TN 17 (03-05)
GN 03940.040 Title II - FO and PC Processing of Fee Agreements on Dual Entitlement Claims
SSA sometimes issues favorable decisions to the same claimant in more than one type of claim for benefits (i.e., dual and/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 usually involve multiple processing centers (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 his/her 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 03940.003A.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 03920.030B.3. discusses computing past-due benefits when there are multiple SSNs.)
B. Procedure – Field Office (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:
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
annotate the claims transmittal with a remark that SSA may authorize an additional fee after completing action on the other claim.
C. Procedure - Jurisdiction
1. PC With Jurisdiction for Primary Claim
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 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:
SSA 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.
SSA will notify the claimant of any additional authorized fee after SSA completes adjudication of the other claim.
Add a special message to the Master Beneficiary Record (MBR) that SSA may authorize an additional fee based on the other claim.
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. SSA Has Already Authorized Maximum Fee Under the Agreement
If SSA has already authorized the maximum fee under the agreement:
do not authorize an additional fee, unless the claims involve separate issues (see GN 03940.040A.);
notify the parties that the maximum fee has been authorized under the other claim; and
if the representative is eligible for direct payment, 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 court or title XVI action pending.
b. SSA Has Not Already Authorized Maximum Fee Under Agreement
If SSA has 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;
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; and
certify direct payment to the representative who is eligible for direct payment 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 auxiliary(ies).
(See GN 03920.017B for the definition of representative 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 actually is processed to payment while the primary claim remains pending (e.g., the wage earner's disability claim on his/her SSN is pending but a survivor claim is ready for effectuation.) Follow the procedures in GN 03940.040C.1. 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.