TN 1 (11-00)

DI 12548.035 Processing Payment Actions after Favorable Adjudication - Title XVI

A. Policy

1. General

After a favorable title XVI adjudication, payments must be processed as expeditiously as possible, applying all appropriate deductions and offsets.

2. Interim Assistance Reimbursement (IAR) Involved

The retroactive check must be sent to the State when appropriate. (See SI 02003.001.)

3. Non-medical Factors of Eligibility

These instructions may be obtained by contacting the Atlanta Regional Office, Disability Programs Branch.

4. No Benefits Payable

If a fully favorable medical determination/decision was issued establishing entitlement based on the earliest Hyatt III claim either on a subsequent application or because of a previous Hyatt III reopening, the DDS/OHA adjudicator completed a Favorable Determination/Decision Worksheet and Transmittal (see DI 12548.095, Exhibit 13 and DI 12548.035B.1.d.).

B. Procedure - Payment

1. Compute Payment

To compute payments consider the following:

  1. Overpayments.

  2. Offsets (see GN 02610.010B and SI 02006.001 ff.).

  3. Interim Assistance Reimbursement (IAR).

  4. If a fully favorable medical determination/decision on a prior or reopened claim established entitlement based on the earliest Hyatt III eligible application in the Hyatt III period, verify that all benefits have been paid. If no additional payment is due because of the new Hyatt III review, use the information provided by the adjudicator from the Favorable Determination/Decision Worksheet and Transmittal (see DI 12548.095, Exhibit 13).

    • 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.

  5. Retain the folder during the appeals period.

2. Initial Denial Posted (e.g., N-30)

If initial denial is posted, proceed as follows:

  1. T-30 prior record (if needed - see SM 01801.001 ff.). Process a start date record with an SSA-450-SI.

  2. No Record Online--Follow routine procedures for establishing a record.  Process SSA-450-SI. Show Hyatt in the CG field.

  3. If IAR is involved - Reimburse State if grant reimbursement (GR) code on record, or a valid IAR authorization exists. If GR code is not on record, post GR code to record.

    If no IAR authorization is in file, but the file indicates that the claimant received reimbursable assistance, and there is no evidence that SSA told the State of the absence of an IAR authorization then contact the State to determine if their files contain a signed agreement.

    If State indicates that there is an agreement, withhold payment for 2 workdays to give the State a chance to provide a copy of the agreement. Do not delay payment if there is no authorization or the State chooses not to send a copy.

3. Record in T-50 or T-51 Status

  1. If record in T-50 or T-51 status, prepare an SSA-450-SI per SM 01005.001 ff. to establish a new record.

  2. If IAR involved:

    • automated or non-automated case with GR on prior record - carry over to new record;

    • non-automated case with no GR on prior record, but IAR authorization in file - input the GR code on the new record. Complete a manual SSA-8125 and mail it to the appropriate state agency.

See SI 02003.020. An award made under the Hyatt decision is a revised determination; therefore, an earlier IAR authorization may still be applicable. If no IAR authorization is in file, but file indicates that the claimant received reimbursable assistance, follow DI 12548.035B.2.

4. Record in T-30 or T-31 Status

If record is in T-30 or T-31 Status, refer to SM 01005.020D.4.

5. Initial Denial - Record in Pay Based on Subsequent Claim

  1. If initial denial - record in pay based on a subsequent claim, first T-30 the C01 record and re-establish an SD record with the Hyatt case filing date. Then, process A-OTP to pay retroactive amount back to Hyatt DOE in accordance with SM 01901.150.

  2. IAR involved - reimburse the state even if the IAR was paid on a later application if there is:

    • a GR code on the prior record; or

    • an IAR authorization in file from a prior claim;

  3. Designate the state agency as payee to send the retroactive check to the State via A-OTP.

  4. Complete and mail an SSA-8125 to the appropriate State agency.

6. Record in Pay – Hyatt III Reopening Results In Earlier DOE on Same Application

  1. Process an A-OTP to pay retroactive amount to the date of eligibility in accordance with SM 01901.150.

  2. If IAR is involved, and only DOE is being redetermined, do not reimburse the state.

  3. Issue any retroactive payment due the individual.

  4. Apply title II and title XVI offset per GN 02610.005D.

  5. Suppress automated notice and issue a manual SSA-L8100-U2, Notice of Revised Determination. 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.

7. Current Initial Denial Posted; Hyatt III Reopening Results In Earlier DOE On Earlier Applications

If current initial denial posted; reopening results earlier DOE on earlier application:

  1. Prepare SSA-450-SI start date per DI 12548.035B.2. The input will create a new record unless there are exceptions. (Refer to SM 01001.000 ff. for exceptions.)

  2. If an exception exists, T-30 or T-50 record, then establish a new record reflecting earlier DOE. (Do not duplicate any Presumptive Disability/ Presumptive Blindness payments made on the prior record.)

  3. If IAR is involved, refer to DI 12548.035B.3.

  4. Issue a manual SSA-L8100-U2, Notice of Revised Determination. 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.

C. Procedure - Notice

  1. Issue the appropriate SSI notice.

    • See NL 00801.010 for instructions on preparing manual notices.

    • See NL 00804.100 ff. for notice language. Issue a manual SSA-L8100-U2, Notice of Revised Determination. 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.

  2. In all cases where retroactive payments are awarded, enclose a “Hyatt Pamphlet”.

    Use the following language to describe the enclosure: “Please read the enclosed pamphlet, 'If You Get SSI Through the Hyatt Court Case...What You Should Know,' for more information about resources and trusts.”  This should be the last sentence under the caption, “Information About Your Back Payments.”


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412548035
DI 12548.035 - Processing Payment Actions after Favorable Adjudication - Title XVI - 09/06/2012
Batch run: 09/06/2012
Rev:09/06/2012