TN 10 (06-10)

GN 02613.875 Title XVI Post-2006 Martinez Settlement Relief Processing

For Supplemental Security Income (SSI) class members selected for post-2006 relief, a Redetermination (RZ) or a re-opening of the affected initial SSI application is required for reinstatement or effectuation of payments. (For exceptions to reinstatement or effectuation of payments, see the NOTE in GN 02613.875E.2.b.) Systems selected these cases using a wide range of criteria. For multiple warrant cases (CCID F6), necessary to identify the specific month(s) for which Martinez relief applies. See the charts in GN 02613.875 A.1 in this section.

The post-2006 Martinez class members are included in the March RZ release with a selection date of April 1, 2010 and are identified by:

  • A profile code of “S” and selection indicator of “J” in the Case Redetermination Data segment (CRZD) field on the Supplemental Security Record (SSR), and

  • A Court Case Identifier (CCID) of F4 - T16 post-2006 class member, in the Civil Action Tracking System (CATS), or

  • A CCID of F6 - T16 post-2006 class member with multiple warrants. (Systems has identified these cases containing multiple warrants and you will need to review the Fugitive Felon System Control File (FFSCF) to determine the period and offense code of each warrant.)

  • The Martinez RZs are located in Starz and Stripes the Next Generation (SSTNG), the Chicago website (ChiNet), and Workload Listings RZ/LI (MI Central).

All of these cases will have a warrant record with an offense code in the FFSCF for other than 4901, 4902, 4999 (felony offense codes) or 5011, 5012, 8101, 8102 (probation or parole violation codes).

For detailed information on the Martinez settlement relief, see GN 02613.860.

A. Title XVI (T16) post-2006 Martinez settlement relief processing - reinstatements

T16 class members may be entitled for reinstatement, reopening and adjudication of a previously denied claim or appeal, or both. This section provides reinstatement processing instructions only for T16 post-2006 class members. Systems selected these cases using a wide range of criteria. For instructions on how to complete actions on all selected cases, see GN 02613.875A.3. through GN 02613.875A.7. in this section.

If an individual is in N25 January 1, 2007 or later, we will reinstate Supplemental Security Income (SSI) payments back to the first fugitive felon suspension month that is in a period of N25. Use the following information as guidance when processing these cases:

  • In instances where the suspension or denial period includes consecutive months prior to and after January 1, 2007, reinstate payments back to the beginning of the suspension period, after considering all other income/resource/living arrangement factors and subsequent unfavorable medical decisions. See example 2 in this section.

  • If an individual filed a new initial claim after his or her record terminated due to N25 suspension, and the claim is still pending in the Field Office (FO) or at the Disability Determination Service (DDS), see instructions in GN 02613.875A.1., in this section.

  • If an individual filed a new initial claim after his or her record terminated due to N25 suspension, and DDS denied the new initial claim for a medical reason, refer the case to DDS for a decision to vacate the subsequent medical determination following instructions in DI 52520.005C.1.b.

  • For cases where we provided a closed period of Martinez relief prior to the subsequent medical denial, complete an unscheduled RZ beginning with the first month after the closed period to the present. Refer the claim to DDS to vacate the subsequent medical denial determination following instructions beginning with DI 52520.005C.1.b, 2nd bullet.

  • If an individual filed a new initial claim after his or her record terminated due to N25 suspension and the FO denied the claim for a non-Martinez technical issue, pay only those months from the beginning of the N25 period through the month prior to the application month of the denied initial claim.

  • In instances where the suspension or denial action occurred on or after January 1, 2007, but the suspension or denial was for a closed period with all months occurring prior to January 1, 2007, reinstatement can also occur.

  • You need to review all prior Supplemental Security Records (SSRs) in order to determine the earliest eligible suspension month.

  • Do not apply the rules of Administrative Finality to prevent delivery of Martinez relief.

  • If you have a case where the recipient is currently incarcerated (PSY N22), do not work the case. Annotate the SSR with the following statement “Apply Martinez relief when released from incarceration”. Forward the individual’s name and SSN to the court case Outlook email address at ^Martinez Settlement. Annotate the SUBJ line: “PRISONER”. Input CG code “NMRG” to the SSR via the MSSICS CMSC screen or 1719 input. This CG code identifies cases that, in accordance with GN 02613.875, are not eligible for relief (or that we cannot presently process for relief). NOTE: If the recipient is no longer incarcerated, provide Martinez relief, even if you have forwarded the case to the mailbox.

Example:

A recipient has a warrant and could be eligible for Martinez relief based upon a suspension period that includes January 2007. The warrant period began in 10/06 and ended in 02/07. In this case, we will reinstate benefits back to 10/06.

Month and Year

Eligible Warrant

8/06

 

9/06

 

10/06

X

11/06

X

12/06

X

1/07

X

2/07

X

3/07

 

4/07

 

For instances where a suspension has occurred and there is an overpayment on the record, the reinstatement of the recipient back to the first suspension date will effectively remove any outstanding fugitive felon overpayment balance. You may have to balance the overpayment sequences. For additional information on balancing overpayment sequences, see SM 01311.390, How to Balance Sequences to Prevent Excess Decisions.

In situations where the person had received an overpayment notice and had repaid benefits, and the record is in current payment status, the system will automatically release any collected overpayment amounts.

Because many of the suspensions or overpayments are on terminated records, the system will not be able to automatically compute the amount that is due. In these situations, you will have to manually compute and issue a one-time payment to release any previously-collected overpayments or payments due for a period of reinstatement.

For situations where a prior overpayment existed and the uncollected overpayment was waived, you must take appropriate action so that the same funds are not paid again (person would receive money twice for the same period of time.)

For all instances where Martinez relief is due, release the funds in the following priority order:

  1. Apply the amounts to any outstanding Interim Assistance Reimbursement (IAR) agreements.

  2. Apply the amounts to any attorney fees that may be due.

  3. Apply remaining funds to any outstanding overpayments caused by a suspension other than for fugitive felon status.

  4. Release any remaining underpayment, subject to installment processing and any other applicable underpayment priority.

For underpayment priority, see SI 02101.001B.4.

1. General information--redetermination (RZ) processing and other actions

Use the following procedure to complete a RZ review for all cases prior to reinstatement of payments. Send all class members, including those needing to file a new application, the redetermination notice that contains plaintiff-approved Martinez notification information and close-out timeframes. A face to face RZ is not required—consider telephone appointments as much as possible. Depending upon the current payment status code, actions in addition to or other than an RZ may be required as explained in GN 02613.875A.3 through GN 02613.875A.7 in this section.

If an individual filed a new initial claim after his or her record terminated due to N25 suspension, and the claim is still pending in the Field Office (FO) or at the Disability Determination Service (DDS), use the following as guidance:

  • If it is to the claimant’s advantage (for example: after completing the redetermination you realize the claimant would be entitled through the period of the new application) and the recipient elects to withdraw the new application, follow instructions in SI 00601.050.

  • Once the claimant withdraws the pending SSI application and the claim is still at DDS, recall the pending disability case following instructions in DI 23015.010.

  • Post the withdrawal to the current record (PSY N12), terminate the record, and complete an RZ back to the earliest N25 suspension period. Start date the record the following day with the appropriate start date month.

  • If the recipient does not wish to withdraw the new application, treat the Martinez relief period as a closed period. Manually compute the payment due and follow the instructions in GN 02613.875A to determine the priority order for release of the underpayment.

  • If you initiate a Martinez RZ and the recipient does not cooperate with your requests for evidence, follow procedures in SI 02301.235 for records in pay statuses other than T50, T51, H70, and T01. For records in pay status H70, do not place in N20. Input “NMRG” in the CG field, which alerts systems to remove the pending RZ.

  • For cases that require a DDS determination for a reopened technically denied claim, a previous medical allowance with a subsequent medical denial, or an age 18 disability redetermination, follow instructions in DI 52520.005.

a. Initial Steps

  • Obtain an SSR for every record to determine the period of N25 suspension for each warrant.

  • Access the Civil Action Tracking System (CATS) to determine whether a recipient is listed as an F4 or F6 class member. (For information on CATS, refer to GN 02613.860D.)

    NOTE: Do not make any entry into CATS even though the date entry in the notice date field of the F4 or F6 CCID entries will show a “00/00/0000”.

  • Use the following chart to analyze the offense codes for each warrant on the FFSCF Database (See MSOM PRISON 001.002):

Offense Code

Offense Charge Symbol

ACTION

4901, 4902, 4999

FELONY

Martinez relief does not apply

  • Title XVI cases — No RZ is necessary. Input CG code “NMRG” to the SSR via the MSSICS CMSC screen or 1719 input.

  • Concurrent cases - process following GN 02613.001 GN 02613.780.

Blank OR 9999 OR 5011, 5012, 8101, 8102

PROBATION OR PAROLE

Martinez relief does not apply

  • Title XVI cases – No RZ is necessary. Input CG code “NMRG” to the SSR via the MSSICS CMSC screen or 1719 input

  • Concurrent cases – process following GN 02613.001 GN 02613.780

Any other offense code (See GN 02613.900) OR Blank OR 9999

FELONY

Martinez relief applies

For title XVI cases, process:

For concurrent cases, process:

b. Reviewing Warrant Periods

If there are overlapping periods for warrants, and one of the warrants is for a code 4901, 4902, 4999, 5011, 5012, 8101, or 8102 that warrant takes precedence and Martinez relief is not provided for any of those N25 suspension months. See Example 3 at the end of this chart.

Determine the period of post-2006 relief in multiple warrant cases by following the chart below:

IF EARLIEST OF ALL QUALIFYING WARRANT PERIODS

AND N25 MONTHS ARE

THEN COMPLETE AN RZ

Begins January 1, 2007 or any later month

01/2007 or later

Starting with the earliest N25 month

Begins PRIOR to January 1, 2007 and continues through January 2007 or later

Continuous from a date prior to 01/2007 through 01/2007 or later

Beginning with the first month of N25. See example 2 in GN 02613.875 A in this section

Begins and ends prior to January 1, 2007 and a separate warrant period begins after December 31, 2006, (there is no continuous or overlapping warrant from pre 2007 to post 2006)

Not continuous from a date prior to 01/2007 through 01/2007 or later

For the N25 months on or after 01/01/07. See example 3 in GN 02613.875A in this section.

Begins and ends prior to 2007

AND

No appeal filed

12/2006 or before

No Martinez RZ is necessary – recipient does not qualify for post-2006 relief

Martinez warrants for periods before January 1, 2007 are included in the pre-2007 relief group. See warrant 2, example 3 in GN 002613.875A in this section.

Begins and ends prior to 2007

AND

Appeal filed with RSN of “blank”,“OTH”, “OP”, or “WA”.

AND

Development shows N25 suspension was appealed

AND

DISP date is 01/01/2007 or later

Any

Starting with the earliest N25 month

Example 3:

In the chart below, the recipient has 3 warrants listed in FFSCF. Warrant 1 has a felony offense code of 4901 for the period 11/06 through 2/07. Warrant 2 has an offense code 1299 and covers the period 10/06 through 12/06. Warrant 3 has an offense code 2299 and covers the period 02/07 through 04/07.

The recipient is not eligible for Martinez relief 11/06 through 02/07 because warrant 1 is for a flight or escape offense.

The recipient is not eligible for Martinez relief 10/06 through 12/06 because that period is not part of the post 2006 Martinez relief.

The recipient is eligible for Martinez relief 3/07 forward, and an RZ should be conducted for all N25 months.

Month and Year - PSY

Warrant 1
Offense Code

Warrant 2
Offense Code

Warrant 3
Offense Code

10/06 – N25

 

1299

 

11/06 – N25

4901

1299

 

12/06 – N25

4901

1299

 

1/07 – N25

4901

  

2/07 – N25

4901

 

2299

3/07 – N25

  

2299

4/07 – N25

  

2299

c. Coding Fugitive Felon System Control File (FFSCF)

To ensure that we do not erroneously select Martinez warrants in the future, you MUST enter the Martinez court decision on the warrant(s) in the Fugitive Felon System Control File (FFSCF), the Fugitive Felon Automated Process (FFAP), and MSSICS. It is important to update the FFSCF because it is the control file used for the settlement agreement.

To enter the Martinez court decision in FFSCF, proceed as follows:

  • Access FFSCF from the SSA main menu, by following instructions in MSOM PRISON 001.002.

  • On the FFDG (Fugitive Felon Warrant Due Process/Good Cause) screen within the FFSCF enter “CRT as the Good Cause reason and use the decision date of 09/24/2009 (Martinez settlement agreement date.) In the remarks section, enter “Martinez Settlement.”

  • For FFDG inputs, see MSOM PRISON 006.007.

To enter the Martinez court decision in FFAP, proceed as follows:

  • On the Good Cause Screen in FFAP, document that Martinez relief was granted to the case by entering the “CRT” code.

To enter the Martinez court decision in MSSICS, proceed as follows:

  • On the Felony Warrant (AWRF) screen, enter “N” for “Warrant Selected/Issued in Error”. Information on the AWRF screen can be found in MSOM – MSSICS 008.023.

  • In the “Good Cause” field, enter “1” to show good cause was established.

d. Exceptions

After querying the class member and entering the Martinez court decision in FFSCF, MSSICS, and FFAP, follow RZ processing procedures found in SI 02305.000, Redeterminations of Eligibility and Payment Amount, with the following processing exceptions:

  • For Martinez cases, we are providing the recipient 60 days to contact us from the issuance date of the appointment notice. Send one follow up notice after 15 days if the recipient does not respond. The follow up notice does not contain Martinez language. If the recipient does not respond at the end of the 60 days, actions on what to do next are included in the procedures for each payment status code as listed in GN 02613.875A.3, GN 02613.875A.4 and GN 02613.875A.5., in these sections.

  • Even though the record may show a completed RZ for the period in which Martinez relief might apply, complete an RZ for all N25 months when you determine eligibility for Martinez relief.

  • Administrative Finality rules do not apply to Martinez RZ relief processing.

  • If a record terminated for reasons other than fugitive felon (N25), do not consider Martinez relief for any payment status period other than N25. Complete the RZ for the N25 period only and pay any retroactive payments according to normal A-OTP procedures. There may be cases where a termination processed with less than 12 months of N25 (e.g. N01 for 4 months, N25 for 8 months). In these situations, fully develop eligibility for each month from the earliest point of Martinez relief forward. If development reveals 12 consecutive months of ineligibility for reasons other than N25 –conduct an RZ only for the applicable closed period. If the claimant alleges a current disability, take a new claim under normal procedures. To determine the correct application date follow SI 00601.020.

2. Preparing the Martinez redetermination (RZ) appointment notice

  1. Prepare an appointment letter using Starz & Stripes the Next Generation (SSTNG) and:

    • On the “Letter Options” screen, select “RZ/LI Interview/Forms” and then select “First Request”, and

    • On the “Initial Fill-Ins” screen, “Status” will automatically identify the case as a “Martinez Court Case”.

  2. SSTNG will automatically include the Martinez settlement language in the appointment letter. The language provides the recipient with the details of the settlement and the kind of relief that we may provide. It also provides the 60 day closeout language.

  3. If additional assistance is needed using the SSTNG system, review the “Help” feature for guidance.

3. Redeterminations (RZ) for records in a hold payment status code of H70

Previously terminated (T31 andT33) records already have been start dated and placed into payment status (PSY) H70 to identify the case as eligible for Martinez relief. Review the H70 record for the correct start date month and budget month. If you determine that the start date or budget month is incorrect on the H70 record terminate the record through direct SSR update. See SM 01801.110 and SM 01801.001. The following day establish the new Start Date record with a 450S input using the appropriate start date and budget month information to ensure that appropriate Martinez relief is provided. Take the following action to process these cases:

  1. If the class member responds to the Martinez appointment notice, conduct the RZ and proceed as follows. After you complete the Martinez RZ, you must take a manual action to pay these cases and post any additional data necessary to effectuate correct payment by using either an SSA-450-SI (SSI Data Input and Determination) or an SSA-1719-B (SSI Posteligibility Input). See SM sections listed below for specific instructions on when to use each form.

    • Complete an SSA-450-SI (SSI Data Input and Determination) PR9 for initial claims to correct, add or delete data fields on the SSR without transmission of an entire SSA-450-SI (SSI Data Input and Determination). Additional information on the SSA-450-SI (SSI Data Input and Determination) can be found in SM 01000.000, SM 01005.000, and SM 01010.000; or

    • Complete an SSA-1719-B (SSI Posteligibility Input) to update post-eligibility data on the SSR. Additional information on the SSA-1719-B is found in SM 01301.000 and SM 01305.000.

    • Transmit an SSA-450-SI (SSI Data Input and Determination) PR9 or SSA-1719-B (SSI Posteligibility Input) input by selecting #15 (SSI Data Inputs) from the Main Menu. Select the type of input from the Title XVI Menu (SXVI). For additional information on the SXVI screen, see MSOM T16INPUTS 001.002.

  2. Make sure that your SSA-1719-B (SSI Posteligibility Input) or SSA-450-SI (SSI Data Input and Determination) input removes the payment status code of H70 and reflects the correct payment status that should have applied to the record before termination for fugitive felon reasons.

  3. If there is an overpayment on a terminated record, see instructions in GN 02613.875B in this section.

  4. If the appointment notice is returned by the post office, follow the normal procedure to locate the person SI 02301.240C. (DO NOT place any of these Martinez cases in PSY S06.)

  5. If the recipient does not respond within 60 days, leave the record in H70 payment status. After attempts to locate the recipient under normal rules, document all attempts to locate the recipient by inserting the following message in the remarks section in SSTNG and on the SSR, – “Martinez Settlement Non-Responder”. If there is a B9 overpayment diary pending, which was created with the establishment of the start date H70 record for Martinez, overlay the D-TAC with the applicable TAC code (G TAC for SSI-only records, K-TAC for concurrent records for which cross-program recovery is applicable, etc.) to remove the diary. No additional actions are necessary.

    NOTE: Systems has already included the following remark on the SSR that identifies these cases: “Start Dated for Martinez Post 06 Group.” Do not overlay this existing remark with a new remark.

  6. If a recipient responds after the 60 day period, consider good cause for not responding based on new or material evidence provided by the recipient per GN 04010.030, Reopenings – New and Material Evidence.

    If you find good cause:

    • Conduct the RZ review and follow the instructions In GN 02613.875A.3 in this section.

    If you do not find good cause:

    • Add the following remark to the SSR, —“Good Cause For Not Responding Requested xx/xx/xxxx but not found.”

    • Treat the request for good cause as a request for a new application per SI 00601.020A.2.

    • Send the recipient an SSA-8165-U2 (SSI Notice of Decision) explaining why we do not find good cause, but that we can consider the request for good cause as protective filing for a new application. In accordance with normal rules, the good cause notice will contain appeal rights since this is an initial determination.

    • Also include an SSA-L991 (SSI Informal Denial Notice) located in the Document Processing System (DPS) to close out the protective writing.

4. Redeterminations (RZ) for records in payment status code of T01

Certain parties may potentially be entitled to Martinez relief underpayments due on the accounts of deceased class members (payment status T01). Follow normal processing instructions in SI 02101.003.

NOTE: If there is no potential party eligible for the underpayment, take no action on the RZ. Add the following Special Message to the SSR: “Not eligible for post-2006 Martinez Relief” as no RZ is necessary. Input CG code “NMRG” to the SSR via the MSSICS CMSC screen or 1719 input. This CG code identifies cases that, in accordance with GN 02613.875, are not eligible for relief (or that we cannot presently process for relief).

5. Redeterminations (RZ) for records in payment status code other than H70, T01, T50, or T51 (T50 and T51 instructions are in GN02613.875A.6.)

These records can be in pay status C01, or in any number of other non-pay status codes. For guidance on identifying the Martinez period, refer to GN 02613.875A.1.a in this section. Take the following steps to complete the RZ:

  1. Start the review period with the earliest period of N25 pay status through the present. For processing reinstatements, see GN 02613.875A in this section.

  2. If there is an overpayment on a prior record, follow instructions in GN 02613.875B in this section.

  3. If there is a pending Martinez-related reconsideration on the record based on a fugitive felon issue, take the following action to update the SSR record:

    • For MSSICS cases, from the MSSI menu, select “2” (Update) and “9” (Appeals).

      On the ADIS screen, input the Decision Type as the “Other Disposition Type” and select 3” (Closed for Other Reason).

    • For non-MSSICS cases, from the MSSI menu, select “2” (Update) and “19” (Direct SSR Update).

      On the UAPD screen, input the Decision Type as “Other Disposition Type” and select “8” (Closed for Other Reason).

    • Input the following message on the SSR - “Martinez Settlement Relief Processing”.

  4. If there is a pending hearing request on the SSR based on fugitive felon issue, see GN 02613.875E in this section.

  5. Non-Responders to RZ appointment letters for records in pay status other than T50, T51, H70, and T01.

    • If, after sending the 15-day follow-up notice, a recipient still does not respond within 60 days of the issuance date of the appointment notice, place the record into pay status N20, Failure to Cooperate, if it is in a pay status code that can be overlaid with N20. For pay status overlay chart, see SM 01305.001H. If the pay status cannot be overlaid with N20 (e.g., N07), annotate the SSR with the remark, “Martinez Settlement Non-Responder”. For those cases which cannot be overlaid with pay status N20, input CG code “NMRG” to the SSR via the MSSICS CMSC screen or 1719 input. This CG code identifies cases that, in accordance with GN 02613.875, are not eligible for relief (or that we cannot presently process for relief).

    • If, after placing the record into pay status N20, the recipient contacts SSA, develop the reason for not responding to our initial appointment and follow-up letters, i.e., out of the country, new address, etc. If the recipient responds he or she does not wish to pursue Martinez relief, complete the RZ following normal procedures up through the current period and annotate the SSR with the following message: “Recipient does not wish to pursue Martinez relief.” Additional information on the RZ review period is found in SI 02305.034.

    • If the recipient does not respond or the appointment notice is returned by the post office follow the normal procedure to locate the person SI 02301.240C. Document the attempts in MSSICS by annotating the SSR with “Martinez Settlement Non-Responder.” In non-MSSICS cases, annotate the SSR with the same remark. For those cases which cannot be overlaid with pay status S06, input CG code “NMRG” to the SSR via the MSSICS CMSC screen or 1719 input. This CG code identifies cases that, in accordance with GN 02613.875, are not eligible for relief (or that we cannot presently process for relief).

  6. If a recipient responds after the 60-day period, consider good cause for not responding based on new or material evidence provided by the recipient per GN 04010.030, Reopenings – New and Material Evidence.

    If you find good cause:

    • Conduct the RZ review and follow the instructions In GN 02613.875A.5 in this section.

    If you do not find good cause:

    • Add the following remark to the SSR—“Good Cause For Not Responding Requested xx/xx/xxxx but not found.”

    • If the record is terminated, treat the request for good cause as a request for a new application per SI 00601.020A.2.

    • Send the recipient an SSA-8165-U2 (SSI Notice of Decision) explaining why you do not find good cause. If the record is terminated, also include that we can consider the request for good cause as protective filing for a new application. In accordance with normal rules, the good cause notice will contain appeal rights since this is an initial determination. If you are providing protective filing for a new claim on the SSA-8165-U2, include an SSA-L991 (SSI Informal Denial Notice) to close out the protective writing.

6. Processing title XVI (T16) post-2006 Martinez class members’ records in payment status code of T50 or T51

Because of the systems characteristics of these cases, they are not on SSTNG. For control purposes, they have been loaded onto the Chicago Region website. To access the control list, either go to the CHINET Home Page, and click on “Martinez SSTNG Exception” or enter http://chcf.ch.ad.ssa.gov/MartinezCaseControl/mainMartinez.cfm . A user guide for the website can be found on the Martinez SSTNG Exception Homepage. We have agreed to issue an RZ Martinez appointment notice as the official notification of the Martinez relief per the settlement agreement. Since a record with a current Payment Status (PSY) code of T50 or T51 will likely require an initial application and medical determination, take the following action:

  1. Review the prior record(s) to determine if there is any period(s) of fugitive felon (N25) suspension.

  2. If there is a prior record in T31 or T33, verify if the suspension on that record was due to fugitive felon (N25). If a T31 or T33 based upon fugitive felon does exist, and it is within the Martinez period of relief with a fugitive felon suspension or denial after 2006 unless GN 02613.875E NOTE applies, complete an RZ and follow the procedures as listed in GN 02613.875A.3. in this section.

  3. If there is a prior record in T31 or T33 and the prior termination was not due to fugitive felon (N25), proceed to e.

  4. If there is no prior record having a T31 or T33 status, proceed to e.

  5. Verify that the warrant offense code is other than 4901, 4902, 4999, 5011, 5012, 8101, or 8102.

  6. Go to Document Processing System (DPS) and select the Martinez RZ appointment, located in the Post Entitlement folder and titled “Martinez T16 Redetermination Letter.” Provide the recipient 60 days from the issuance date of the appointment notice to contact us. Send the person an Adult Disability Starter Kit along with the Martinez RZ letter.

  7. If a response is received within the 60 day period, follow procedures for filing an initial claim based on the following information:

    • The protective filing date for the claim is the protective filing date of the previous claim that was denied due to a fugitive felon warrant. On the CMSC screen in MSSICS, select option 1 for the reason the protective filing date is over 90 days old. If this is a MSSICS exclusion, when you complete the AP field on the SSA-450SI, make sure to use code A after the application date.

    • If there is an overpayment on a prior record which was not related to fugitive felon, follow instructions in GN 02613.875B in this section.

    • When processing new applications, place “ZZZ” in the first three positions of the “unit” field for identifying Martinez cases and to exclude from processing time statistics. Send the case to DDS for a medical determination per instructions in DI 52520.005C.1.a.

  8. If the recipient does not respond, issue a manual SSA-L991, located in the Document Processing System (DPS). If the appointment notice is returned by the post office, follow the normal procedure to locate the person SI 02301.240C. (DO NOT place any of these Martinez cases in PSY S06.) After 60 days have lapsed since the Martinez RZ appointment letter was mailed and you have not located the person, stop development. Since these cases are T50 or T51, we cannot add a remark to the SSR documenting a Martinez non-responder case. To verify that we released the Martinez RZ appointment notice and the SSA-L991, access the Online Retrieval System (ORS).

  9. If a recipient responds after the 60 day period, consider good cause for not responding based on new or material evidence provided by the recipient per GN 04010.030 Reopenings – New and Material Evidence.

    If you find good cause:

    • Conduct the interview review and follow the instructions In GN 02613.875A.6. in this section.

    If you do not find good cause:

    • Treat the request for good cause as a request for a new application per SI 00601.020A.2.

    • Send the recipient an SSA-8165-U2 (SSI Notice of Decision) located in the Document Processing System (DPS) explaining why you do not find good cause, but that we can consider the request for good cause as protective filing for a new application. In accordance with normal rules, the good cause notice will contain appeal rights since this is an initial determination. Also, include an SSA-L991 (SSI Informal Denial Notice) located in DPS to close out the protective writing.

NOTE: If the T50 or T51 record terminated due to N25 pay status and the record shows a posted medical allowance, do not take a new initial claim and do not request a new medical determination. Reopen the application and complete an RZ back to the earliest N25 period covered by the post-2006 relief. For Type C cases on the Martinez SSTNG Exception Cases Website that the prematurely cleared Martinez RZ addressed all Martinez issues, choose the “mark complete” option for the case.

7. Redeterminations (RZ) in concurrent cases

If a concurrent case exists, the Title II (T2) Martinez post-2006 retroactive relief payments should have been released by automatic reinstatements that occurred in December 2009. Review the master beneficiary record (MBR) to verify that the record is in current pay status (LAF C). Take the following action based on your review of the MBR:

  1. If the MBR shows current pay status, complete the RZ back to the first month of N25 suspension eligible for Martinez relief. Post the T2 retroactive income as UM type A for each month of the retroactive period. No interface will occur for this action.

  2. If the MBR is not in pay, contains a special message indicating post-2006 Martinez relief, and a PCACS shows there is an exception to the automated T2 processing which requires manual reinstatement by the processing service center (PSC), still complete the RZ back to the first month of N25 suspension. Before you clear the RZ:

    • Place a U TAC on the SSR to hold the T16 underpayment.

    • Control the T16 case until the PC clears the T2 case.

    Once the MBR is in current pay:

    • Post the T2 retroactive income in the UM field as type A income for each month of the retroactive period. (This will readjust the T16 underpayment.)

    • Release the T16 underpayment by removing the U TAC. (Prior to releasing any T16 underpayment, pay any outstanding Interim Assistance Reimbursement (IAR) agreements and attorney fees that may be due, or offset any non-fugitive felon overpayment which may also exist. The remaining underpayment is subject to installment processing and any other applicable underpayment priority.)

  3. If the MBR is not in pay, contains a special message indicating post-2006 Martinez relief, and there is no PCACS, send an MDW to alert the servicing PSC of Martinez post-2006 relief. Instructions on how to proceed are in GN 02613.875A.7.b in this section.

B. Overpayment processing on terminated records

Review the current and prior records to determine if Martinez related post-2006 overpayment months exist. If such overpayment months exist, take the following action:

  • Compute the fugitive felon overpayment and remove that amount using an N TAC. Annotate the SSR with remark “Overpayment Removed – Martinez Relief.”

  • If necessary, hold the underpayment using a U TAC and apply the collected amounts from the fugitive felon overpayment to any outstanding Interim Assistance Reimbursement (IAR) agreements and attorney fees that may be due. Apply any remaining funds to overpayments caused by a suspension other than that of fugitive felon.

  • Release any remaining underpayment, subject to installment processing, and applicable underpayment priority.

C. Missed continuing disability reviews (CDRs) during suspension

The Martinez settlement does not impact our statutory requirement to schedule CDRs at selected intervals. The instructions for the CDR review process are in DI 28001.000. After we resume monthly benefits, the system will automatically add the recipient to the pool of cases selected for CDRs during the regular CDR review operation.

D. Processing of title XVI (T16) post-2006 Martinez class members who had or have a representative payee

1. Policy

Before reinstating benefits to a representative payee following a suspension period of 3 or more months, determine the recipient’s current custody or guardianship status and the representative payee’s continued suitability to serve as representative payee. The instructions for developing for a suitable representative payee are in GN 00504.160.

2. Procedure for developing representative payee suitability

Use the following chart for guidance on determining payee suitability:

Step

Action

1.

Review the SSR to verify that the recipient has or had a representative payee (RP). If so, go to step 2.

2.

Query the Representative Payee System (RPS) to determine the status of the record. See MSOM RPS 001.001.

3.

If there is a current pending RP application, determine whether or not the current payee applicant is suitable and process it to completion. For procedures on selecting a suitable RP, see GN 00502.100 GN 00502.183. For advance notice requirements, see GN 00503.100 GN 00503.430.

4.

Once we select a suitable RP and the SSR is updated with the new RP information, release the underpayment (U/P) to the new RP, following guidelines stated in GN 02613.875A.1.d in this section.

5.

If there is no current pending RP application in the RPS system:

Review all information for indicators that the payee of record is no longer suitable to serve.

Contact the recipient to verify the recipient and representative payee relationship.

Consider whether or not the recipient continues to need a payee—see instructions in GN 00502.020A

If the need for a representative payee continues and you determine that the current representative payee is suitable, document your findings in the RLST screen of the RPS. See MSOM RPS 002.022. Take necessary action to reinstate the Title XVI (T16) payments.

If the need for a representative payee continues and you determine that the current representative payee is not suitable or there is no longer a relationship with the recipient, develop for a new representative payee per GN 00502.100. If the current representative payee does not know the whereabouts of the recipient, follow instructions in GN 00504.150D.1. Record on the RPRC screen (MSOM RPS 003.006) the results of the investigation and the recommendation. Once we select the new RP within the RPS system update the SSR and release the underpayment.

6.

If a representative payee applicant or an existing representative payee has an outstanding felony arrest warrant use it as a factor to determine an applicant’s suitability (or continued suitability) to serve as a representative payee, per GN 00502.132, GN 00502.133, and GN 00504.102.

7.

If you are unable to find a suitable representative payee and direct payment is not permissible, continue efforts to locate a suitable representative payee. If you must place the record in suspension for payee development, see GN 00504.110. Document your efforts in the Remarks field of the SSR and MSSICS, if possible.

8.

If you determine that a representative payee is no longer necessary, secure an SSA-11 from the recipient. Once this is processed through RPS, update the SSR and release the underpayment, following guidelines stated in GN 02613.875A.1.d in this section.

E. Title XVI (T16) post-2006 Martinez class members who have a hearing for a fugitive felon issue

If a recipient has a hearing pending or has a hearing decision posted on or after January 1, 2007, and the appeal is for a non-medical fugitive felon issue (appealing the fugitive felon issue, appealing the fact of an overpayment due to fugitive felon status, or appealing a waiver denial decision on a fugitive-felon related overpayment), hold the case until any remand decision is received from the Office of Disability Adjudication and Review (ODAR) or the Appeals Council Review (AC). When the decision is received in the FO, complete the Martinez Redetermination (RZ) or develop for a new claim as listed in GN 02613.875A in this section.

1. Cases for review of pending medical appeals

Cases needing a medical decision will remain in the appeal process and ODAR will make a determination on the medical issue.

Use the following chart when reviewing F4 and F6 cases:

Issue

Medical Appeal

FO Actions

Medical appeal with fugitive felon information

(There may or may not be an N25 on the SSR. Fugitive Felon info will be in Remarks on SSR.)

Case stays at ODAR or AC for a medical decision

  • Check the APPE field on the SSR for a pending appeal

  • Check to see if medical issue present (RSN = DI)

  • Review the N25 claim for a medical determination. If a medical determination exists, notify ODAR of any earlier protective filing date. If no medical determination exists, see the “NOTE” in this section.

  • Add a remark under fugitive felon information on the SSR stating: “If favorable medical allowance, develop for possible Martinez relief per GN 02613.875.”

  • If RSN is other than DI, refer to GN 02613.875E.2. in this section.

NOTE: If a hearing is pending on a medical issue and a fugitive felon (N25) claim never had a medical determination, reopen the N25 claim and route to DDS following instructions in DI 52520.005. Notify ODAR that the FO sent the case to DDS for a disability determination on the Martinez relief period. After you receive the disability determination from DDS for the Martinez relief period, route the claim to ODAR to associate with the pending hearing.

2. Cases for review with non-medical fugitive felon issue.

If a case has an unfavorable decision on the record and there has been no request for an AC or court review, we will provide Martinez relief when we identify these cases from the RZ selection. There is no need to vacate the ODAR or AC decision.

a. Reviewing F4 and F6 non-medical cases pending at the OCALJ

If a case is pending in ODAR, it may remand the Martinez case issue to the field office (FO). Once the case is remanded to the FO and Martinez relief has been applied, action will be required to close out the hearing appeal on the SSR record.

Use the chart when reviewing F4 and F6 non-medical cases pending in ODAR:

Issue

ODAR Actions

FO Actions

Non-medical fugitive felon issue

fugitive felon status, or

fact of an overpayment due to fugitive felon status, or

waiver denial decision on a fugitive-felon related overpayment

Remand the appeal back to the FO

Flag the case “Martinez Settlement Case”

Check the APPE field on the SSR for a pending non-medical appeal

Check to see if a non-medical issue is present (RSN = OT, OP, WA, or blank).

If present, check CPMS to verify the appeal is for a fugitive felon issue.

If CPMS indicates the appeal is not for a fugitive felon issue, the case will stay at ODAR for a decision.

If a fugitive felon appeal issue exists, take the following action to close out the appeal on the SSR record:

MSSICS cases:

On the MSSI menu, select “2” (Update) and “9” (Appeals).

On the ADIS screen, input the Decision Type as the “Other Disposition Type” and select “3” (Closed for Other Reason).

Non-MSSICS cases:

On the MSSI menu, select “2” (Update) and “19” (Direct SSR Update).

On the UAPD screen, input the Decision Type as “Other Disposition Type” and select “8” (Closed for Other Reason.)

Input the following message on the SSR - “Martinez Settlement Relief Processing”.

Process Martinez relief, as appropriate, per GN 02613.875A.3. or GN 02613.875A.6. in this section.

b. Reviewing F4 and F6 non-medical cases pending at the AC:

If a case is pending at the AC level, the AC may take action to vacate the hearings decision and remand the case to the field office.

Use the chart when reviewing F4 and F6 non-medical cases pending at the AC:

Issue

AC Actions

FO Actions

Non-medical fugitive felon issue

fugitive felon status, or

fact of an overpayment due to fugitive felon status, or

waiver denial decision on a fugitive-felon related overpayment

Issue an order vacating the unfavorable decision by the Administrative Law Judge (ALJ).

Return the case to the local FO via form HA-505 “Transmittal by Office of Disability Adjudication and Review” identified as “Martinez Settlement Case”. A red “Special” label will be added to form HA-505 prior to remanding the case to the FO.

Check the APPE field on the SSR for a pending non-medical appeal

Check to see if a non-medical issue is present (RSN = OT, OP, WA, or blank).

If present, check CPMS to verify the appeal is for a fugitive felon issue.

If CPMS indicates the appeal is not for a fugitive felon issue, the case will stay at the AC for a decision.

If a fugitive felon appeal issue exists, take the following action to close out the appeal on the SSR record:

MSSICS cases:

On the MSSI menu, select “2” (Update) and “9” (Appeals).

On the ADIS screen, input the Decision Type as the “Other Disposition Type” and select “3” (Closed for Other Reason).

Non-MSSICS cases:

On the MSSI menu, select “2” (Update) and “19” (Direct SSR Update).

On the UAPD screen, input the Decision Type as “Other Disposition Type” and select “8” (Closed for Other Reason.)

Input the following message on the SSR - “Martinez Settlement Relief Processing”.

Process Martinez relief, as appropriate, per GN 02613.875A.3. or GN 02613.875A.6. in this section.

NOTE: For N25 periods before January 1, 2007, the Post-2006 Martinez Relief phase affects individuals with an administrative appeal pending as of August 11, 2008. However, an individual who has received a final Federal court disposition regarding payment or nonpayment of benefits due to a fugitive felon status is not a class member with respect to nonpayment months. If you learn of a Federal court decision on a class member case, refer the case to your Regional Fugitive Felon Coordinator (RFFC) who will contact the Office of General Counsel for advice on whether it precludes giving Martinez relief.

F. Processing Title XVI (T16) post-2006 Martinez cases that show current prisoner, fugitive felon, or probation or parole violation status

Late in 2009, the Social Security Act was amended to prohibit paying retroactive payments to recipients while they are in prison, a fugitive felon, or violating a condition of their probation or parole. Prior to releasing any past due payments, review the Prisoner Update Processing System Data (PUPS) or the Fugitive Felon System Control File (FFSCF) to determine the recipient’s status. Refer to EM-10013 SEN, No Social Security Benefits for Prisoners, for instructions.

NOTE: If the individual’s current incarceration precludes completing the RZ, input CG code “NMRG” to the SSR via the MSSICS CMSC screen or 1719 input. This CG code identifies cases that, in accordance with GN 02613.875, are not eligible for relief (or that we cannot presently process for relief). If the record is in payment status H70 with B9 overpayment diary pending, follow instructions in GN 02613.875A.3.e. to post the overpayment disposition.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202613875
GN 02613.875 - Title XVI Post-2006 Martinez Settlement Relief Processing - 10/05/2012
Batch run: 10/05/2012
Rev:10/05/2012