DI 12027: Statutory Benefit Continuation (SBC)
Citations:
Social Security Act -- Section 223(g) and 1631(a)(7);
Regulations -- 20CFR 404.1597, 404.1597a, 416.995 and 416.996
BASIC (10-06)
Citations:
Social Security Act -- Sections 223(g) and 1631(a)(7) ;
Regulations -- 20 CFR 404.1597 , 404.1597a , 416.995 and 416.996
A. General – Statutory Benefit Continuation (SBC)
This subchapter contains the policy and field office (FO) instructions for processing SBC during an appeal under Title II and/or Title XVI of:
a medical cessation determination where the disabled individual’s physical or mental impairment(s) has ceased, never existed, or is no longer disabling, i.e., medically improved, or
a medical adverse reopening/revision determination.
Appealing the medical cessation (or medical adverse reopening/revision determination) is required to have the option of SBC.
A beneficiary that elects SBC is required to sign a specific statement (SSA-795) to that effect. See DI 12027.010B.4.
A beneficiary that declines SBC is required to sign a specific statement (SSA-795) to that effect. See DI 12027.010B.4.
The continued benefit provisions do not apply to an initial determination on an application for disability benefits or to a determination that an individual was disabled only for a specified period of time.
B. Policy – Statutory Benefit Continuation (SBC)
1. Medical Cessation
A beneficiary may elect or decline to continue receiving Title II social security disability benefits, Title XVI Supplemental Security Income (SSI) disability or blindness payments, and/or Medicare during a reconsideration or an Administrative Law Judge (ALJ) hearing appeal for a medical cessation determination.
2. Medical Adverse Reopening/Revision Determination
A beneficiary may elect or decline SBC of Title II social security disability benefits, Title XVI SSI disability or blindness payments, and/or Medicare during a reconsideration or an Administrative Law Judge (ALJ) hearing appeal of a medical adverse reopening/revision determination:
allowance to denial
allowance to closed period
continuance to medical cessation
revision to an earlier cessation date
revision to a later cessation date.
3. Appeals Council (AC) Court Remands
SBC also applies in cases remanded to the ALJ by the AC, when the appeal issue is a medical cessation (or medical adverse reopening/revision determination), including court remands not covered by Section 2(d) of P.L. 98-460.
See AC Remand Medical Cessation Cases - Title II, DI 12027.060
See AC Remand Medical Cessation Cases – Title XVI and Concurrent Title II/Title XVI, DI 12027.065
4. SBC provisions apply in each of the following situations:
Title II - Medical improvement determination (after January 11, 1983)
Title XVI - Medical improvement determination (after October, 1984)
-
Title II and/or Title XVI - Medical adverse reopening/revision determination of:
allowance to denial
allowance to closed period
continuance to medical cessation
revision to an earlier cessation date
revision to a later cessation date
Title XVI Age 18 Medical Redetermination - Medical Cessation That Uses the Disability Standard for Adult Applicants
-
AC Remands to ALJ - When appeal issue is medical cessation (or medical adverse reopening/revision determination)
See Cases Excluded From Statutory Benefit Continuation (SBC), DI 12027.015.
See Benefit Continuation Revisions – Policy, DI 28001.070.