IM-177 09/26/01 TEMPORARILY DISABLED INDIVIDUALS EXCLUSION CODE (4)
|TEMPORARILY DISABLED INDIVIDUALS EXCLUSION CODE (4)|
|The purpose of this memorandum is to clarify
when it will be appropriate to use exclusion code (04), Temporarily Disabled
Individual, for individuals who have been determined ineligible by Old
Age Survivor's and Disability Insurance (OASDI), Supplemental Security
Income (SSI), or employer-sponsored disability insurance based on permanently
After reviewing hearing decisions related to Permanently Disabled Individuals and the new two step process that we are using, it has come to our attention that staff may not be taking into consideration the temporarily disabled individual.
INDIVIDUALS WHO ARE DETERMINED INELIGIBLE FOR THE EXEMPTION PERMANENTLY DISABLED INDIVIDUAL
When an individual is determined to be ineligible for OASDI, SSI, or employer-sponsored disability insurance, staff have been instructed to send the information regarding the disability claim through the Medical Review Team for a decision on disability. MRT will now be determining if the individual meets the criteria for permanent disability or temporary disability.
If MRT requests additional information to make this determination, staff must supply it as soon as possible. MRT cannot determine any disability without sufficient information.
If MRT rejects the permanent disability claim, staff have been instructed to take appropriate action to determine if the participant can engage in a work activity or meets the criteria for Temporarily Disabled Individual (exclusion code 04).
INVESTIGATING THE APPROPRIATENESS OF TEMPORARILY DISABLED INDIVIDUAL (EXCLUSION CODE 04)
It is appropriate for staff to evaluate the use of this exclusion, Temporarily Disabled Individual, at the time a Temporary Assistance participant is called in after being rejected for permanent disability. If the individual meets the criteria listed below, they qualify for the exclusion:
Temporary physical or mental circumstances may exist that inhibit an individual from immediately engaging in a work activity. Participation may be delayed to receive appropriate medical attention to eliminate or minimize the condition.
Adequate information to determine this exclusion is based on the nature of the individual's condition as well as its severity. Typical methods of verification to establish the extent and length of the disability may include:
If verification or information of the individual's condition is inconclusive, the worker may need to discuss the case with the immediate supervisor. Referrals to the Medical Review Team for the determination of temporary disability are not required, however they will now be making this determination for us when they make a determination on permanent disability.
Re-evaluate as appropriate based on the anticipated length of the disability.
Refer to Temporary Assistance/Case Management Manual Section 0255.010.00 #5 Temporarily Disabled Individuals (Exclusion Code 4).PRIOR TO A HEARING
Prior to a hearing related to no exemption based on disability, evaluate the individual for the exclusion of temporarily disabled. If the individual meets the criteria, change their status to excluded individual and no longer attempt to engage them in a work activity until the temporary disability is handled.
EXAMPLE: Anne has had her SSI application rejected. Staff receives notice of the rejection and sends information about the disability to MRT for a decision. The MRT decision also states the individual is not permanently or temporarily disabled. Case management staff call Anne in to discuss work activities.
During the interview Anne tells you she has knee surgery scheduled in 20 days and provides a physician's statement.
In this scenario, Anne qualifies for the temporarily disabled individual exclusion code and should be given it through her surgery and recovery time. This is a decision that can be made by county staff. Staff should re-evaluate this decision based on the anticipated length of the recuperation time.