TN 55 (08-96)

Policy

1. Fully Favorable Determinations

If the class member is disabled throughout the DEVELOPMENT PERIOD, and he or she remains disabled, the DDS prepares a fully favorable allowance/ continuation determination. The determination is fully favorable for Stieberger reopening purposes, even though the onset is later than the original AOD.

Payment is made for the PAYMENT PERIOD, and, if all factors of eligibility continue to be met, from the end of the PAYMENT PERIOD through the present. Cases in which there is no possible additional entitlement (i.e., all possible benefits have been entitled as a result of a determination on a subsequent claim), are screen-outs.

2. Partially Favorable Determinations

Partially favorable determinations include closed periods and actual onset dates established other than the earliest possible Stieberger period.

If the DDS cannot establish disability for the entire DEVELOPMENT PERIOD (basic 48 months plus date of receipt of request for review to the present), it will usually establish an actual onset when Section 10 (e)(5) exceptions are met (see DI 12586.035D). When the DDS establishes an actual onset, the presumption of insured status does not apply. The DDS will annotate “Actual Onset” in the remarks block of the SSA-831-U3 in all actual onset cases. Payments may have to be adjusted in actual onset and closed period cases (see DI 12586.060, item 2. and DI 12586.065, item 2.). See DI 12586.015D, for Stieberger cessation cases.

3. Affirmations

The DDS will send fully unfavorable decisions to the FO for retention during the appeals period. The DDS will prepare and release the notice to the class member and any representative.

4. Appeals

Unfavorable and partially favorable New York DDS Stieberger determinations may be appealed to the ALJ level.

5. Tolerances

Tolerances have been established for developing work activity in title II and title XVI initial entitlement and in title II continuing eligibility determinations (See DI 12586.070) and for title XVI nonmedical factors of eligibility (See DI 12586.080).

6. Claimant Deceased

If the claimant is deceased apply existing procedures (see DI 23510.001ff and SI 02101.003). See GN 02301.055A for determining distribution of any potential underpayment, etc.