Example 1 – This example illustrates a scenario where the fee is unknown or unresolved when
the Title XVI decision is effectuated.
Tom was awarded concurrent benefits with an overlapping period of past eligibility.
Tom had an appointed representative who was eligible to charge a fee. Tom’s representative
did not submit a fee agreement before Tom’s case was awarded.
A claims specialist (CS) in Tom’s local FO processed Tom's case, following policy
in SI 02006.204. The CS coded the UFEE screen to show “FEE SITUATION: 1=UNKNOWN OR UNRESOLVED FEE”
and established the “FEEAUTHPEND” issue on the CCE development worksheet when the
CS processed Tom’s award.
32 days later, the CS received notification via HP MDW from PC that Tom’s representative
was authorized to charge and collect a fee. The CS followed the instructions in SI 02006.204F to update Tom’s record. The CS noted the initial windfall offset had automated with
no exceptions. The CS updated the UFEE screens and sent the update to the SSR. The
simulated SSR showed:
-
•
UMIH with Type U income; and
-
•
PMTH showing the system released an underpayment that takes into account RMA and corresponding
months of Type U income.
Once the CS confirmed the system accounted for the fees and computed the underpayment,
the CS typed the date of completion in the RECEIVED column for the “FEE UPDATE” issue.
Example 2 – This example illustrates the steps needed when a fee is unknown or unresolved when
the Title XVI decision is effectuated and the total amount of the fee is delayed for
an extended period because of additional fees due from an auxiliary claim.
Jeff was awarded concurrent benefits with an overlapping period of eligibility. Jeff
had an appointed representative who will charge a fee. Jeff’s representative submitted
a fee agreement, which the ALJ approved. A CS in Jeff’s local FO, processed Jeff's
case. The CS noticed Jeff had two auxiliaries listed on the record, a spouse and a
child. The CS realized that because the two auxiliary claims had not been processed
yet, the CS did not know the total amount of the authorized fees.
The CS coded the UFEE screen to show “FEE SITUATION: 1=UNKNOWN OR UNRESOLVED FEE”
and established the “FEEAUTHPEND” issue and a “FEE UPDATE” issue on the CCE development
worksheet. The CS receipted in the “FEEAUTHPEND” since the fee agreement was approved
by the ALJ. The CS set a TICKLE for 60 days for the “FEE UPDATE” issue. The CS completed
a PERC with Jeff, closed the event, and updated the SSR. The system successfully computed
the initial windfall offset.
61 days later, the CS was checking the TICKLE list in WAC and noticed the “FEE UPDATE”
issue on Jeff’s case had matured. One of the auxiliary claims on Jeff’s record had
been processed, but the other had not. The CS extended the TICKLE for the “FEE UPDATE”
issue another 60 days.
20 days later, the CS received notification from the PC of the authorized fees for
the Title II claims via a HP MDW. The PC had processed both auxiliary claims to completion
and determined the fee amounts for both claims. The CS now knew the total authorized
fee amounts. The CS updated the UFEE screen on Jeff’s record and sent the update to
the SSR. The simulated SSR showed:
-
•
UMIH with Type U income; and
-
•
PMTH showing the system released an underpayment that takes into account RMA and corresponding
months of Type U income.
Once the CS confirmed the system accounted for the fees and computed the underpayment,
the CS typed the date of completion in the RECEIVED column for the “FEE UPDATE” issue.