These are waiver determinations involving an SBC overpayment.
Example 1: Full cooperation
Ruth received a notice of medical cessation. They filed an appeal and elected to
receive SBC payments through the hearing level where the administrative law judge
(ALJ) upheld the denial decision. After Ruth did not appeal and the decision became
final, we issued the notice of overpayment for the SBC payments received during the
appeal process. Ruth requested a waiver for the SBC overpayment. We reviewed Ruth’s
file and found that they appealed in good faith because they cooperated during the
appeals process by submitting requested documentation and otherwise cooperating during
the appeal. We found Ruth not at fault, and uncovered that Ruth has two children.
The family receives Temporary Assistance for Needy Families (TANF), and the household
receives Supplemental Nutrition Assistance Program (SNAP) benefits. We waived recovery
of the SBC overpayment because Ruth is not at fault in causing the overpayment and
recovery is deemed to defeat the purpose.
Example 2: Full cooperation
Lily received a medical cessation notice. Lily filed an appeal and elected to receive
SBC payments while they awaited the decision on the appeal. Lily completed all forms
that we sent to them for the appeal process. Lily attended the hearing with the state
agency for the reconsideration and received an affirmation of the original decision
on their disability appeal. Lily requested and attended a new hearing before an ALJ.
The ALJ issued their unfavorable decision to Lily. After Lily did not appeal and
the decision became final, we issued the notice of SBC overpayment to Lily, and they
requested a waiver. We found Lily cooperated during the appeals process.
We completed full waiver development. Although we found Lily not at fault because
they cooperated during appeals process, we cannot approve the waiver because Lily
has the ability to repay the overpayment, and recovery is not against equity and good
conscience. We will propose a waiver denial and schedule a file review and personal
conference.
Example 3: Good reason for failure to cooperate
James received a medical cessation notice. They filed a timely request for reconsideration
and benefit continuation during the appeal process. James received paperwork to complete
but failed to return it timely because they were hospitalized due to their medical
condition. We denied their reconsideration. Then, James filed a timely request for
a hearing with an ALJ and elected benefit continuation again. James showed up for
the hearing and provided all of the requested information (including proof of hospitalization)
and otherwise cooperated during the hearing level of the appeals process. The ALJ
upheld the decision to cease James’ disability benefits. After 65 days passed, we
sent James an overpayment notice for the months of benefit continuation during the
reconsideration and hearing. James requested waiver of the overpayment, stating that
they had no income or resources.
Although James did not cooperate during all levels of appeal, there is an indication
that James had limitations preventing them from cooperating. Because James had a good
reason for not cooperating, we found James not at fault for causing the overpayment.
We waived the overpayment because they are not at fault and recovery would defeat
the purpose.
Example 4: Overpayment partly caused by a reason other than SBC
Same details and outcome as Example 1. We found Ruth was not at fault in causing the
overpayment because they cooperated during the appeal, and recovery was deemed to
defeat the purpose. However, during the appeal period while receiving benefit continuation,
Ruth started a job working one day a week at a local grocery store to help with household
expenses, but they did not report the earned income timely. The late discovery and
verification of the wages caused an overpayment for 2 months during the same period
of the SBC months. Because part of the overpayment in those 2 months is not related
to the SBC, we cannot consider Ruth’s cooperation during the appeal for the overpayment
caused by the late reported wages when evaluating whether Ruth is not at fault. Instead,
we must determine whether Ruth is not at fault for those 2 months by following the
guidance in GN 02250.005-GN 02250.025. If we find Ruth at fault for those 2 months, we will not waive the overpayment for
that portion. However, we can still waive the portion related to the SBC months.
Example 5: Failure to cooperate without good cause
Ivory received a medical cessation notice. They filed an appeal and elected to receive
SBC payments while awaiting an ALJ hearing. Ivory provided us with their parent’s
mailing address for business with us. We sent Ivory a notice for the date of the
hearing, but they did not appear at the hearing. The ALJ dismissed the request for
hearing. After receiving the notice of overpayment, Ivory requested a waiver. Ivory
told us that they periodically pick up their mail from their parent’s residence. Ivory
told us that they picked up the hearing notice only after the hearing had already
passed. They read the notice but did not attempt to contact the hearing office to
request that we reschedule the hearing. We will find Ivory at fault for the overpayment
because they did not cooperate during the appeal process and did not provide a good
reason for not cooperating. We will refer the case to an independent decision maker
so they can schedule a file review and personal conference.