TN 22 (04-09)

A. Procedure

1. Disability established

If the disabled widow(er) filed in the month of the number holder’s (NH's) death, alleging a disability onset date well before the waiting period for entitlement in the month of death, and the evidence does not establish a precise date but does establish disability before the beginning of the waiting period, check the onset date eView or the paper SSA-831, (Disability Determination and Transmittal).

• In such cases, eView or the paper SSA-831 may show an onset date exactly 5 months before the NH's death and preceded by “at least by.” Unless the NH died on the first day of the month, such an onset date does not permit payment for the month of death because the first month shown by the Disability Determination Services (DDS) cannot be counted as part of the waiting period (i.e., it is not shown to be a full month of disability).

• In this situation, if the evidence in file clearly indicates that an onset on the first day of the month established by the DDS is reasonable, telephone the DDS to see if the onset date should be revised and document the file in accordance with its response.

• Use this procedure only when it is necessary to prevent the loss of a month's benefit or the loss of a month's health insurance (HI) protection.

• Referral to the DDS for a revision of its determination of the date of onset is necessary. Make the appropriate entry in the Electronic Disability Collect System (EDCS) or item 41 (remarks) of the paper SSA-831. Changing the date of onset to any date in an earlier calendar month is not authorized by these instructions.

Transmit the claim to the servicing Program Center (PC) under cover of an SSA-3601 (Claims Routing), EF101 or A101 cover sheet (COVR).

2. Claim disallowed non-medical reasons

If it is determined that the claimant is ineligible for disability widow’s benefits (DWB) for non-medical reasons, process the claim in accordance with DI 11015.030.

3. Disability denied

For procedure regarding substantial gainful activity (SGA) and technical denials see DI 11010.050 and DI 11015.030.

The DDS prepares and releases the denial notice in most initial Title II disability claims.

If the claim involves the family maximum, prepare an A101 or EF101 to correct the benefit rates of any beneficiaries whose benefits have been adjusted because of the widow(er)'s potential entitlement. Transmit to the PC using Form SSA-3601 (Claims Routing) if paper folder exists.

4. Denied claimant files reconsideration

If a denied claimant files a request for reconsideration on the disability issue, handle the request as prescribed in DI 12005.001.

B. References

DI 81010.005, Electronic Disability Collect System (EDCS) Overview

DI 81010.085, Transferring Cases in Electronic Disability Collect System (EDCS)

DI 81001.020, Paper Folder Indicators (PFI)

DI 81010.150, Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS)