TN 10 (10-20)

DI 42010.215 Processing Interim Benefits in Cases of Delayed Final Decisions

A. Disability interim benefits

Interim benefits (IB) are payable when the Appeals Council (AC) exercises its own motion authority to review an administrative law judge’s (ALJ) favorable disability decision, but a final decision has not been issued within 110 days from the ALJ decision date. 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 the Office of Appellate Operations (OAO) to clarify any inconsistencies in the IB start order.

CS are required to provide the Benefit Authorizer (BA) with the following details:

  • IB start date,

  • if applicable, IB suspension months due to non-payment provisions,

  • 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 Title XVI, and if an appointed representative or representative payee 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. In concurrent Title II/XVI, coordinate with the field office (FO) to avoid creating a Title XVI windfall. Contact the servicing FO to provide the Title II IB amount and to ensure the FO defers Title XVI IB until processing of Title II IB. See SI 02007.001.

The BA initiates IB payments using the Critical Payment System (CPS) and sends the notice titled “Notice of Interim Benefits for Administrative Law Judge Cases – Section 8001, P.L. 100-647 – Exhibit” to the claimant and, if applicable, the claimant’s appointed 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

OAO issues a stop order when the decision is final. For Title II decisions, OAO sends the stop order to the appropriate Program Service Center (PSC). Process the stop order upon receipt. Do not consider IB paid as an overpayment, unless fraud is involved. Terminate IB effective the month before the month of the final decision. Do not establish an overpayment due to untimely termination of IB.

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.

NOTE: The ALJ decision date becomes the final decision date if the claimant does not appeal or the AC does not initiate its own motion review. The OAO will send a stop order when the 60-day appeal period ends (without an appeal), or action is taken on an appeal of the unfavorable decision.

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 - 10/16/2020
Batch run: 03/08/2021