TN 3 (03-95)

GN 03960.057 PC Reviewer Responsibilities - Completing Administrative Review of the Fee Authorized Under the Fee Agreement Process

A. Introduction

Complete your review now that you have followed GN 03960.055 and:

  • decided that the requester, if he/she filed late, has established good cause;

  • decided that the requester, if he/she was the decision maker, has shown that either the representative did not represent the claimant's interest adequately or the fee is clearly excessive in light of the services provided; and

  • given the other party(ies) the opportunity to respond to the request for administrative review.

B. Procedure

1. Consider the statements

  1. a. 

    If either of the following applies, consider the statements and proceed to 3. below. Otherwise, proceed to b. below:

    • You are reversing the decision maker's approval and disapproving the fee agreement.

    • GN 03960.040C.2.c. applies, i.e., you are modifying an incorrectly calculated fee amount under the terms of the fee agreement in a manner consistent with the party's request; and no other party objected during the comment period.

  2. b. 

    Consider the requester's statements.

    Is the requester protesting the fee under the agreement or is he/she:

    • protesting the proposed manner of payment, e.g., direct payment from an auxiliary beneficiary's past-due benefits (GN 03960.040C.5. discusses the policy.);

    • objecting to the direct payment when the representative has funds held in a trust or escrow account; or

    • seeking payment from the claimant because SSA did not withhold benefits or released benefits withheld (see GN 03920.055B.)?

2. Consider whether the fee is reasonable

  1. a. 

    Consider the factors listed in GN 03960.050C.1. and any additional information or comments received.

  2. b. 

    Determine whether the fee is reasonable, adhering to the principles in GN 03960.050 and, when applicable,
    GN 03960.040C.4. or GN 03960.040C.5. If the fee authorized under the fee agreement process:

    • Reasonably reflects the value of the services provided, affirm the fee amount. Proceed to 3. below.

    • Does not reasonably reflect the value of the services provided, authorize a reasonable fee based on your evaluation of all of the factors listed in GN 03960.050C. Then proceed to 3. below.

      NOTE: Follow GN 03920.015 if you find that a reasonable fee would exceed $5,000.

3. Issue notice of SSA's determination

  1. a. 

    Follow GN 03960.070 to prepare a letter to the requester, consistent with b. through g. below, for release over the appropriate official's signature (see GN 03960.070A.2.). Refer to GN 03960.085 for model letters.

  2. b. 

    State the authority for administrative review if a party questioned or challenged SSA's authority to review or to authorize the fee under an approved agreement.

    NOTE: Do not cite regulations pertaining to administrative review of fees determined under the fee petition process. They do not apply to fees determined under the fee agreement process.

  3. c. 

    If the requester did not file timely and you did not resolve the issue in your acknowledgment or interim letters, include a brief explanation of your good cause finding.

  4. d. 

    State whether you are affirming, decreasing, or increasing the fee amount.

    EXCEPTION: You are disapproving the fee agreement as explained in GN 03960.040C.1.b.

  5. e. 

    Respond to the issue(s) raised.

  6. f. 

    State that the determination is not subject to further review.

  7. g. 

    Discuss the method of payment, e.g., SSA will certify direct payment of all or a portion of the fee to the attorney representative; that the claimant is responsible for all or a portion of the fee; or the representative must refund any excess amount previously certified or paid. For additional information regarding the recovery of an excess fee payment, see GN 03920.051C.8 and GN 03920.051C.11.

  8. h. 

    State that you are sending copies of the determination to the parties named.

  9. i. 

    Send copies of the determination to the other parties, as GN 03960.040D. requires.

  10. j. 

    See GN 03960.060.2. or GN 03960.065.2. or both, for subsequent actions, which vary depending on the result.

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GN 03960.057 - PC Reviewer Responsibilities - Completing Administrative Review of the Fee Authorized Under the Fee Agreement Process - 04/04/2016
Batch run: 04/04/2016