TN 3 (01-07)

A. Policy

When an individual's disability has been ceased or benefits have been suspended, an FTC or WU determination should be reopened and revised if the rules of administrative finality (AF) allow (see DI 27505.001 and GN 04001.001 to determine if reopening is appropriate). FTC in this situation involves the beneficiary who fails to cooperate with the DDS and the DDS made a medical determination to cease benefits.

NOTE: A streamlined FTC process was implemented for medical CDR’s on January 27, 2007 in the FOs. If the beneficiary fails to cooperate with the FO and benefits are in suspense for 12 months, eligibility will be terminated in the 13th month and no medical determination is necessary. Therefore, no reopening is applicable because no determination was made. (See DI 13015.001C.)

1. The following levels of appeal apply:

a. Work Issue Cases (title II cases only) -- An appeal on this type of case is a reconsideration (see DI 13010.145 on reconsiderations of work issue cases).

b. Medical Issue Cases -- When the FTC determination is based on medical/vocational factors, the appropriate level of appeal is a disability hearing at the reconsideration level (see DI 12026.020 for FO responsibilities when the beneficiary wishes to appeal).

2. Revised Determination (Reopening under AF not Possible):

If an SSI recipient is ineligible for any SSI benefit for 12 consecutive months, or if the recipient (title II or title XVI) is found under the medical improvement review standard (MIRS) to no longer have a disabling impairment, and benefits are terminated, the disability standards applicable to initial claims would apply to any subsequent disability decision which may become necessary.

B. Procedure

1. Work Issue - If the case involves work issues:

1. Complete work issue development per DI 13010.025.

2. Secure and/or update an SSA-454-BK and obtain new medical release forms (SSA-827), if needed.

3. Conduct the CDR in the usual manner.

4. Prepare a new determination to revise the FTC or WU determination.

2. Medical Issue - If the case involves medical/vocational issues:

1. Secure and/or update an SSA-454-BK and obtain new medical release forms (SSA-827), if needed.

2. Conduct the FO CDR interview in the usual manner.

3. Forward the folder to the DDS for a revised determination.