TN 15 (09-04)

GN 03940.002 Fee Agreement Decision Maker

The decision maker is the person who adjudicates the claim or post-entitlement (PE) action at a given level of the administrative appeals process. Disability Determination Services employees are never decision makers for the fee agreement process. Decision makers at the various administrative levels are defined below.

A. Definitions - Initial level

  • Title II district office final authorization (DOFA) claims: the field office (FO) claims representative (CR).

  • Title II non-DOFA claims: the processing center (PC) claims authorizer (CA), claims technical examiner (CTE), or senior claims processing specialist (SCPS).

  • Title II PE actions: depending on who makes the favorable decision, either the CR, the CA/CTE, the SCPS, the debt specialist (DS), or recovery reviewer (RECOVR).

  • Title XVI only claims: the Title XVI CR. This includes concurrent claims where the Title II portion is denied.

  • Concurrent Titles II and XVI claims: depending on whether the Title II is DOFA or non-DOFA, the Title II CR, CA/CTE, SCPS, or RECOVR will make the determination for both Titles.

NOTE: If the CR decision maker did not approve or disapprove the fee agreement, the CA may do so.

B. Definitions - Reconsideration level

  • Title II DOFA claims for benefits based on disability (including widow(er)'s and child's, but excluding Railroad Retirement Act disability): the CR.

  • Title II non-DOFA claims: the CA/CTE.

  • Title II PE actions: the CR if the issue involves disability; or the CA/CTE, RECONR (reconsideration reviewer), SCPS, DS, or RECOVR, depending on who in the PC has responsibility for the favorable decision.

  • Title XVI only claims: the Title XVI CR. This includes concurrent claims where the Title II portion is denied.

  • Concurrent Titles II and XVI claims, depending on who makes the favorable decision: for favorably decided claims involving disability in which the Title II claim is DOFA, the Title II CR will make the determination for both titles. When the Title II claim is non-DOFA, the CA/CTE, RECONR, SCPS, DS, or RECOVR will make the determination for both titles.

  • For Railroad Retirement board (RRB) disability claims: the CA or SCPS who effectuates the Great Lakes PSC-DPB reconsideration decision.

NOTE: If the CR decision maker did not approve or disapprove the fee agreement, the CA may do so.

C. Definition - Hearing level

The Administrative Law Judge (ALJ).

D. Definition - Appeals Council level

The Administrative Appeals Judge (AAJ).

E. Definition - Favorable decision after court remand

If SSA makes a favorable decision on a court remand, the decision maker is either the ALJ or the AAJ who favorably decided the claim(s) or post entitlement action(s).


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203940002
GN 03940.002 - Fee Agreement Decision Maker - 12/18/2015
Batch run: 12/18/2015
Rev:12/18/2015