DI 28501.020:
Unfavorable Reopening of Prior Continuance Determination
Effective Dates: 09/24/2013 - Present- Effective Dates: 12/12/2017 - Present
BASIC (03-86)- TN 1 (12-17)
- DI 28501.020 Unfavorable Reopening of Prior Continuance Determination
Cases may be encountered in which the DDS finds a previous favorable continuance determination was wrong. In such cases, the DDS should complete any outstanding development of the case. If the evidence indicates the prior determination should be revised under the rules of administrative finality, afford the claimant due process in accordance with DI 27525.000 and prepare a revised determination according to the usual procedures.- A. Revision of a prior favorable continuance under administrative finality
In addition, cases may be encountered in which the “error” exception to medical improvement is applicable. If a cessation determination is prepared based on applicability of the “error” exception and the individual's capacity for SGA (i.e., where a reopening is not permitted under the rules of administrative finality), it will be processed according to the usual procedures (completion of Forms SSA-832-U5, SSA-833-U5, rationale preparation, predetermination due process (if applicable) and notice preparation).- If a prior favorable continuance is incorrect, the Disability Determination Services (DDS) must complete any outstanding development of the case. If the evidence shows that the prior determination needs revision and the rules of administrative finality allow, the DDS should take the following actions:
- * follow the rules of due process in DI 27525.000, and
- * prepare a revised determination using the evidence received from the outstanding development.
- B. Exception to medical improvement (MI) applies
- There may be cases in which the “error” exception to MI applies. If the DDS based the cessation determination on applying the “error” exception and the individual’s ability to perform substantial gainful activity (SGA) (where administrative finality does not allow a reopening), process the cessation determination according to the continuing disability review (CDR) determination procedures by completing the following:
- * Form SSA-832 (Cessation of Disability or Blindness Determination and Transmittal – Title II) or SSA-833 (Cessation of Disability or Blindness Determination and Transmittal – Title XVI),
- * Rationale,
- * Predetermination due process (if applicable), and
- * Determination notice.
- For more information on exceptions to MI, see DI 28020.001.
- For more information on CDR cases involving Group II exceptions, see DI 28020.900. For more information on reopening cases where the Medical Improvement Review Standard (MIRS) applies, see DI 28020.375.
x
← This means that the line
was removed and
was added – in other words, the "Effective Dates" line at the top of the document has been updated to reflect that the new version is effective as of the date the change was made.