TN 2 (10-09)

DI 10110.001 Requirements for Disabled Widow(er)'s Benefits (DWB)

A. Attain age 50

To be eligible for DWB, a widow(er) must have attained age 50, but not attained age 60.

  • Benefits to a widow(er) on the basis of disability are not payable for months before the attainment of age 50 even though the impairment may have existed before age 50.

  • If a widow(er) receiving “D” benefits, i.e., benefits paid to widows(er)s age 60 and older, becomes disabled after attaining age 60 and is still within the prescribed period, he or she may file a DWB claim for Medicare entitlement purposes. For additional information, see DI 10110.001G.2 in this section.

References

  • GN 00302.001 – Situations Where Age Must Be Immediately Developed

  • GN 00302.030 – Tolerances for Developing Evidence of Age

B. Prove relationship to the deceased number holder (NH)

The claimant is considered the widow(er) of the deceased NH if he or she meets the required conditions described in RS 00207.001 – Widow(er)’s Benefits Definitions and Requirements.

C. Prove disability under the Social Security Act

The disability standard for disabled widow(er)s and surviving divorced spouses, (collectively referred to as disabled widow(er) beneficiaries (DWBs)), is the same as the disability standard for disabled wage earners effective for benefits payable January 1991 and later.

NOTE: For information on the disability requirements for DWB claimants seeking benefits for months before January 1991, see DI 00115.015A.

D. Found disabled before the end of the prescribed period

To qualify for disability benefits, a widow(er) (including certain surviving divorced spouses) must be found disabled before the end of a certain prescribed period as defined in the law. The widow(er) may allege a disability onset date that is earlier than the prescribed period however, DDS will determine if disability can be established before the prescribed period end date.

To determine the prescribed period, follow instructions in DI 11005.050, Prescribed Period and Controlling Date.

E. File an application

An application for DWB is necessary unless an automatic conversion from a spouse’s benefit is involved.

References

  • RS 00207.005 – Widow(er)’s Benefits – Conversion of Benefits - Policy

  • RS 00208.085 – Mother’s/Father’s to Widow(er)’s Benefits at Full Retirement Age (FRA)

F. Complete the disability report

Complete the SSA-3368 (Disability Report – Adult) to obtain basic information about the claimant's condition, sources of medical evidence, and other information needed to process the claim to completion. Additionally, the claimant must sign medical release forms SSA-827 (Authorization to Disclose Information to the Social Security Administration) so that SSA may obtain medical records from his or her treating sources.

References

  • DI 10005.001 – Field Office (FO) Role – General

  • DI 11005.055 – Completing the Authorization Form SSA-827

  • DI 81010.025 – Completing Electronic Disability Collect System (EDCS) Forms for Initial Claims

NOTE: The SSA-3368 is not required if collateral estoppel applies. For instructions, see DI 81010.142 – Processing Collateral Estoppel / Field Office Adoptions Cases in the Electronic Disability Collect System (EDCS).

G. Serve a waiting period

1. For entitlement to cash benefits

Payment of DWB is subject to a waiting period of five full consecutive calendar months. The waiting period can begin no earlier than the later of:

  • The first day of the 17th month before the month of filing; or

  • The first day of the 5th month before the month in which the prescribed period began.

There is no waiting period if the claimant becomes disabled again before age 60, and the new period of disability began within 84 months following the month in which prior entitlement to DWB terminated. Benefits begin the first month the claimant is disabled for the entire month.

NOTE: Supplemental Security Income (SSI) and or federally administered State Supplementary Payments (SSP) eligibility months can be credited toward the five month waiting period for DWB benefits (see DI 11015.001 – Disabled Widow(er)’s Benefits - General).

Reference

For the waiting period for DWB benefits payable prior to 01/1973, see DI 10105.070B.

2. For entitlement to Medicare coverage

DWBs are eligible for Medicare insurance if they have received (or deemed receipt of) disability benefits for 24 months. For complete instructions on the Medicare waiting period for DWB see HI 00801.151 through HI 00801.155.

A widow(er) may file for Medicare-only if ineligible for regular DWB benefits. Usually, a claim for deemed DWB for Medicare is filed by a widow(er) who:

  • Receives E benefits based on having a child in his or her care; or

  • Receives D benefits, i.e., benefits paid to widows(ers) aged 60 and older; or

  • Files a claim for regular DWB, but onset cannot be established prior to age 59 and 7 months, and there is a possibility of extending the prescribed period beyond age 60.

NOTE: SSI and or SSP eligibility months can be credited toward the 24 month waiting period for Medicare coverage. For additional information, see HI 00801.154, SSI/SSP Credit for Disabled Widower(er)s.

3. Medicare waiting period for DWBs diagnosed with amyotrophic lateral sclerosis (ALS)

Effective July 1, 2001, a DWB diagnosed with ALS will not have to serve the 24-month Medicare waiting period.

  • For a DWB diagnosed with ALS, the date of entitlement to Medicare is the date of entitlement to disability (DOED) benefits or July 1, 2001, whichever is later.

  • If ALS onset is established later than the month of initial disability onset, but the ALS onset is still within the 24-month Medicare waiting period, Medicare entitlement begins with the ALS onset month or July 1, 2001, whichever is later.

NOTE: This affects both new and current beneficiaries, see (DI 11036.001).

H. References

RS 00207.000 – Widow(er)’s Benefits - Table of Contents

RS 00207.004 – Widow(er)’s Benefits - Table of Proofs and Development - Policy

RS 00207.020 – Health Insurance (HI) for Disabled Widow(er)s

DI 10135.001 – Deemed Entitlement to DWB for Medicare - General

DI 11015.000 – Disabled Widow(er) Benefit (DWB) Cases - Table of Contents

DI 11015.015 Field Office (FO) Processing of a Disabled Widow(er)’s Claim for an Electronic Disability Collect System (EDCS) Exclusion or Limitation Case

DI 11040.000 – Deemed Medicare Cases - Table of Contents

DI 11036.001 – Amyotrophic Lateral Sclerosis (ALS) – Medicare Waiting Period Waived – Field Office (FO)

DI 25501.360 – Established Onset in Deemed Entitlement to Disabled Widow(er)’s Benefits for Medicare Claims

SM 03040.020 – Deemed DIB for Disabled Widow's Benefits (DWB)


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DI 10110.001 - Requirements for Disabled Widow(er)'s Benefits (DWB) - 04/16/2013
Batch run: 04/16/2013
Rev:04/16/2013