BASIC (02-02)

DI 55075.005 Disputes Between Beneficiaries/Recipients and ENs That Are Not State VR Agencies

A. Policy – 3-step dispute resolution process

There is a 3-step dispute resolution process available to beneficiaries/recipients and ENs that are not State VR agencies. The process is available after the parties sign an Individual Work Plan (IWP) (see DI 55020.001B.1.). The purpose of the process is to resolve disputes that arise during the implementation of the IWP. For example, a dispute could arise about the services spelled out in an IWP, or about the beneficiary's/recipient's participation in the plan.

1. Step 1 – EN's internal grievance procedures

The first step of this dispute resolution process involves an internal grievance procedure that each EN is required to have. Under this procedure beneficiaries/recipients have the opportunity to work with representatives of the EN to try to resolve the dispute that has arisen. If the dispute is not resolved using these procedures, both the beneficiary/recipient and the EN have the option of contacting the PM for assistance in resolving the dispute.

2. Step 2 – PM review and recommendation

The second step of this dispute resolution process involves a full review of the matter in dispute by the PM. The PM will make a recommendation to the beneficiary/recipient and EN as to how the dispute might be resolved. After receiving the PM's recommendation, either party to the dispute may request a review by SSA.

3. Step 3 – SSA review and decision

The third step of this dispute resolution process involves bringing the dispute to SSA. SSA's decision with regard to the dispute is final. If either party to the dispute is unwilling to accept SSA's decision, that party has the right to terminate its relationship with the other.

NOTE: The PM will refer the request for SSA review to staff in the Office of Employment Support Programs (OESP) where the final SSA decision will be made by the Dispute Resolution Board.

B. Policy – right to representation

1. Both parties can be represented

Both the beneficiary/recipient and the EN may use an attorney or other individual of their choice to represent them at any step in the dispute resolution process.

2. State protection and advocacy (P&A) system

a. General

At any stage in the dispute resolution process, a beneficiary/recipient can seek and receive assistance from the State P&A system. SSA awards grants to the P&A system in each State and U.S. Territory to provide services under the Protection and Advocacy to Beneficiaries of Social Security (PABSS) program (see DI 55001.005B.).

b. EN's role

ENs must inform beneficiaries/recipients of the availability of P&A services at three times. They are when:

  • the EN and beneficiary/recipient sign the individual work plan (IWP);

  • services in the beneficiary's/recipient's IWP are reduced, suspended, or terminated; and

  • a dispute arises about the services spelled out in the IWP or the beneficiary's/recipient's participation in the program.

C. Procedure – handling questions and inquiries

Field components have no direct role in disputes between beneficiaries/recipients and ENs that are not State VR agencies.

1. Beneficiary/Recipient complaints about an EN

Refer beneficiaries/recipients with complaints about an EN to MAXIMUS, SSA's the PM or suggest they contact their State's P&A system.

MAXIMUS' toll free numbers are:

  • 1-866-968-7842 (1-866-YOUR TICKET); and

  • TTY/TDD 1-866-833-2967 (1-866-TDD 2WORK).

2. EN complaints about a beneficiary/recipient

Refer ENs with complaints about a beneficiary/recipient that they are serving to MAXIMUS.

3. State P&A inquiries

Refer State P&A employees who are representing beneficiaries/recipients in a dispute with an EN to MAXIMUS.

EXCEPTION: Answer any general, program-related questions the P&A employee may have.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0455075005
DI 55075.005 - Disputes Between Beneficiaries/Recipients and ENs That Are Not State VR Agencies - 05/23/2013