TN 3 (03-95)

GN 03960.043 Administrative Review of the Fee Authorized Under the Fee Agreement Process - Concurrent Titles II and XVI Cases or Affected Auxiliary Beneficiary(ies) Involved

A. POLICY

When a party requests administrative review of a determination of the amount of the fee under a properly approved agreement, the reviewer must consider the total fee for all administrative level services.

1. Concurrent Titles II and XVI Cases

In concurrent claims involving a common issue, e.g., disability, this means considering the total fee amount based on the past-due benefits resulting from both the titles II and XVI claims. (See GN 03960.050C.4. for the criteria.)

2. Affected Auxiliary Beneficiary

In title II claims involving one or more affected auxiliary beneficiaries, this means considering the total fee amount based on the past-due benefits of the primary claimant and the auxiliary beneficiary(ies). (See GN 03920.035.)

B. PROCEDURE

If a party requests administrative review and SSA has not authorized the total fee under the agreement, take the following actions if you are the PC reviewer.

1. Concurrent Titles II and XVI Cases

  1. Call the FO.

    • Ask the title XVI CR to: estimate when he/she will make a fee determination; notify each party as quickly as possible; and send a copy of the Fee Agreement Notice with the claim(s) file to you.

    • Advise the CR that because of the pending request, he/she should not adjust the title II income as SI 00830.100 and SI 02006.210 require, until receiving the claim(s) file and a copy of the determination you make on administrative review.

  2. Explain that you cannot work on the request until SSA authorizes the total fee under the agreement, when acknowledging receipt and notifying the parties.

  3. Diary the case for 30 days for receipt of the copy of the Fee Agreement Notice(s), unless the estimate for completion is greater than 30 days.

2. Affected Auxiliary Beneficiary

  1. Call the PC module. Ask the Benefit Authorizer (BA) or CA to:

    • estimate the date of completion of the auxiliary claim(s) and fee determination(s);

    • notify all parties of the amount of the representative's fee as quickly as possible; and

    • send a copy of the fee determination(s) to you.

  2. Explain that you cannot work on the request until SSA authorizes the total fee under the agreement, when acknowledging receipt and notifying the parties.

  3. Diary the case for 30 days for receipt of a copy of the notice(s) of the outstanding fee amount(s), unless the estimate for completion is greater than 30 days.

C. EXAMPLE

In a concurrent claims case favorably decided at the reconsideration level, the claimant timely requested administrative review of the title II portion of the fee. The FO has not yet authorized the title XVI portion of the fee. The reviewer contacts the FO and asks that it authorize the title XVI portion of the fee, notify the claimant and representative of the fee, and send him the claim(s) file with a copy of the Fee Agreement Notice. The reviewer acknowledges receipt and notifies the representative and the title II decision maker of the request, explaining that he will continue the review once the FO has authorized the title XVI portion of the fee.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203960043
GN 03960.043 - Administrative Review of the Fee Authorized Under the Fee Agreement Process - Concurrent Titles II and XVI Cases or Affected Auxiliary Beneficiary(ies) Involved - 01/08/1997