TN 21 (01-12)

GN 03103.250 Payment Center (PC) Effectuation of Administrative Law Judge (ALJ) Decisions

A. How to effectuate the ALJ decision

1. Effectuate ALJ decisions immediately upon receipt of the folder

If an ALJ decision is unfavorable to another party (adverse action), effectuate the decision immediately against the adversely affected individual provided the individual was a party to the hearing and we notify the individual of the results of the hearing. (For information about adversely affected claimants, see GN 03103.150.) If the individual is not a party to the hearing, refer the case per instructions on how to protest ALJ decisions in GN 03103.260.

2. ALJ oral (bench) decisions

ALJ oral (bench) decisions are abbreviated fully favorable decisions entered into the record of the hearing proceedings and provide an alternative procedure for the ALJ to use instead of the usual multi-page, formal ALJ decision. The ALJ may use the oral (bench) decision for initial adult disability cases; when the he or she decides that the case will be fully favorable. For guidance in processing wholly favorable ALJ oral (bench) decisions, see DI 12010.041.

B. Development of nonmedical issues

1. When necessary to develop nonmedical issues

If the ALJ decision does not include information on a successful claimant's continuing eligibility to benefits up to the date of the hearing, the reviewing office will ask the servicing FO to check with the claimant and undertake any necessary development on deduction, suspension, and termination events. You may develop by phone per GN 01070.200.

NOTE: Verify claimant direct deposit, address, and phone information prior to effectuating appeal decisions.

2. Who develops nonmedical issues

Reconsideration reviewers are responsible for developing nonmedical issues pertaining to requirements for entitlement. However, claims authorizers are responsible for developing issues that do not pertain to entitlement; e.g., workers' compensation, representative payee, as well as deduction, suspension and termination events.

C. Produce a notice when the PC effectuates an ALJ decision

1. Information on paragraphs to use

When the PC effectuates an ALJ decision that reverses the reconsideration determination, or when taking favorable action per GN 03103.080D.4. and GN 03103.220A.2.g, it sends a notice to the claimant, the claimant’s appointed representative (if any). (See NL 00730.106 for C paragraphs). Send copies of the Office of Earnings Operations (OEO) notice of earnings record action (see GN 03103.220A.2.g.) to the same places.

NOTE: Include language in the notice (DID029) reminding claimant to notify SSA of direct deposit and address changes.

2. Multiple levels of appeal

Sometimes in effectuating an ALJ decision (which may be appealed to the appeals council (AC), the PC’s also make initial determinations (which can be appealed to reconsideration). (For information on multiple levels of appeal, see GN 03101.001B.) The ALS170 paragraph clarifies that AC review applies to the ALJ decision while the right to reconsideration applies to the initial determination the PC makes.

3. When a notice is not required

A notice is not required when the PC effectuates some ALJ reversals.

EXAMPLE:

  1. ALJ decision reverses a reconsideration determination denying a waiver, and the PC did not start overpayment recovery action. The only PC action required is to clear the Recovery of Overpayment Accounting and Reporting (ROAR) system control; the ALJ notice is sufficient.

  2. If the ALJ reverses a cessation and the beneficiary continued to receive disability payments during the appeal, the ALJ notice is sufficient.

D. Change in wages or self employment income (SEI)

If the ALJ makes a change in the established wages or a change in the amount of self-employment income (SEI), the Earnings Modernization Item Correction (ICOR) System electronically makes corrections to the earnings record. Re