SSA - POMS: GN 03940.040 - Title II - Field Office (FO) and Processing Center (PC) Processing of Fee Agreements on Dual Entitlement Claims

A. Introduction

Sometimes we issue favorable decisions to the same claimant in more than one type of claim for benefits (i.e., dual or simultaneous entitlement such as disability based on a claimant's Social Security Number (SSN) and as a survivor on another's SSN). These claims often involve multiple PCs.

Dual entitlement claims usually involve a common issue (e.g., disability based on an individual's own SSN and as a disabled adult child). In claims involving a common issue, the representative is authorized a single fee for their services. Therefore, the fee authorized under the fee agreement process for multiple claims is controlled by the provisions of the agreement and cannot exceed the statutory maximum indicated in GN 03940.003B.3. (or any lower maximum fee specified in the fee agreement). However, when a representative is instrumental in obtaining benefits for a claimant on more than one SSN, the combined family maximum applies to the computation of past-due benefits if the claimant is entitled to child's benefits on more than one SSN. GN 03920.030D.3. discusses computing past-due benefits when there are multiple SSNs.

B. FO Actions

In dual entitlement claims involving a fee agreement, follow the instructions in GN 03940.010 and GN 03940.015 and take the following additional actions:

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Designate an incomplete notice, allowing the PC to add language advising the claimant and representative that SSA may authorize an additional fee based on another claim; and
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Add a special message to the Supplemental Security Record (SSR) explaining that SSA may authorize an additional fee after completing action on the other claim.

C. Jurisdiction

1. PC With Jurisdiction for Primary Claim

a.
If you have jurisdiction for processing the primary claim (i.e., the claim based on the claimant's SSN), follow the instructions in GN 03940.020 or GN 03940.025 for processing the fee agreement and authorizing a fee under the agreement.

Also, if the past-due benefits due to the primary claimant do not yield the maximum representative's fee based on the approved fee agreement, add language to the notice advising the parties that SSA may authorize an additional fee based on the other claim. Include in the notice the following information:
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  We may authorize an additional fee (or a fee, if there are no past-due benefits on the current claim) based on past-due benefits resulting from another claim.
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  We will notify the claimant of any additional authorized fee after we complete adjudication of the other claim.
NOTE: If there is a valid assignment of direct payment of a representative’s fee to an entity, the entity’s point of contact (POC) may need to review fee-related information to resolve fee-related issues. However, do not send a copy of the award notice or other protected information (e.g. claimant information) to the entity’s POC unless it is the minimum amount of information necessary for the POC to review it to resolve fee-related issues. Only disclose information that is not relevant or necessary to resolve fee-related issues if the claimant has expressly consented on a Form SSA-3288 or other written consent that meets the requirements of GN 03305.003. For information on assignment of direct payment of fees, including the roles and responsibilities of a POC, see GN 03920.021.
b.

Add a special message to the Master Beneficiary Record (MBR) that we may authorize an additional fee based on the other claim.
c.

Advise the other PC, by special message, of the amount of the fee authorized under the fee agreement based on the primary claim.

If there are no past-due benefits under the primary claim, do not disapprove the otherwise valid fee agreement on this basis; remember that past-due benefits may flow from the other claim.

2. PC With Jurisdiction for Secondary Claim

In dual entitlement claims with a fee agreement, authorize a fee up to the maximum allowed under the fee agreement, taking into consideration any fee authorized based on the past-due benefits from the primary claim.

a. We Have Already Authorized Maximum Fee Under the Agreement

If we have already authorized the maximum fee under the agreement:

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do not authorize an additional fee unless the claims involve separate issues (see GN 03940.040A.);
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notify the parties that the maximum fee has been authorized under the other claim; and
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release any remaining withheld past-due benefits to the claimant(s), provided the representative has not filed a request for administrative review (or after SSA completes the review if one was filed) and there is no Fedearl court or Title XVI action pending.

b. We Have Not Already Authorized Maximum Fee Under the Agreement

If we have not already authorized the maximum fee under the agreement:

•

authorize a fee, making sure not to exceed the maximum allowed under the agreement and the statute by considering the fee authorized under the other claim;
•

notify the parties of the authorized fee and of the right to request administrative review;

NOTE: If there is a valid assignment of direct payment of the representative’s fee to an entity, the entity’s POC may need to review fee-related information to resolve fee-related issues. However, do not send a copy of the award notice or other protected information (e.g. claimant information) to the entity's POC unless it is the minimum amount of information necessary for the POC to review to resolve fee-related issues. Only disclose information that is not relevant or necessary to resolve fee-related issues if the claimant has expressly consented in writing on a Form SSA-3288 or other written consent that meets the requirements of GN 03305.003.
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withhold the amount of the authorized fee from the past-due benefits for direct payment when the representative is eligible for direct payment and has not waived a fee or direct payment. If there is Federal court involvement or we received a request for administrative review, withhold 25% of past-due benefits; and
•

certify direct payment to the representative who is eligible for direct payment, or an eligible entity if there is a valid assignment, if no one requested administrative review (or once SSA completes the review if one was requested) and, unless there is a court or Title XVI action pending, release any remaining past-due benefits to the claimant and any auxiliaries.

(See GN 03920.016B for the requirements for a representative to be eligible for direct payment.)

D. Procedure — Secondary Claim Processed First

Be aware that there may be times when the primary and secondary claim(s) are not processed simultaneously and the secondary claim is processed to payment while the primary claim remains pending (e.g., the wage earner's disability claim on their SSN is pending but a survivor claim is ready for effectuation.) Follow the procedures in GN 03940.040C.1. in this section to notify the PC with jurisdiction over the primary claim of the fee action.

In this situation, if past-due benefits are payable on the secondary claim, do not defer action on the fee agreement or defer authorizing a fee because another claim is pending.

Social Security

Program Operations Manual System (POMS)

GN 03940.040 Title II - Field Office (FO) and Processing Center (PC) Processing of Fee Agreements on Dual Entitlement Claims