DI 13005: Medical Issues
BASIC (10-01)
See DI 55025.010 for medical CDR processing instructions for beneficiaries with Tickets to Work.
A. Process
1. General
Send a letter to the beneficiary or payee as follows.
2. Domestic Claim Cases
Send a letter from the Workload Action Center (WAC) with language appropriate for the way the CDR is going to be handled, i.e., face-to-face in the FO, FO telephone call, beneficiary or payee telephone call, or by mail only.
3. Foreign Claims Cases
In foreign claims cases, the beneficiary will not be called for a personal contact. A letter will be sent to the individual to notify him/her of the review and request completion of Form SSA-454-BK as follows:
| REASON FOR CDR | TITLE | NOTICE |
|---|---|---|
| MIE Diary | II Only | SSA-L1190-U2-FC |
| MIP Diary | II Only | SSA-L1219-U2-FC |
| NONDIARIED Review | II Only | SSA-L293-U2-FC |
4. Follow-up Letter
If the beneficiary or representative payee does not respond to the initial come-in letter and a follow-up letter is necessary, send a follow-up letter from WAC.
B. Policy
A medical CDR will not be conducted on title XVI recipients who are ineligible for either 1611 or 1619 benefits.
A title XVI or concurrent title II/title XVI individual who is in current pay, suspense, or nonpay status (unless the DDS field on the SSR reflects an initial denial) is entitled to title XVI due process.
If the PSY field reflects N07, N08, N30-N54, T01, T31, or T51 the individual is not eligible for payment under title XVI and the case is considered title II only.
With the establishment of the section 1619 provisions, certain suspense and termination codes took on revised meanings (see SI 02302.030).
Further development may be necessary to determine if a case actually has become a title II only case. Document on an RC the determination, including the rationale (e.g., T5 or T3 status for 12 months, folder reflects no entitlement to benefits, case in N04 due to an initial excess resources denial or case in M01 but record will not be reestablished). Attach all documentation to the SSA-454-BK when completed.
NOTE: The FO will include an R/C in every file transmitted to any component including the DDS which explicitly states whatever disability entitlement exists (e.g., title II only, HA/DAB, SSI DC, HA/SSI-BI, etc.).