TN 7 (11-16)

DI 42010.205 Interim Benefits in Cases of Delayed Final Decisions — Title II

Citations:

Social Security Act, Section 223(h)

20 CFR § 404.969(d)

A. Payment of disability interim benefits

If an administrative law judge (ALJ) decision is favorable to a claimant on the issue of disability, we will pay the claimant interim benefits if the Appeals Council (AC) initiates review of the ALJ decision on its own motion and does not issue a final decision within 110 days from the date of the ALJ decision.

NOTE: To process interim benefit payments for Title XVI Supplemental Security Income cases, see SI 02007.000.

B. Who is entitled to disability interim benefit payments

We pay interim benefits to disabled wage earners, disabled widow(ers), and childhood disability beneficiaries.

Interim benefits are payable only to the claimant filing for disability benefits. Defer payment of auxiliary benefits until receipt of a final decision.

C. When interim benefits begin and end

1. When interim benefits begin

We pay interim benefits under Title II beginning the month before the month in which the 110th day falls.

Example: The 110th day after the ALJ's favorable disability decision is October 5, 2015. Interim benefits begin September 2015.

2. When interim benefits end

We stop paying interim benefits under Title II the month before the month in which the Commissioner issues a final decision.

Example: The Commissioner issues a final decision on December 15, 2015 after AC's own motion review. Interim benefits would terminate November 2015.

D. Retroactivity of interim benefit payment

If we did not process the interim benefit payments timely, and the AC issues an unfavorable final decision, interim benefits are still payable the month before the month in which the 110-day falls, through the month before the month of the unfavorable final decision.

Example: In November 2015, SSA receives an interim benefit start order dated March 2015 with a start date of February 2015, after a final decision dated October 2, 2015. A closed period of interim benefits would be payable February 2015 through September 2015.

E. Overpayment situations involving interim benefit payments

If the final decision is unfavorable, do not consider interim benefits as an overpayment, unless fraud is involved. Do not establish an overpayment because SSA stopped interim benefits untimely.

If SSA erroneously processed an ALJ decision that was pulled for AC’s own motion review, see DI 42010.220C.

If we did not apply suspension timely based on any suspension provision, and the claimant was otherwise eligible to receive interim benefits, do not consider any interim benefits paid for those months to be an overpayment. See, DI 42010.205F.

Example: SSA begins paying interim benefits August 2015. In December 2015, we find that the interim benefits should have been suspended as of August 2015 due to the prisoner provisions. Because we did not apply the prisoner suspension timely, we cannot consider the interim benefits paid from August 2015 through December 2015 to be an overpayment. Suspend interim benefits beginning January 2016. For more information on prisoner suspension, see GN 02607.160.

F. Suspension and reduction events for interim benefit payments

Prior to initiating interim benefit payments, verify that proof of US citizenship or lawful presence is on record. See RS 00204.010 for lawful presence payment provisions.

Do not pay interim benefits if the claimant is subject to non-payment provisions due to prison conviction and confinement, or if lawful presence is not resolved. See GN 02607.160 and RS 00204.010.

Interim benefit payments are subject to reduction due to workers’ compensation (WC), public disability benefit, and windfall elimination provision offset. If you are unable to verify WC data and no payment amount is alleged, use the State’s maximum weekly WC rate based on the year of the date of injury listed in DI 52150.045 to determine offset amount.

Annotate form SSA-5002 (Report of Contact) with any pertinent payment information,