  • Special routing
  • Complete as usual with the following exceptions:
  • Item 17: Enter
  • * “NXP” for the diary type,
  • * “0000” for the diary date (may be 4 or 6 characters depending on DDS legacy system), and
  • * “7” for the diary reason.
  • Item 29 (Ltr./Par. No.): Leave blank
  • Item 34 (Remarks): If claimant filed for self, enter “Claimant deceased (date of death) – determination for Medicaid only”.
  • No DDS-prepared notification is needed for fully favorable allowances.
  • Route the case to the FO with a Special Handling flag (see, DI 81030.090 Certified Electronic Folder (CEF) Alerts, Flags, and Messages).
  • Alert the FO via email or other electronic means that, "SSI claimant deceased - claim allowed but not input - please notify welfare of Medicaid determination."
  • For eDib cases, see DI 81020.090 Certified Electronic Folder (CEF) Messages.
  • 2. Partially favorable allowance
  • Use this chart for partially favorable allowance determinations:
  • SSA-831
  • Notification
  • Special routing
  • Complete as usual with the following exceptions:
  • Item 17: Enter
  • * “NXP” for the diary type,
  • * “0000” for the diary date (may be 4 or 6 characters depending on DDS legacy system), and
  • * “7” for the diary reason.
  • Item 29 (Ltr./Par. No.): Enter “DO D/L 1029, 1373”. (If the system is unable to generate the proper disability determination notice and a manual notice must be prepared.)
  • Item 34 (Remarks): If claimant filed for self, enter, “Claimant deceased (date of death) – determination for Medicaid only.”
  • DDS prepares a personalized disability explanation in the third person.
  • Alert the FO to release the notice attachment with the final notice prepared by the FO.
  • For eDib cases, see DI 81020.130 Electronic Case Closure.
  • Do not prepare an interim notice SSA-1157-U2 (SI).
  • Route the case to the FO with a Special Handling flag (see, DI 81030.090 Certified Electronic Folder (CEF) Alerts, Flags, and Messages).
  • Alert the FO via email or other electronic means that, "SSI claimant deceased – claim allowed but not input – please notify welfare of Medicaid determination."
  • For eDib cases, see DI 81020.090 Certified Electronic Folder (CEF) Messages.
  • 3. Denial
  • Use this chart for denial determinations:
  • SSA-831
  • Notification
  • Special routing
  • Complete as usual with the following exceptions:
  • Item 29: Enter “DO D/L 1029, 1373”. (If the system is unable to generate the proper disability determination notice and a manual notice must be prepared.)
  • Item 34 (Remarks): If claimant filed for self enter, “Claimant deceased (date of death) – determination for Medicaid only.”
  • DDS prepares a personalized disability explanation in the third person, and includes the appropriate decision paragraph per DI 23510.040, Determination Paragraph, Death after filing - Title XVI (Chart).
  • Route the case to the FO with a Special Handling flag (see, DI 81030.090 Certified Electronic Folder (CEF) Alerts, Flags, and Messages).
  • Alert the FO via email or other electronic means that, "SSI claimant deceased – claim denied but not input – notify welfare of Medicaid determination."
  • For eDib cases, see DI 81020.090 Certified Electronic Folder (CEF) Messages.
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