When a disability denial is erroneously treated as an allowance, one of the following issues is involved:

• •

  An award notice is issued with the check/benefit release;

• •

  An award or any other kind of notice is not issued with the check benefit release.

Receipt of an award notice or a check, even though erroneously issued, creates a substantive right on which the beneficiary may rely. Utilize the following procedures to correct this situation:

• •

  Extend due process before termination of the erroneous payments. If the claimant received an allowance notice or payment without any notice, handle the case just as other reopening cases; see Providing Due Process in Erroneous Payment Cases (DI 27525.015) for instructions.

• •

  If the claimant receives an award notice, but the first check has not been issued, suspend payment until the due process issue is resolved.

• •

  Return the case to the Disability Determination Services (DDS) with a brief outline of the facts that resulted in the erroneous award notice. For Certified Electronic Folder (CEF) cases see Processing Reopenings - DI 81020.115.

• •

  Request the DDS to extend due process and issue a revised determination notice. Alert the DDS regarding concurrent Title II/Title XVI situations.

If the DDS prepares a denial determination and releases a denial notice, stop erroneous payments without advanced notice. Since a denial notice has already been issued, the beneficiary does not get appeals rights. When the field office (FO) becomes aware of this situation, or when due process has been completed after an erroneous allowance notice was issued, the FO immediately sends a Modernized Development Worksheet (MDW) 2560HP Priority Request to the appropriate Processing Service Center (PSC) for termination of Title II payments. The 2560HP MDW must contain the following information:

1. 1. 

   Title -- Title II erroneous trigger;

2. 2. 

   Claim Account Number (CAN);

3. 3. 

   Beneficiary Identification Code (BIC) -- (up to three alphanumeric positions) that is assigned to the beneficiary;

4. 4. 

   Last name followed by the first three letters of the beneficiary’s first name;

5. 5. 

   Initial date of entitlement (DOEI) to disability; and

6. 6. 

   Date of Denial Notice (DODN) or Date of Erroneous Allowance Notice (DOEAN) -- the date shown on the initial notice to the beneficiary. If no notice was sent, the DODN is none.

The FO prepares a letter advising the beneficiary of the erroneous payment. Do Do not include appeals language since the DDS issued a denial notice and that notice includes all appropriate due process language. Notify auxiliary residing in a household other than the primary beneficiary in a separate notice.

NOTE: Do not use 2560HP MDWs to communicate with Office of Disability Operations (ODO). Use the Manager to Manager Process for high priority requests; e.g., allegation of potentially violent behavior threats or cases with potential adverse public relations.

See Guide For Contact for a guide to this process.