TN 7 (11-16)
DI 42010.205 Interim Benefits in Cases of Delayed Final Decisions — Title II
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, e.g., WC offset. For electronic folders, create a barcode coversheet and fax the SSA-5002 into eView. For paper folders, fax the complete form SSA-5002 into the non-disability repository for evidentiary documents system (NDRED).
Interim benefits are not payable in cases where we certify payments to the Railroad Retirement Board (RRB). SSA cannot certify payment to the RRB in the absence of a final decision.
G. Claimant does not meet Title II insured status requirement
Interim benefits are payable even if the claimant does not meet Title II insured status requirements. Compute the monthly interim benefit amount using the onset date established in the ALJ decision for the disabled individual based on the earnings record for the social security number on which the ALJ's favorable decision was issued. If the informational/certified earnings records system (ICERS) is unable to determine the primary insurance amount, use the interactive computation facility program (ICF). ICF will calculate the beneficiary’s PIA, ignoring the insured status requirement. See ICFT2 001.001 for more information on ICF.