TN 1 (07-87)

GN 02335.045 Special Provisions Regarding Development of Underpayment Claim from a Survivor of the Beneficiary

A. Evidence Requirements

In addition to the general provisions in GN 02335.030, the relative(s) highest on the list of priorities in GN 02335.025 A.2. must provide information in writing regarding:

  1. His relationship to the deceased beneficiary;

  2. His status with respect to entitlement for monthly social security or railroad retirement benefits on the same earnings record as the deceased beneficiary; and

  3. Whether there is a person in a higher priority.

B. Allegation of Entitlement, Relationship Etc.

In the absence of evidence to the contrary, a written and signed allegation of the claimant as to his entitlement status and his relationship to the deceased will be accepted. The allegation should include a statement that there is no relative in a higher priority to receive the Medicare payment, and that there is no legal representative of the estate.

C. Distribution of Payment to Children

If the claim is filed by a surviving child, explain to the claimant that if there is more than one child, the Medicare payment will be divided equally among all children in the highest priority (those entitled to monthly benefits on the same earnings record as the deceased beneficiary), subject to the $200 rule in GN 02335.030 G.

D. Payment to Parents

If a parent of the deceased beneficiary is the claimant and there is more than one surviving parent, explain that if they are living together, the payment will be combined and a joint check will be issued. If the surviving parents are not living together, the payment will be divided equally between them even if the total amount payable is $200 or less. Of course, if one parent is entitled to monthly benefits on the same earnings record as the deceased and the other is not, the entitled parent takes precedence over the other.

E. Payment to Minors or Incompetent Adults

If a relative who qualifies for payment is incompetent or a minor, the claim may be made on such person's behalf by his legal guardian or other individual who has assumed responsibility for him. The representative payee for monthly social security benefits will also qualify as payee for health insurance purposes. If there is no legal guardian or representative payee, the claimant's statement that he has authority to act for the qualified individual may be accepted in the absence of evidence to the contrary.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202335045