TN 8 (02-17)
GN 05002.040 Handling Benefit Statement Inquiries in Field Offices
A. Background on benefit statement inquiries
1. Accuracy of benefit statement questioned
Although the benefit statement is usually correct, some people may not understand the statement or believe the figures are correct.
2. Reason for Questions
Most of the questions regarding statements are the result of internal adjustments and systems limitations such as:
Automated Job Stream (AJS) adjustments — In the Automatic Earnings Reappraisal Operations (AERO) process, internal adjustments with overpayment or underpayment actions can result in questions by the beneficiary. Since the SSA-1099 would be confusing if it reflected the adjustments that equal a “zero” amount, all overpayment amounts in AJS actions are suppressed and do not appear on the SSA-1099.
Annual Enforcement Operation Adjustments —Adjustments during the enforcement process may result in an incorrect net benefit. The MBR updates and the Payment History Update System (PHUS) query corrections can result in a deflated net benefit. The PSC will correct such benefit statements at the beneficiary’s request. See discussion in SM 00630.071 Deflated Benefit Statements.
Date of Payment or Repayment — The PHUS does not show actual payment for nonscheduled payment or the date SSA receives repayments. Refer the case to the PSC with proofs when the beneficiary insists on a corrected benefit statement and SSA makes a payment in late December.
Facility of Payment — Benefit statements involving facility of payment (the offsetting of payment to non-workers to pay workers per Section 203(i) of the Act) usually result in an inflated statement for the worker. This also applies when workers' compensation and deferred payments are involved for workers. The PSC will issue corrected benefit statements upon request. As of January 1996, this provision no longer applies.
B. Policy for handling benefit statement inquiries
1. General Rule
FO personnel and 800 Number Agents can resolve most questions with a general explanation. Consider the benefit statement to be correct unless the:
If you cannot resolve the question with a general explanation, get a PHUS query (PHU1 or PHU2). Review the transaction history with the beneficiary. If you still cannot resolve the question, refer the case to the PSC (see GN 05002.046B.2. for how to refer).
NOTE: You do not need to refer the issue to the PSC if the beneficiary understands your explanation but remains dissatisfied with your response.
2. When to issue corrected benefit statements
SSA should issue a corrected benefit statement upon request in the following situations:
When the benefit statement is incorrect and the beneficiary may need to include Social Security benefits in taxable income; or
To avoid public relations problems when the benefit statement is incorrect and the beneficiary does not need the information for tax purposes; or
When Box 5 is correct and the corrected benefit statement will only change figures in Boxes 3 and 4.
3. Supplementary Medical Insurance (SMI) Premiums
When a beneficiary entitled to SMI receives a monthly Social Security payment, the premium is deducted from the payment for each month of coverage. In some cases, however, the amount of the monthly benefit may be lower than the amount of the monthly premium (we refer to this workload as LESSDO cases). After offsetting the monthly benefit for premium collection purposes, a premium liability amount remains. The PSC will bill the beneficiary directly for the remaining liability amount. Additionally, the PSC will post a 020 event, which creates the Medicare premiums on the SSA-1099 on the line Medicare Part B Premiums deducted from your benefits. Since Box 3 (and Box 5) will no longer show zero, we can generate a benefit statement at the same time using the tax statement year (TSY) entry.