TN 2 (02-06)

DI 13050.080 Overpayments

A. Policy

The overpayment policies and procedures outlined in GN 02201.001 to GN 02201.055 are applicable to expedited reinstatement (EXR) overpayments. There are, however, situations that specifically relate to EXR.

1. What Is An Overpayment?

a. Provisional Benefits

When the request for EXR is denied, the following circumstances can be considered an overpayment:

  • The amount of provisional benefits paid after the date the beneficiary is notified benefits will end.

  • Provisional benefits paid to an individual that the individual knew, or should have known, he or she was not entitled to receive (i.e. individual files for EXR even though they know they have performed SGA in that same month).

  • The amount of title II provisional benefits paid after the initial month of SGA.

b. Reinstated benefits

When an EXR request is approved, benefits will be reinstated. The policy guidelines in GN 02201.001B.2. are applicable in determining overpayments.

Normal suspension and deduction provisions apply to reinstated benefits in addition to the requirement no reinstated benefit can be paid in the IRP to a title II beneficiary for any month of SGA.

When a reinstatement is processed the provisional benefit paid in a month is compared to the reinstated benefits due for that month. Any excess provisional payment is considered an overpayment.

2. What is Not an EXR Overpayment?

Provisional benefits are not an overpayment unless one of the situations outlined in DI 13050.080A.1.a. applies. See DI 13050.080A.1.b. for what can be considered an EXR overpayment. See GN 02201.001B.3. for a list of situations that are not considered an overpayment of reinstated benefits.

B. Policy - Notification of Overpayment

When a determination is made that an individual is overpaid, he/she will be informed of the overpayment in accordance with the notice procedures in GN 02201.009.

While a decision to pay, not pay, or adjust a provisional benefit carries no appeal rights, an overpayment involving provisional payments does carry normal rights to file a request for waiver of recovery and to appeal the overpayment decision.

C. Policy - Waiver of Recovery/Reconsideration

1. Waiver of Recovery

A person may request waiver either orally or in writing. The request for waiver of an overpayment can be made at any time (see GN 02201.019).

2. Reconsideration

A reconsideration request must be in writing (see GN 03102.100 to GN 03102.375). See GN 02201.025 for policy and procedures for handling a reconsideration request on an overpayment.

D. Policy - Recovery of Overpayments

1. Preexisting Overpayments

If at the time of filing a request for EXR an individual has an existing overpayment, recovery will not be undertaken against provisional benefits. If the individual volunteers to use provisional benefits to refund an overpayment, recovery can be initiated at the agreed rate.

If the individual is approved for reinstatement, normal adjustment/recovery procedures will be followed regarding overpayment recovery from reinstated benefits.

2. Provisional and Reinstated Benefit Overpayments

If an individual's provisional benefits cause an overpayment of reinstated benefits, adjustment and recovery can be initiated using normal collection techniques (see GN 02210.001). Reinstated benefits due should be withheld to recover an overpayment in the same manner as is currently done.

Overpayments related to reinstated benefits are to be handled in the same manner as regular benefit overpayments.

E. References

For Waiver of Recovery – FO Action, see GN 02201.021.

For Waiver of Recovery – OCO/PC Action, see GN 02201.023.