Interim benefit payments require close management to prevent payment beyond the month
of final decision. Because of the sensitivity of this workload, please follow the
development guidelines in this section.
The procedures in this section apply if the case is pending an AC decision or was
remanded back to the ALJ for a decision. Therefore, PC staff and management should
carefully evaluate which office to contact.
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If
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then
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The claimant is still in interim benefit payment status for nine months
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The PC will query eView to see if the case is pending with the AC or is pending in
the Hearing Office (HO).
If the case is pending with the AC:
The PC will email ^DA Compliance 8001 and inquire about the status of the claim pending.
The AC will provide status. Establish diary to recontact the AC in three months if
necessary and return the case to the holding file for the next followup.
If the case is pending in an HO:
The PC will email the HO mailbox and inquire about the status of the claim pending.
The HO will provide status. Establish diary to recontact the HO in three months and
return the case to the holding file for the next followup.
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The claimant is still in interim benefit payment status for 12 months
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The PC will query eView to verify whether the case is pending with the AC or HO.
If the case is pending with the AC
The PC will write an email indicating that interim benefit payments continued for
12 months without a final decision and submit an official request to the AC to expedite
processing. Include any special characteristics of the case. The module manager will
forward the memorandum via email to ^DA Compliance 8001 and CC ^DA DICompliance Appeals
Quality and return the case to the holding file for the next followup.
If the case is pending in an HO
The PC will write an email indicating that interim benefit payments continued for
12 months without a final decision. Include any special characteristics of the case
and submit an official request to the AC to expedite processing. The module manager
will send the email to |||DA HQ DIGovernance APP and return the case to the holding
file for the next followup.
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The claimant is still in interim benefit payment status for 15 months
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The PC will query eView to verify whether the case is pending with the AC or HO.
If the case is pending with the AC
The PC will send an email with subject line URGENT-SECOND NOTIFICATION to ^DA DICompliance
Appeals Quality and inquire about the status of the claim pending decision. The AC
will provide status. Return the case to the holding file for the next followup.
If the case is pending with the HO
The PC will send an email with subject line URGENT-SECOND NOTIFICATION to |||DA HQ
DIGovernance APP and inquire about the status of the claim pending. Adjudication Practices
and Procedures (APP) will provide status via email. Return the case to the holding
file for the next followup.
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The claimant is still in interim benefit payment status for more than 16 months
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Refer the issue to the PCs Operation Support Branch with a summary of the facts and
a copy of the original email. The OSB Chief will forward the original email to the
Executive Directors of Governance and Compliance at ^DA DIGovernance Controls (for
HO cases) and ^DA DICompliance Controls (for AC cases). Inform the Executive Directors
that interim benefit payments have continued for more than 16 months without a final
decision. Include any previous correspondence with the AC or HO (if available) or
special characteristics of the case. Return the case to the holding file pending a
reply.
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