BASIC (06-09)

GN 03943.015 Revised Fee Agreements

A. Receipt of revised fee agreement

The parties to a fee agreement may revise the fee agreement to comply with the requirements of the fee agreement process or to revise a provision in the agreement as indicated in GN 03940.001C. As a result of the increased specified dollar cap on fee agreements, components may receive revised fee agreements. When a component receives a revised fee agreement:

  • Document the date of receipt (date stamp, etc.) if it is not already stamped or otherwise date-documented.

  • If the claim is pending, associate the revised fee agreement, or fax it for association with the claim folder.

  • If SSA has issued a favorable decision, the revised fee agreement should be faxed into the certified electronic folder and forwarded to the decision maker who acted on the initial fee agreement. For paper folders, the revised fee agreement should be faxed to the decision maker who acted on the initial fee agreement.

  • If SSA issued an unfavorable decision, associate the revised fee agreement with the certified electronic folder. If a paper folder is involved, forward the fee agreement to the component with jurisdiction for association with the claim folder.

NOTE: In considering a revised fee agreement, the decision maker must consider whether the agreement is between the claimant and the same representative or representatives, i.e., whether the name(s) and signature(s) are all the same as on the earlier agreement. See GN 03940.003 for policy on exceptions to the fee agreement process.

B. Decision maker receives revised fee agreement before SSA issues favorable decision

When the decision maker receives a revised fee agreement and SSA has not yet issued a decision, the decision maker acts on the last fee agreement SSA received before the date of the favorable decision, as indicated in GN 03940.003C.

C. Decision maker receives revised fee agreement after the date SSA issued favorable decision

When the decision maker receives a revised fee agreement after the date of the favorable decision, the decision maker determines if the revised fee agreement meets the conditions for approval.

  • In each situation, provide notice to the parties as appropriate. For policy on fee agreement notices, see GN 03940.008. Include additional sample language appropriate to each situation, as outlined in GN 03943.015C.1. and GN 03943.015C.2. (in this section).

  • Associate the revised fee agreement and the fee agreement determination with the certified electronic folder. If a paper folder is involved, forward the revised fee agreement and the fee agreement determination to the component that effectuated or is effectuating the favorable decision.

1. Revised fee agreement does not meet the conditions for approval

If the decision maker determines that SSA did not receive the revised fee agreement before the date of the favorable decision, or that it does not meet all the conditions for approval for another reason, the decision maker disapproves the fee agreement. Provide notice to the parties advising of the disapproved fee agreement, and of the right to request administrative review of the determination. For policy on fee agreement notices, see GN 03940.008. The notice should also identify the specific agreement to which the determination applies.

If the decision maker approved an earlier fee agreement, disapproves the revised fee agreement, and the approval of the earlier fee agreement continues to be the correct action, provide notice to the parties in accordance with GN 03940.008. The following additional sample language may be used as a model to include in the notice:

Sample A“

We wrote you earlier to tell you that we approved your fee agreement. We also received a revised fee agreement between you and your representative, dated [date of revised fee agreement]. We did not approve the revised fee agreement because: [provide reason from GN 03940.090C, Exhibit 2]. Therefore, the approval of the earlier fee agreement remains in effect.”

2. Revised fee agreement meets the conditions for approval

If the decision maker determines that SSA received the revised fee agreement before the date of the favorable decision and that the revised agreement meets the other conditions for approval, the decision maker approves the fee agreement. Provide notice to the parties advising of the approved fee agreement. The special determination approving the fee agreement should specify the date of the agreement by modifying the language in GN 03940.090C, Exhibit 2, as follows:

        “I approve the fee agreement, dated [date of fee agreement], between the
       claimant and his or her representative…”

D. PC and FO actions when decision maker approves revised fee agreement

When SSA already acted on a prior fee agreement and the PC or the FO receives an approval of a revised fee agreement, SSA’s next action depends on the response to the issues listed below. Further detail is provided in sections GN 03943.015D.1. through GN 03943.015D.6. (in this section).

  • Has SSA already issued the fee authorization notice(s) to the claimant and representative?

  • If SSA already issued the fee authorization notice, would the approved revised fee agreement yield a higher authorized fee?

  • In concurrent Titles II and Title XVI cases, did SSA authorize the maximum fee from Title II only or from both Title II and Title XVI past-due benefits?

  • Can the representative receive direct payment from the claimant’s Title II or Title XVI past-due benefits? If so:

    1. Did SSA pay the representative the previously authorized amount?

    2. Is SSA still withholding past-due benefits?

Follow the appropriate policy to provide notice to the parties for each situation listed in GN 03943.015D (in this section). For policy on fee agreement notices, see GN 03940.008. Include additional sample language that may be appropriate to each situation, as outlined in GN 03943.015D.1. - GN 039430.015D.6. (in this section).

Associate the revised fee agreement and the fee agreement determination with the certified electronic folder. If a paper folder is involved, forward the revised fee agreement and the fee agreement determination to the component that effectuated or is effectuating the favorable decision.

1. Fee authorization notice not yet issued

If SSA has not issued the fee authorization notice(s) or paid the representative from past-due benefits, substitute the revised fee agreement for the earlier fee agreement, calculate the representative’s fee, and provide notice to the parties as indicated in GN 03940.008. For authorization of fees based on Title II past-due benefits, see GN 03920.030; for authorization of fees based on Title XVI past-due benefits, see GN 03920.031; for information on calculation of the direct payment amount, see GN 03920.017D Payment of Representative’s Fees.

2. Fee authorization notice was previously issued

The PC or FO determines whether the revised fee agreement yields a higher fee than the fee that resulted from the earlier approved agreement. This will depend on the amount SSA authorized under the earlier fee agreement:

  • If SSA authorized a fee of less than $5,300 under the earlier approved agreement (based on both Titles II and XVI, if applicable), the revised fee agreement does not change the representative’s fee. Refer to procedures in GN 03943.015D.3. (in this section).

  • If SSA authorized a fee of $5,300 under the earlier approved agreement (based on both Titles II and XVI, if applicable), SSA must recalculate the fee based on the past-due benefits amount and the revised fee agreement. Refer to the appropriate procedure in GN 03943.015D.4.-GN 03943.015D.6. (in this section).

The PC or FO adjudicator places a special message on the Master Beneficiary Record (MBR) or Supplemental Security Record (SSR) indicating what action was taken. If applicable, the benefit authorizer in the PC updates the APPFEE data to the MBR when the revised fee agreement produces a fee amount different from the amount previously authorized and currently shown.

3. Approved revised fee agreement does not yield a higher fee

If SSA authorized a fee less than $5,300 under the earlier fee agreement (e.g., 25 percent of past-due benefits was less than $5,300), SSA cannot authorize a higher fee based on the revised fee agreement. Provide notice to the parties. For policy on fee agreement notices, see GN 03940.008. The following additional sample language may be used as a model to include in the notice:

Sample B

“We wrote you earlier to tell you that we approved your fee agreement. We also received a revised fee agreement between you and your representative, dated [date of revised fee agreement]. We have approved this revised fee agreement.”

“The fee your representative can charge is the same under both agreements. Therefore, the earlier notice about your representative’s fee provides correct information on the maximum amount your representative can charge you for acting on your behalf in matters before us, unless we issue a later decision that changes your past-due benefits.”

4. Approved revised fee agreement yields a higher fee in Title II only or Title XVI only case

If the representative’s fee authorized under the earlier fee agreement was $5,300 and the case is a Title II only or Title XVI only claim, the PC or FO:

  • Recalculates the representative’s fee based on the past-due benefits amount and the revised fee agreement. For authorization of fees based on Title II past-due benefits see GN 03920.030; for authorization of fees based on Title XVI past-due benefits see GN 03920.031; for calculation of the direct payment amount see GN 03920.017D.

  • Updates the MBR or SSR representative fee fields with the correct authorized fee information; and

  • Provides notice to the parties. For policy on fee agreement notices see GN 03940.008.

a. Representative must collect additional amount authorized from claimant

For purposes of the notice, you may use the following sample language as a model for additional language to include in the notice, with fill-ins based on the facts in the situation:

Sample C

“We are writing to tell you that we have approved the revised fee agreement between you and your representative, dated [date of revised fee agreement]. Earlier, we told you that your representative could charge you $[total amount previously authorized]. Based on the revised fee agreement, your representative can charge you $[total amount calculated under the revised fee agreement]. This is instead of, not in addition to, the fee we approved earlier. [Your/your family’s] past-due benefits used to decide the amount of the fee were $[total amount of past-due benefits].”

“The amount of the approved fee does not include any out-of-pocket expenses (for example, costs to get copies of doctors’ or hospitals’ reports). This is a matter between you and your representative.”

[Use this paragraph if the representative received direct payment of a fee from Title II or Title XVI past-due benefits.]

“Earlier, we paid your representative $ [total amount actually paid to representative from withheld past-due benefits AFTER subtracting the user fee] from your past-due benefits. This amount is the fee we approved before, less a service charge.”

“After we paid your representative, we paid you the rest of the amount we withheld from your benefits. Therefore, you and your representative must decide how to settle the additional $[total amount calculated under the revised fee agreement MINUS total amount previously authorized BEFORE subtracting the user fee] you owe. We are sending a copy of this letter to your representative.”

NOTE: If an additional fee amount is authorized based on past-due benefits and a representative who may receive direct payment later contacts SSA indicating that he or she has been unable to collect the additional amount authorized, follow the procedures in GN 03920.055C.

b. SSA is still withholding past-due benefits

For purposes of the notice, you may use the first and second paragraphs from Sample C in GN 03943.015D.4.a. (in this section) as a model for additional sample language to include in the notice, with fill-ins based on the facts in the claim. Also include Sample D:

Sample D
“Because of the law, we usually withhold 25 percent of total past-due benefits to pay an approved representative’s fee. Earlier, we paid your representative $ [total amount actually paid to representative from withheld past-due benefits AFTER subtracting the user fee, if any] from the benefits we withheld. This amount is the fee we approved before, less a service charge.”

“Because we still have benefits that we withheld for payment of the representative’s fee, we are sending your representative an additional $ [amount of additional direct payment].”

Take action to pay the additional amount authorized to a representative eligible for direct payment.

5. Approved revised fee agreement yields a higher fee in concurrent Titles II and Title XVI claims and an additional amount is authorized based on Title II past-due benefits.

NOTE: If the past-due Title II benefits does not cover the additional amount of the authorized fee, follow the instructions in GN 03943.015D.5. Then refer to GN 03943.015D.6. (in this section) to determine if additional fees can be authorized based on Title XVI past-due benefits.

If the case involves concurrent (Titles II and XVI) claims, and SSA previously authorized a $5,300 maximum fee based only on Title II past-due benefits, then any additional amount authorized under the revised fee agreement may be based on the past-due Title II benefits. If this is the case:

  1. Recalculate the representative’s fee based on the past-due benefits amount and the revised fee agreement. For authorization of fees based on Title II past-due benefits see GN 03920.030. For Title II benefits subject to withholding see GN 03920.035;

  2. Update the MBR or SSR representative fee fields with the correct authorized fee information. If applicable, the PC should notify the FO that the Title II fee amount has increased and that the new fee amount has been updated to the MBR; and

  3. Provide notice to the parties. See GN 03940.008 for policy on fee agreement notices

a. Representative must collect an additional amount authorized from the claimant

For purposes of the notice, you may use Sample C in GN 03920.015D.4.a. in this section as a model for additional language to include in the notice, with fill-ins based on the facts of the claim.

NOTE: If an additional fee amount is authorized based on past-due benefits and a representative who may receive direct payment later contacts SSA indicating that he or she has been unable to collect the additional amount authorized, follow the procedures in GN 03920.055C.

b. SSA is still withholding past-due benefits

For purposes of the notice, you may use the first and second paragraphs from Sample C in GN 03943.015D.4. (in this section) as a model for additional language to include in the notice, with fill-ins based on the facts in the claim. Also include the language in Sample D in GN 03943.015D.4.b. (in this section).

Take action to pay the additional amount authorized to a representative eligible for direct payment.

6. Approved revised fee agreement yields a higher fee in concurrent Title II and Title XVI claims and an additional amount is authorized based on Title XVI past-due benefits.

In concurrent cases, if the amount of the Title II past due-benefits does not cover the fee authorized based on the revised fee agreement, an additional amount may be authorized based on Title XVI past-due benefits. This may happen in two situations:

  1. A fee was previously authorized based on Title XVI past-due benefits because the previously authorized fee ($5,300 or lesser cap) could not be authorized based solely on the Title II past-due benefits; or

  2. A fee was not previously authorized based on Title XVI past-due benefits because the previously authorized fee ($5,300 or a lesser cap) was based solely on the Title II past-due benefits. As a result of the approved revised fee agreement, an additional amount is authorized, based upon Title II past-due benefits, but the amount of the Title II past-due benefits is not sufficient to cover the increase in the authorized fee ($6,000 or lesser cap.)

In those situations:

  1. Recalculate the representative’s fee based on the past-due benefits amount and the revised fee agreement. For authorization of fees based on Title XVI past-due benefits see GN 03920.031. For Title XVI benefits subject to withholding see GN 03920.036.

  2. Update the MBR or SSR representative fee fields with the correct authorized fee information; and

  3. Provide notice to the parties. For policy on fee agreement notices, see GN 03940.008.

a. Representative must collect additional amount authorized from the claimant

For purposes of the notice, you may use Sample C in GN 03920.015D.4.a i(n this section) as a model for additional language to include in the notice, with fill-ins based on the facts of the claim.

NOTE: If an additional fee amount is calculated from Title XVI past-due benefits and a representative who may receive direct payment later contacts SSA indicating that he or she has been unable to collect the additional amount authorized, follow the procedures in GN 03920.055C.

b. SSA is still withholding past-due benefits

For purposes of the notice, you may use the first and second paragraphs from Sample C in GN 03943.015D.4.a. (in this section) as a model for additional language to include in the notice, with fill-ins based on the facts in the claim. Also include Sample D in GN 03943.015D.4.b. (in this section).

Take action to pay the additional fee authorized to a representative eligible for direct payment.


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