TN 4 (10-15)

SI 02007.020 Follow ups and Controls on Continuing Title XVI Interim Benefits

Section 1631(a)(8) of the Social Security Act requires us to pay monthly Federal benefits prospectively if the Commissioner of Social Security (COSS) does not make a final decision within 110 calendar days after the date of a favorable administrative law judge’s (ALJ) disability or blindness decision. These interim benefits start with the month in which the 110th day falls, and end with the month in which we make a final decision.

A. No interim benefits start order

The notice to a claimant about the favorable ALJ decision and the Appeals Council (AC) decision to review or reopen the decision tells the claimant that we may be able to pay interim benefits effective with the month in which the 110th day falls. The claimant may contact the field office (FO) to inquire about interim benefits as early as the first of the month in which the 110th day falls.

If the FO has not received the email information sheet “Potential Interim Benefit Case,” request the information you need to initiate interim benefits by sending a fax to:

Office of Appellate Operations (OAO)
(703) 605-7201

B. Final ALJ or AC decision not issued within nine months

Interim benefit payments require close management controls to prevent payment beyond the month of a final decision. Because of the sensitivity of this workload, follow the OAO development guidelines in the chart in this section.

The following procedures apply when a case is pending an AC decision or was remanded to the ALJ for a decision.

If

then

The claimant is still in interim benefit payment status for nine months

FO staff will query the Case Processing & Management System (CPMS) or Appeals Review Processing System (ARPS) to determine whether the case is pending with the AC or the Hearing Office (HO).

 

If the case is pending with the AC:

The FO will email the OAO at |||ODAR OAO 8001 and inquire about the status of the pending claim.

The OAO will provide status via telephone, fax, or email if the case is pending with the AC.

Contact OAO again in three months to follow up on the case.

If the case is pending in an HO:

The FO will email the Hearing Office Director (HOD) and inquire about the status of the pending claim.

Use the HO staff listing at: http://odar.ba.ssa.gov/hq-components/ocalj/field-staff-listings/

Obtain the name of the HOD. The HOD will provide status via telephone or email if the case is pending with the HO.

Contact The Office of Disability Adjudication and Review (ODAR) again in three months to follow up on the case.

The claimant is still in interim benefit payment status for 12 months

The FO will query CPMS to verify if the case is pending with the AC or the HO.

 

If the case is pending with the AC:

The FO will write a memorandum to the Executive Director of the OAO requesting they expedite the case and inform the Executive Director that interim benefit payments have continued for 12 months without a final decision. Include any special characteristics of the case.

Send the memorandum via email to:

|||ODAR OAO and follow up on the case in three months.

If the case is pending in an HO:

The FO manager will write a memorandum to the Director of the Division of Field Procedures (DFPP), Office of the Chief ALJ, requesting they expedite the case and inform the director that interim benefit payments have continued for 12 months without a final decision. Include any special characteristics of the case. The FO manager will forward the memorandum via email to |||ODAR OCALJ DFP and follow up on the case in three months.

The claimant is still in interim benefit payment status for 15 months

The FO will query CPMS or ARPS to verify if the case is pending with the AC or the HO.

If the case is pending with the AC:

The FO will send an email with subject line “URGENT-SECOND NOTIFICATION” to |||ODAR OAO and inquire about the status of the claim pending decision. The OAO will provide status via telephone or email.

Follow up on the case in three months.

If the case is pending with the HO:

The FO will send an email with subject line “URGENT-SECOND NOTIFICATION” to |||ODAR