TN 8 (12-07)
SI 00510.025 Monitoring and Determinations of Compliance — Filing for Other Benefits
A. Procedure — Provide Assistance
Provide assistance in filing for and pursuing the other program benefit if an individual and/or representative appear physically or mentally incapable of doing so alone.
B. Procedure - Expedite Claims
Use the following guidelines to expedite claims processing.
Do not delay adjudication of the SSI claim pending evidence of the individual's compliance within the 30 calendar day time period.
Deny or suspend the claim immediately when the claimant/recipient informs the FO at any time that he/she will not comply with the requirement to file for or pursue the other benefits.
NOTE: It is not necessary to wait for the 30-day close-out period to expire to deny SSI to a claimant/recipient who refuses to comply with the requirement to file for other benefits. It is also not necessary to get the individual's statement in writing.
C. Procedure — Monitor Compliance
a. Benefit is Not Title II
If the “other program benefit” is not Title II, follow the procedures in SI 00510.025C.2. and SI 00510.025C.3. of this section to determine that the individual has filed and is otherwise pursuing his/her claim.
b. Benefit is Title II
If the “other benefit” is Title II and the FO uses specialization, follow up with the Title II adjudicator using local procedures to determine that the individual has filed and is otherwise pursuing his/her claim.
If an SSA-L8051-U3 has been issued, follow the procedures in SI 00510.025C.2. and SI 00510.025C.3. to remind the individual to file, if necessary.
2. Initial Diary Length
Determine the length of the initial case diary by the date the claimant/ recipient receives or should receive the notice.
3. Filing Reminder
If you do not receive notification of the individual's application for other benefit by the initial follow-up date:
4. Claim Filed — Follow-up
When the FO receives notification that the individual has filed an application for the other benefit, check with the other benefit source (either directly or through the individual, see SI 00510.020A.2.b.) at the end of the initial 30-day period for filing (35 if mailed) to:
Determine if there has been a final decision to allow or deny the claim, and
Confirm that the claimant/recipient is cooperating in pursuit of the claim, and
Document the file with the response.
5. Continuing Follow-ups
If there has been no decision in the initial 30 days and the individual is not at fault, continue to follow up every 30 days with the benefit source (either directly or through the individual, see SI 00510.020A.2.b.) until there is a decision.
6. 30-Day Follow-up — Exceptions
a. Agency Processing Time
When the FO knows that the other benefit provider has a fixed or minimum processing time for claims:
Modify the standard follow-up/closeout date procedure to agree with the expected date, and
Schedule all follow-ups beyond the initial one to more closely coincide with the source's average processing time.
b. Benefit Source Failure to Cooperate
If the benefit source refuses to complete the SSA-L8050-U3 or provide the necessary information in some other form:
Summarize the actions and document the file, and
Submit the case to the regional office program staff for coordination with the benefit source.
D. Procedure — Document the Determination
Record the FO determination for failure to pursue the other program benefit and document the claims file. For MSSICS, document the DROC screen.
Explain in the determination:
What step(s) the individual failed to take, and
What assistance, if any, SSA provided to the individual.
REMINDER: Before finding failure to take all appropriate steps, consider the individual's and/or his/her representative's physical and mental ability to take the necessary steps.
E. Procedure — Special Notices
1. When to Use a Manual Notice
Send a manual notice when benefits are being denied or suspended for any of the following reasons:
Withdrawal of a lump sum from a pension fund;
Failure to file for the highest benefit possible without limiting retroactivity; or
Failure to select the earliest month of entitlement/eligibility.
2. How to Issue a Manual Notice
Suppress the automated notice per SM 01301.675 for non-MSSICS cases and MSOM BUSSR 002.018 for MSSICS cases;
Refer to NL 00801.010. for general information about manually prepared notices;
Advise the individual that SSI payments are being denied or suspended beginning with the month he/she received the SSA-L8050-U3 or SSA-L8051-U3; and
Place a copy of the manually prepared notice in the file.
Diary Process, SM 01301.200
Diary Process-Claims Active in MSSICS, SM 01301.205
Diary Process-claims not Active in MSSICS, SM 01301.210
Manually Prepared Notices - General, NL 00801.010
Use of the SSA-L8051-U3, SI 00510.021