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.

  • Provide an SSA-L8050-U3 in cases that were previously subject to deferred development after the adjudicator determines that the individual meets all other eligibility requirements (including final disability or blindness determinations). Any overpayment period resulting from failure to file starts the month you provided written notification.

C. Procedure — Monitor Compliance

1. General

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.

  • Notice handed to the individual — diary for follow-up in 15 days.

  • Notice mailed to the individual — diary for follow-up in 20 days.

3. Filing Reminder

If you do not receive notification of the individual's application for other benefit by the initial follow-up date:

  • Contact the individual and remind him/her to file for the benefit before the 30-day time limit expires; and

  • Document the file to show that contact was made.

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.

F. References

  • 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


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0500510025
SI 00510.025 - Monitoring and Determinations of Compliance -- Filing for Other Benefits - 01/06/2009
Batch run: 01/27/2009
Rev:01/06/2009