RS 02807.040 Processing Retirement or Survivor Claims After Preliminary Payments Initiated

A. Claim Input

To avoid duplicate payments to claimants who are receiving preliminary payments, the Modernized Claims System (MCS) has been interfaced with CPS. MCS will either stop the CPS payment and withhold an amount equal to the CPS paid amount from the PMA check, or will block processing on any award where CPS is involved. Therefore, when all entitlement requirements are met after preliminary payments have begun, MCS should be utilized to process the award action unless MCS processing is precluded due to some other reason.

B. Development

The additional evidence for a final determination will be secured in the normal claims development process (follow the provisions in GN 00301.230-GN 00301.305 concerning assistance to give claimants in securing proofs). Establish necessary controls and ensure that every effort is made to complete the required development for a final determination before the 4th check is due to be issued since only 3 checks can be issued under preliminary payment procedures. If the claimant is unaware of what is being developed (third party contact involved. DO/BO certification of public record, etc.), the DO/BO must advise the claimant in writing of the pending action.

C. Development Complete — Claimant Entitled

Upon completion of all development, prepare and adjudicate the award. Complete Part II of the Form SSA-1877. Forward the Forms SSA-1877 and SSA-795 attached to the top of the claim to the appropriate special processing center address for critical cases. If the award is processed by MCS, enter the 553 listing code on the SSA-450. If MCS processing is precluded, forward both copies of the SSA-5015-U2.

D. Development Complete — Claimant Not Entitled

There may be instances where, upon completion of all development, evidence for a final determination shows a claimant receiving preliminary payments is not entitled to benefits. In these cases, action must be taken to stop the preliminary payments being paid through CPS and to process the disallowance.

Enter the disallowance through MCS if the action can be processed to completion by DO input (DOFA Case). Since MCS is interfaced with the CPS, the MCS disallowance will stop the CPS payments and alert the PC to the CPS involvement.

If the disallowance cannot be processed to completion by DO input, and less than three payments have been issued by CPS, enter a stop-payment transaction into the CPS. (When the TPT is C03, the CPS automatically stops payment after three checks have been paid.) Also, prepare an SSA-3428-U2 (Determination of Disallowance) per instructions in SM 00380.001.

Advise the claimant in writing (the MCS notice should be suppressed) that based on the evidence received, the allegation of his or her entitlement is now questionable. Therefore, the preliminary payment requirements are no longer met and the preliminary payments are being stopped. Also include in the notice that further notification will be received shortly from the processing center.

No notification of the overpayment will be sent to the claimant at this time (see RS 02807.050).

Forward the SSA-1877, SSA-795, and copy of the notice to the claimant attached to the top of the claim to the appropriate special PC address for critical cases. Also, forward both copies of the SSA-5015-U2 if the 553 listing was not entered through MCS.


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http://policy.ssa.gov/poms.nsf/lnx/0302807040
RS 02807.040 - Processing Retirement or Survivor Claims After Preliminary Payments Initiated - 10/03/2012
Batch run: 10/03/2012
Rev:10/03/2012