TN 7 (11-16)

DI 42010.230 Effectuating Final Decision in ODIO/PSC—Interim Benefits Being Paid

A. Favorable decision

Interim benefits terminate effective the month before the month of the final disability decision.

Process any favorable or partial favorable final decision manually using an EF101. The benefit authorizer should adjust for payments previously released against payments currently due. See DI 42010.000 for instructions on processing ALJ and AC decisions. Develop any outstanding issues, e.g., workers' compensation, following instructions in DI 52150.001 - DI 52150.090. Handle any overpayment in accordance with GN 02201.000.

B. Unfavorable decision

Do not terminate critical payment system (CPS) payments until receipt of a stop order from the Office of Appellate Operations (OAO). Terminate interim benefits effective the month before the month of the final decision. Do not consider interim benefits paid as an overpayment, unless fraud is involved. Do not establish an overpayment due to untimely termination of interim benefits. Code the MADCAP action to ignore the erroneous payments. See SM 00865.045. Manually archive CPS data on the master beneficiary record. See MSOM INTRANETCPS 001.001.

C. Partially favorable decision

When an ALJ changes his or her decision from fully favorable to partially favorable after AC own motion review, SSA will not consider any interim benefits paid during an unfavorable period as an overpayment. SSA will adjust for payments previously released against payments currently due, only for entitlement concurrent with payments due during the interim benefit period.

Example: A fully favorable decision grants a claimant entitlement beginning October 2011. SSA began paying interim benefits August 2015. After the AC’s own motion review, the decision becomes partially favorable. The claimant is granted a closed period of disability beginning October 2011 and ending January 2013. Because SSA paid interim benefits beginning August 2015 outside of the new favorable period, SSA will not create an overpayment for any interim disability payments. SSA will release any underpayment due during the favorable closed period, since no payments due were payable during entitlement to interim benefits.

D. Applicability of attorney fees

SSA does not consider interim benefits in the past-due benefits calculation to determine applicable attorney or representative fees. When calculating past due benefits for purpose of determining applicable attorney fees, exclude any interim benefit payments from the past due benefit calculation.