UPM 2530.10 - SSA Disability Determination are Conclusive

CONNECTICUT DEPARTMENT OF INCOME MAINTENANCEPRIVATE UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 2-1-93 Transmittal: UP-93-2 2530.10 ______________________________________________________________________________ Section: Type: Categorical Eligibility Requirements POLICY ______________________________________________________________________________ Chapter: Program: Disability AABD _______________________________________________________________ MAABD Subject: SSA Disability Determination are Conclusive ______________________________________________________________________________

2530.10 A. Disability Determinations Made by SSA

1. An individual who is considered disabled by SSA is considered disabled by the Department.

2. A final determination by SSA that an individual is not disabled takes precedence over a determination by the Department, except in the situations described in paragraph C, below.

3. An SSA decision denying disability is binding for 12 months from the date the decision becomes final.

4. The SSA determination is considered final when there is no further right to administrative appeal through the SSA appeals process. Administrative levels in the SSA appeals process include all of the following:

a. reconsideration of the initial decision;

b. hearing before an administrative law judge;

c. Appeals Council review

5. The right to administrative appeal ends when a decision is rendered by the SSA Appeals Council or when the 60 day time limit for appealing a lower level decision expires without an appeal being filed.

6. If assistance is granted based on an MRT disability determination and SSA subsequently determines the individual is not disabled, benefits are terminated unless eligibility exists on some other basis or the recipient timely appeals the SSA decision. (cross reference 2530.10 D.)

7. Prompt action to terminate benefits is taken once the Department is notified of the initial SSA decision to deny disability, or when a denial is upheld at an appeals level.

8. The Department may delay action to terminate benefits if the recipient indicates that an administrative appeal will be filed with SSA; however, benefits are terminated if the recipient does not promptly file the appeal.

9. Action to terminate benefits must begin no later than the date the deadline for filing an administrative appeal expires.

CONNECTICUT DEPARTMENT OF INCOME MAINTENANCE UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 2-1-93 Transmittal: UP-93-2 2530.10 page 2 ______________________________________________________________________________ Section: Type: Categorical Eligibility Requirements POLICY ______________________________________________________________________________ Chapter: Program: Disability AABD _______________________________________________________________ MAABD Subject: SSA Disability Determination are Conclusive ______________________________________________________________________________

2530.10 B. Disability Determinations Made by the Department

1. The Department does not make a separate determination of disability if SSA already has determined that the individual is disabled.

2. The Department makes a determination of disability under the following conditions:

a. when the applicant has not previously applied to SSA as a disabled person;

b. when the applicant has applied to SSA on the basis of disability and the application is pending or a final decision has not been rendered;

c. when the applicant is denied by SSA for a reason other than disability;

d. in the circumstances described in paragraph C, below.

3. A determination is made within the 90 day standard of promptness requirements for processing disability applications if SSA has not rendered a decision.

C. Exemptions to Precedence of SSA Disability Determinations

The Department makes a separate determination of disability in each of the following situations, even though SSA has previously determined that the individuals was not disabled. The prior decision by SSA is not considered binding under these conditions.

1. The Department makes a separate determination any time an applicant alleges a disabling condition which is different from, or in addition to the conditions considered by SSA in making its last determination.

2. The Department makes a separate determination if within 12 months of the most recent SSA decision the following conditions exist:

a. the applicant alleges that he or she is disabled as the result of a change or deterioration of the same condition; and

b. the applicant has applied to SSA and SSA has refused to reconsider the new allegations or has denied SSI for a reason other than disability.

CONNECTICUT DEPARTMENT OF INCOME MAINTENANCE UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 2-1-93 Transmittal: UP-93-2 2530.10 page 3 ______________________________________________________________________________ Section: Type: Categorical Eligibility Requirements POLICY ______________________________________________________________________________ Chapter: Program: Disability AABD _______________________________________________________________ MAABD Subject: SSA Disability Determination are Conclusive ______________________________________________________________________________

2530.10 C. Exemptions to Precedence of SSA Disability Determinations (continued)

3. The Department makes a separate determination if more than 12 months after SSA denies disability the following conditions exist:

a. the applicant alleges that he or she is disabled as the result of a change or deterioration of the same condition; and

b. SSA has not made a determination with respect to the new allegations.

4. The Department refers individuals who allege new information or evidence affecting previous SSA determinations to SSA for reconsideration or reopening of the disability determination, except in the circumstances specified above.

D. Eligibility Status During SSA Administrative Appeal Process

1. An individual receiving assistance at the time SSA denies disability is entitled to continued benefits under the following conditions:

a. the individual timely appeals the SSA decision; and

b. the appeal is filed at an administrative level.

2. Individuals who timely appeal an SSA decision are not required to file a separate appeal with the Department to receive continued benefits.

3. The Department may terminate assistance before the deadline for filing an administrative appeal to SSA expires; however, benefits must be reinstated if an administrative appeal is filed before the deadline.