TN 96 (10-23)
SI 02220.009 SSI Overpayment - Disability Cessation Cases
A.
Policy for disability cessation overpayments
If, after appealing a medical cessation decision, an individual elects to have the
payment of their benefits continued and the final decision of the Commissioner of Social Security
affirms the determination that they e are not entitled to such benefits, any benefits
paid are considered overpayments. No overpayment exists until the appeals process
is exhausted, the agency’s decision is final, and we issue an overpayment notice to
the individual.
B. Procedure for overpayment notification in disability cessation cases
Do not send the initial overpayment notice until appeal of the medical cessation has
been exhausted. In such cases, do not send an overpayment notice to recover any statutory
benefit continuation (SBC) payment during the 65-day period (60-day appeal period
plus 5-day period for mailing) after a reconsideration determination, administrative
law judge (ALJ) decision, or appeals council (AC) action (e.g., denial of review,
extension of time to file action in federal district court, dismissal, or decision),
or if an appeal or federal court complaint was timely filed.
Do not send the overpayment notice even when the Title XVI case is listed on the “B3”
diary list. Do not send the initial overpayment notice until the recipient’s medical
cessation appeal is exhausted; i.e., when:
• The ALJ or the AC returns the folder (electronic file) after the 65-day period for
requesting judicial review expires; or
• You receive the court decision, if judicial review is requested.
Once the relevant appeal period has expired and no appeal has been filed, or all appeals
have been exhausted, follow normal overpayment notice procedures.
C. Examples of delayed SBC overpayment notification
Listed below are six examples of overpayments due to the claimants' receipt of statutory
benefit continuation (SBC) payments and the corresponding TSC or FO actions.
Example 1:
The individual received SBC payments through the reconsideration level of appeal.
The reconsideration determination affirmed the medical cessation, but the individual
did not file a hearing request within 65 days after the date of the reconsideration
affirmation notice.
TSC/FO Action:
Send the overpayment notice no earlier than 66 days after the reconsideration affirmation
notice date.
Example 2:
The individual received SBC payments through the reconsideration level of appeal.
The reconsideration determination affirmed the medical cessation; however, the individual
filed a request for a hearing. The hearing decision affirmed the medical cessation
and the individual filed no further appeal within the 65 day period after the hearing
decision date.
FO Action:
DO NOT send the overpayment notice while the request for a hearing is pending. Send
the overpayment notice after the ALJ/AC returns the folder and the period for requesting
further review has expired (see GN 02201.009).
TSC Action: At the time you discover that a hearing is pending, transfer the overpayment diary
to the FO (see the Teleservice Center Operating Guide, OVERPAYMENTS (Title XVI--TSRs)
chapter (TC 26010.030B), systems-identified exclusion number 18). The FO should control
the overpayment diary for the return of the folder.
Example 3:
The individual received SBC payments through the reconsideration level of appeal.
The reconsideration determination affirmed the medical cessation; however, the claimant
filed a request for a hearing. The hearing decision affirmed the medical cessation.
The claimant then filed a request for review of the ALJ's decision with the AC.
TSC/FO Action:
DO NOT send the overpayment notice while the request for a hearing or the request
for AC review is pending. Send the overpayment notice after the AC returns the folder
and the period for requesting judicial review expires (see GN 02201.009.). The FO should control the overpayment diary for the return of the folder. If the
TSC gets an overpayment diary, transfer it to the FO (see SI 02220.009C, Example 2).
Example 4:
The individual received SBC payments through the hearing level of the administrative
review process. The hearing decision affirmed the medical cessation and the individual
filed no request for review with the AC within the 65-day period after the hearing
decision date.
TSC/FO Action:
DO NOT send the overpayment notice while the request for a hearing is pending. Send
the overpayment notice after the ALJ/AC returns the folder and the period for requesting
further review has expired (see GN 02201.009). The FO should control the overpayment diary for the return of the folder. If the
TSC gets an overpayment diary, transfer it to the FO (see SI 02220.009C, Example 2).
Example 5:
The individual received SBC payments through the hearing level of the administrative
review process. The hearing decision affirmed the medical cessation; however, the
claimant filed a request for review with the AC.
TSC/FO Action:
DO NOT send the overpayment notice while the request for a hearing or the request
for AC review is pending. Send the overpayment notice after the AC returns the folder
after the period for requesting judicial review expires (see GN 02201.009). The FO should control the overpayment diary for the return of the folder. If the
TSC gets an overpayment diary, transfer it to the FO (see SI 02220.009C, Example 2).
Example 6:
The individual received SBC payments through the hearing level of the administrative
review process. The hearing decision affirmed the medical cessation; however, the
claimant filed an appeal to the AC level. The AC denied the claimant's request for
review of the ALJ's decision and the claimant requested judicial review in the federal
courts.
TSC/FO Action:
DO NOT send the overpayment notice while a request for a hearing, a request for AC
review, or federal court review is pending. Send the overpayment notice after a court
decision affirming the medical cessation decision is issued (see GN 02201.009). The FO should control the overpayment diary pending the court decision. If the
TSC gets an overpayment diary, transfer it to the FO (see SI 02220.009C, Example 2).
In addition, DO NOT send an overpayment notice if the AC remands a case to the ALJ
on its own decision, or after the federal court remands the case to the agency for
further proceedings. In such a case, the overpayment notice should only be sent when
all proceedings on remand (including any appeals of the new ALJ decision to the AC
or federal court) are completed, as outlined in SI 02220.009C, Examples 1 through 6.
D. References
DI 12027.065 Appeals Council (AC) Remand Medical Cessation Cases - Statutory Benefit Continuation
(SBC) - Title XVI and Concurrent Title II/Title XVI
GN 02201.009 Notification of a Title II Overpayment
SI 02260.007 Waiver Procedures for Disability Cessation Cases
SI 02220.010 SSI Overpayment - Notifying the Individual