TN 18 (09-11)

GN 00504.110 When We May Suspend Benefits

A. Policy for suspending benefits

We must pay benefits directly to the beneficiary, unless we determine that substantial harm would result. For examples of substantial harm determinations see GN 00504.105C.

We suspend benefits only if

  • a representative payee problem surfaces,

  • a new representative payee is not available, and

  • direct payment is prohibited.

If you decide to suspend benefits for a reason other than a payee's death or refusal to continue as payee, you must obtain approval at a second tier level (e.g., technical assistant or member of management). The field office (FO) or processing center (PC) making the decision is responsible to suspend benefits.

B. When to suspend benefits

You may suspend benefits when we cannot find a suitable payee in the following situations:

  • a beneficiary in direct pay is adjudged legally incompetent;

  • a representative payee dies, is unwilling to continue serving, or is no longer qualified and there is a reason that prohibits direct payment, or substantial harm would result from direct payment. Document this decision and record the reason for suspense. For more information on required suspension, see GN 00504.105A.2.b.

NOTE: The policy on suspensions described in GN 00504.105 applies to all situations. For example, failure to return an accounting form is not a valid reason to suspend benefits automatically. Make direct payments pending development for a new payee if there would be no substantial harm.

C. How to suspend benefits

If you determine that we cannot pay the beneficiary directly while resolving the representative payee issue use the following guidelines to suspend benefits.

1. Suspending an initial award

Process the initial “no payment” award suspending all benefits, and promptly continue representative payee development.

a. Suspending title II claims

  • Establish the Master Beneficiary Record (MBR)

  • Input the payee issue using the Special Message Field on the (CIPM) screen (MSOM RSDHI 001.001)

NOTE: Modernized Claims System (MCS) can process these claims and build a notice based on the suspension action.

b. Suspending title XVI claims

Prepare a manual award notice, using language in NL 00801.010B.2. Input the payee issue in the Remarks field.

2. Suspending benefits after adjudicating the claim

  • Input the suspense code action (S8/S08). The system generates the appropriate notice language.

  • Expedite payee development.

  • Suspend payment for reason “whereabouts unknown” rather than for representative payee development if you are unable to make direct payment because you cannot locate the beneficiary.

  • Input suspense code S9 for title II and enter “WHEREU” in the RFST field

  • Input suspense code S06 for title XVI.

For more information on reasons for suspension or termination (RFST) see SM 00510.175C.11.

For guidance on lack of representative payee or address unknown, see SM 01305.590.

REMEMBER: If the reason for suspension is NOT suitable for the payee, you may contact the payee of record to act on the beneficiary's behalf in SSA related matters.

3. Suspending concurrent claims

Before suspending the claim

  • Determine if the beneficiary has concurrent claims.

  • Take appropriate action on both records.

  • Verify status on each by querying the MBR and Supplemental Security Record (SSR).

  • Query the Representative Payee System (eRPS) to determine if a payee application is pending.

4. Documenting your reasons for suspending benefits

Input the reason for suspense on the MBR/SSR, and indicate why direct payment is not possible.

Input direct payment as an interim measure on the Report of Contact Details screen of eRPS (MS INTRANETERPS 016.002).

Input information for title II cases using the Special Message field of the MBR on the CIPM screen. Use the Remarks field to record this information on the SSR.

Use language such as “pye died-direct payment prohibited - unable to locate payee - development in process” or “misuse by pye - substantial harm - new payee not available.”

D. Initiate dire