TN 1 (11-00)
After a favorable title II adjudication, payment must be processed as expeditiously
as possible, applying all appropriate deductions, offsets, and fees.
Claims are District Office Final Authorization (DOFA).
Title II awards are input through MCS. MCS processing exclusions must be sent to the
PC for Manual Adjustment Credit and Award Processing (MADCAP).
For OHO cases, normal procedures are followed for processing awards based on ALJ or
Appeals Council decisions.
To compute benefits, consider the following:
Medicare premiums - Consider state buy-in provisions. If it appears that the claimant
will be liable for over 6 months of retroactive Medicare premiums, initiate equitable
relief development (see HI 00805.170 ff.). Do not delay adjudication pending resolution of the equitable relief issue.
If the issue is still pending when the claim is forwarded to the PC, indicate that
fact on the SSA-3601.
Overpayments - apply normal rules.
Attorney fees - apply normal attorney fee withholding rules.
Offsets - apply normal rules.
If a fully favorable medical determination/decision was issued based on the alleged
onset date of the earliest Hyatt III claim either because of a subsequent application or a previous Hyatt III reopening, the DDS/OHO adjudicator completed a Favorable Determination/Decision Worksheet
and Transmittal (see DI 12548.095, Exhibit 13)
Verify payment. If no additional benefits are payable, prepare and release the notice “No Benefits Payable”
(see DI 12548.095, Exhibit 12). If the earliest application filed within the Hyatt III period is not a Hyatt III eligible claim, include the optional paragraph found in DI 12548.025A.1.
Release the notice to claimant, claimant's representative, if any class counsel and
the Litigation Staff.
Retain the folder during the appeals period.
Prepare A101 or EF101 for PC processing. Show "Hyatt Court Case" in item 11.
Route the case to PC under cover of SSA-3601. Check "Other" block and enter in "Remarks"
that "Process case per DI 42548.001 ff."
Take the following actions when a cessation is reversed to a continuance or an earlier
onset date is established.
Process for benefit payments for the retroactive period.
Route the folder(s) to the PC via an SSA-3601. Check the “other” block and indicate
in “Remarks” that the DDS notice language is in the folder.