TN 19 (09-97)
GN 02210.006 Adjustment of Benefits Due the Overpaid Individual
1. Adjustment of Current Monthly Benefits
Delay in Recovery
Do not reduce or interrupt a monthly benefit until the person has had an opportunity to:
Appeal the overpayment determination; and/or
Request that recovery be waived, including opportunity for a personal conference if waiver cannot be approved (GN 02201.011).
Additionally, recovery is delayed when nonreceipt of a check (or electronic funds transfer) is alleged and the criteria for handling the case in accordance with the nonreceipt instructions in GN 02406 ff. are met.
If a decision on a reconsideration and/or waiver request (including a personal conference decision) is pending, delay adjustment of benefits.
2. Adjustment Of Underpayments
a. Recovery Not Waived/Waiver Not Pending
If the issue of recovery is not open (see c. below), and it is subsequently determined that an underpayment is due the individual, withhold the underpayment to the extent of the overpayment to that individual. This applies even if partial recovery of the overpayment is ongoing.
EXAMPLE 1: In 1/88, it was determined that Bea Smith was overpaid $2,500 because of work and earnings in 1987; her 1988 estimated earnings precluded payment. Her request for waiver was denied in 4/88 and in 7/88 she began to refund the overpayment via $20 monthly installments. In 8 /88, based on a revised 1988 earnings estimate, Ms. Smith is due payment beginning 6 /88 and is underpaid $980 through 8/88. Because the issue of recovery is final, the $980 underpayment is withheld to reduce the overpayment. The balance of the overpayment is recovered by adjustment of her benefits beginning 9/88. This applies even if partial recovery of the overpayment is ongoing.
EXAMPLE 2: In 10/79, Mr. Lee is notified of a $2,300 overpayment and begins to refund. Efforts to collect were discontinued in 1/80. In 2/89, a new period of disability is established and his reentitlement to benefits was processed in 5/89. An underpayment of $900 (benefits due 3/89 and 4/89) is withheld to reduce the overpayment. However, Mr. Lee has not had an opportunity for a personal conference because his overpayment notice was sent prior to 3/80 and did not explain the personal conference rights. Therefore, the award notice proposed benefit withholding beginning 7/89 (i.e., COM+2) to complete recovery.
b. Recovery Waived
If recovery has been waived and it is subsequently determined that an underpayment is due:
Use any additional benefit due for months before the overpayment notice was sent to refigure the amount overpaid (GN 02201.025C.).
Withhold any part of the underpayment representing additional benefits due for months before the month waiver was requested.
NOTE: A request for waiver made within 30 days of the date of the overpayment notice is considered to have been made in the month of that notice.
EXAMPLE 1: On 4/12/87 Pete Rock was notified of a $1,680 overpayment because of an incorrect computation. His 5/87and 6/87 benefits of $400.00 monthly were withheld, and the outstanding overpayment had been reduced to $880 ($1,680 minus $800) prior to his 7/87 request for waiver. Waiver was approved and there was no further recovery of his overpayment. In 10/88, an AERO resulted in a $2 monthly benefit increase effective 1/87. The additional 1/87 through 3/87 benefits totaling $6 cause a refiguring of his overpayment; the refigured overpayment is $1,674 (see GN 02201.025C.).
The additional 4/87 through 6/87 benefits totaling $6, due for months before the month that waiver was requested, are withheld to adjust the overpayment for which recovery has been waived to $868 (i.e., $1,674 minus $800 minus $6). The additional benefits due beginning 7/87, the month of the waiver request, are paid.
EXAMPLE 2: If, given the facts in Example 1, Mr. Rock had requested waiver on May 9, 1987 (i.e., within 30 days of the overpayment notice), only the additional benefits due through 3/87 will be withheld to refigure the $1,680 overpayment. In this case, the overpayment for which recovery has been waived is $1,674 (i.e., $1,680-$6). The entire underpayment (i.e., additional benefits due from 4/87, the month of overpayment determination and notice) is paid.
c. Waiver Pending
If the issue of recovery is not final, any part of an underpayment subsequently determined to exist for months beginning with the month the overpayment or its recovery was protested must be paid.
The issue of recovery is not final if:
The 30-day advance notice period has not expired; or
Reconsideration and/or waiver has been requested but a decision has not yet been made; or
A personal conference decision is pending.
EXAMPLE 1: In 12/88, Shawn Roberts was notified that he was overpaid $5,800 because his disability benefits were not terminated timely. In 2/89, he requested reconsideration of the overpayment determination and waiver of recovery. In 6/89, he filed for a new period of disability. Reconsideration affirmed the overpayment and waiver could not be approved. Prior to the scheduled personal conference date, it is determined that Mr. Roberts is entitled to a new period of disability effective 6/89 and is underpaid $2,310. The entire underpayment must be paid to Mr. Roberts since the decision on his 2/89 waiver request has not become final (i.e., the personal conference decision is pending) and none of the additional benefits are due for months before the month he requested waiver.
EXAMPLE 2: If, given the facts in Example 1, the new period of disability was established effective 1/89, the part of the underpayment representing benefits due for 1/89 will be withheld to reduce the overpayment. However, because the personal conference decision on the 2/89 waiver request is still pending, the part of the underpayment representing additional benefits for 2/89 and subsequent months must be paid.