GN 02230.010 Critical Case Overpayments

AUDIENCE: CA, CRTA, CR, CLADJ, BA, BATA, SR

A. General

In critical/sensitive situations, district offices and reviewing offices will initiate critical case payments based on less than full claims folder information because the beneficiary is suffering hardship or dire need by not having received an apparently due check timely or a bad public relations situation has evolved. Critical case payments may be made through the IMPACC process or in some situations though a manual one-check-only action.

Each time a check of this nature is issued, the beneficiary will be notified of the payment by letter. This notice advises him/her that:

  1. A special payment is being made because regular work on the claim is not complete;

  2. The amount of the check that he/she will receive;

  3. The possibility that he/she will receive a second check covering all or part of the emergency payment;

  4. The importance of returning any duplicate payment; and

  5. The need to withhold future benefits if duplicate benefits are received but not returned.

B. Reviewing Office Action

  • AUDIENCE: CA, CRTA, CR, CLADJ, BA, BATA, SR, RECOVR

Although steps are taken to avoid the issuance of duplicate checks or any other overpayment, occasionally subsequent claims folder review reveals that a duplicate or incorrect payment(s) has been made. Due to the critical nature of these cases, special procedure must be followed in the recovery of the overpayment to avoid future critical case handling.

If, in the process of associating the “dummy” or duplicate folder with the original claims folder, it is discovered that an incorrect payment(s) was issued and the amount involves at least $1.00, a record of the overpayment will be established on ROAR. A 30-day diary period will be estabished automatically unless a different period is input.

Where the 30-day period has already expired or upon maturity of the diary if the overpayment has not been refunded or the check(s) returned, the reviewing office will send notice of the overpayment and institute regular recovery procedures. The explanation of overpayment to the beneficiary should include the month(s) involved, the exact amount of the checks issued for the month(s), the exact or approximate date(s) of payment(s), and the amount that was actually due.

Example:

“A review of your claims record indicates that you received duplicate payments for the months of May, 1974 and July, 1974. You were paid checks on June 3, 1974, and August 3, 1974, for those months in the amount of $144.40 each. You were also paid checks covering this same period on or about June 24, 1974, and August 14, 1974, in the amount of $150.00 each. Since you were due only $144.40 for each month, you were overpaid $300.00.”

If at any time a protest to the LDO determination or a request for waiver is received by the benefit authorizer, the case will be immediately referred to the recovery reviewer for any required action, after preparing an SSA-1112, TC 23.

C. Return or Refund of Duplicate Payment

  • AUDIENCE: SR, RECOVR

The DO will follow normal procedures for returning duplicate checks issued under emergency procedures to the Treasury Department. However, the check should be coded “DC” as reason for return (GN 02403.100B)). The DO will also ascertain whether the overpayment is recorded on ROAR and, if so, input form SSA-3079.

If the beneficiary refunds the duplicate payment, the DO will prepare Form SSA-1395-BK and send the refund to the reviewing office per GN 02403.001).


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202230010
GN 02230.010 - Critical Case Overpayments - 04/30/2012
Batch run: 04/30/2012
Rev:04/30/2012