TN 7 (11-16)

DI 42010.215 Processing Interim Benefits in Cases of Delayed Final Decisions

A. Payment of disability interim benefits

Interim benefit (IB) payments are payable 110 days after a favorable administrative law judge (ALJ) decision on the issue of disability, and the Appeals Council (AC) has exercised its authority to review the ALJ's decision on its own motion. The AC may exercise this authority if an SSA office protests the ALJ's decision, or because of quality review sampling.

When the AC decides to review a decision, the claimant receives a notice. The notice informs the claimant that their favorable ALJ decision has been selected for review. The notice also informs the claimant of the delay in payment of benefits while the case is under review and that there is a limit to the delay.

B. Claims Specialist (CS) responsibilities

The CS receives the IB start orders via the Paperless case control system. If no start order is received for IB, see DI 42010.225A.

CS are responsible for contacting OAO to clarify any inconsistencies in the IB request.

CS are required to provide the Benefit Authorizer (BA) with IB payment start date, IB suspension period due to non-payment provisions if applicable, primary insurance amount, and monthly benefit amount after any benefit adjustment due workers’ compensation (WC), public disability benefit, and windfall elimination provision offset. If the CS is unable to verify WC data and no payment amount is alleged, use State’s maximum weekly WC rate based on the year of the date of injury listed in DI 52150.045 to determine offset amount.

The CS will instruct the BA if the case is concurrent Title II and SSI Title XVI, and if an attorney or representative is involved.

NOTE: Defer completion of form SSA-831-UF (Disability Determination and Transmittal) or an A101 and EF101 (Determination of Award) until issuance of a final decision.

C. Benefit Authorizer (BA) responsibilities

1. Initiating CPS payment

BAs are responsible for determining any retroactive benefit amount after Supplemental Security Income (SSI) windfall offset. Only pay current benefits if windfall offset is pending. To determine correct offset amount, the BA will contact the servicing FO and initiate an e4345 if needed.

The BA initiates IB payments using the Critical Payment System (CPS) and sends the exhibit notice titled notice of interim disability to the claimant and if applicable, claimant’s attorney or representative. See NL 00703.580. Suppress the regular CPS notice. Receipt of IB is an initial determination. Include due process language in your notice of IB.

2. Terminating CPS payments after an unfavorable decision

Do not terminate IB payments until receipt of a stop order from the Office of Appellate Operations (OAO). Do not consider interim benefits paid as an overpayment, unless fraud is involved. Terminate interim benefits effective the month before the month of the final decision. Do not establish an overpayment due to untimely termination of interim benefits.

Manually archive CPS data on the master beneficiary record. See MSOM INTRANETCPS 001.001.

EXAMPLE: An ALJ issues a final decision on December 15, 2015 after AC's own motion review. IB would terminate November 2015.

D. References

NL 00703.580 Notice of Interim Disability Benefits for ALJ Cases.

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DI 42010.215 - Processing Interim Benefits in Cases of Delayed Final Decisions - 06/21/2017
Batch run: 05/14/2019