TN 46 (01-17)

GN 00502.060 Making a Capability Determination

A. Policy for making a capability determination

A determination that a beneficiary is incapable effectively takes away his or her right to decide how benefits are used. Therefore, you must carefully consider all evidence, use sound and reasoned judgment, and properly document the capability determination. For information on documenting your capability determination, see GN 00502.065.

When making a capability determination, give primary consideration to the beneficiary's best interests. Do not feel compelled to find a beneficiary incapable in order to provide him or her “protection” or as a matter of convenience.

B. Procedure

1. Who is responsible for making capability determinations?

Field Office (FO) technicians are responsible for making the final capability determination. For information on when a Workload Support Unit claims taker may make a capability determination, see the NOTE in GN 00501.015A.1.

2. How do I make a capability determination?

Weigh all the evidence you have obtained (legal, lay, and medical) to make a capability determination. Consider the facts you have learned about the beneficiary such as:

  • physical and mental health (including medical evidence of capability);

  • living situation (whether the beneficiary lives alone, whether any third party manages or helps the beneficiary manage financial or business affairs);

  • handling of any money now received (whether the beneficiary shows ability to make reasonable decisions about how to use money or if some third party must make those decisions); and

  • how beneficiary needs are being met (whether the beneficiary can obtain his or her own food, clothing and shelter or is dependent on others to supply those needs).

Based on the evidence, determine whether representative payment or direct payment would be in the beneficiary's best interests.

3. What if an Administrative Law Judge (ALJ) states in his or her decision that a beneficiary is incapable?

Unless capability is specifically set before the ALJ to decide, you are not bound to follow the ALJ's opinion and you must make the capability determination yourself. However, the ALJ's opinion regarding capability is lay evidence and you should evaluate it as such when making a capability determination.

4. What if the beneficiary is already entitled to benefits on another account?

Unless you have new evidence (including evidence revealed because of recent contact with the beneficiary) about the beneficiary's capability/incapability, assume the initial determination about the beneficiary's capability/incapability remains in effect for any other benefits to which the beneficiary becomes entitled.

Appoint one payee for all benefits to which the beneficiary is entitled (see GN 00502.183B.4.).

REMEMBER: The electronic Representative Payee System (eRPS) permits you to take one payee application for all beneficiary entitlements via the Claimant Entitlement screen (MS INTRANETERPS 009.018).

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GN 00502.060 - Making a Capability Determination - 01/26/2017
Batch run: 01/26/2017