POMS Reference

DI 10105: Disability Insurance Benefits (DIB) and Freeze

BASIC (06-06)

A. Policy

Any physical or mental impairment(s) arising or aggravated (but only to the extent of the aggravation) in connection with the commission of a felony is to be permanently disregarded for all disability program purposes. (These restrictions do not apply to title XVI cases.)

B. Effective date

This applies only for felonies committed after October 19, 1980.

C. Additional provisions

In order for the disregard to apply:

  • The claimant must be subsequently convicted.

  • The impairment must be closely related to, or associated with, the commission of the offense. The impairment or aggravation of a pre-existing impairment must occur at a time and location that is near to the felony. It is not necessary that there be a causative connection between the commission of the felony and the impairment.

EXAMPLE 1:

Doug Hall has an automobile accident which occurs while fleeing the scene of a bank robbery (a felony), which results in an injury to his back. This impairment would be considered associated with the commission of the offense.

EXAMPLE 2:

Marsha Guffey injures her back while shopping in a grocery store the week after she commits a bank robbery. The police assist her to her car, find the stolen money in the car, and charge her with a felony. The impairment would be too remote to be considered to have arisen in connection with the robbery. This accident ordinarily would not be considered sufficiently close in time and place to the scene of the robbery to be considered associated with the felony.

NOTE: Submit questionable situations to the regional attorney.

D. Procedure-claims decided prior to final court decision

The permanent disregard of an impairment or aggravation of a pre-existing impairment incurred in the commission of a felony hinges on the individual's subsequent conviction. There may be claims allowed considering all the medical evidence in which the person has been charged with but not convicted of a felony.

1. Court decision-conviction

In a case where benefits were allowed on the basis of an impairment which arose or aggravation of a pre-existing impairment incurred in connection with the commission of a felony, the subsequent conviction of the individual for that offense could invalidate the earlier award. In such a case of subsequent conviction:

  • Disability determination service will reevaluate the original medical decision to exclude any such impairments or aggravations.

  • If the claim is then denied because of this exclusion, the benefits paid under the original award will be considered overpayments.

2. Court decision-subsequent acquittal

A denial because of disregard of an impairment(s) connected with a felony may be reopened under the rules of administrative finality in the event the felony conviction is subsequently overturned.