TN 18 (10-98)

SI 02301.330 How to Correct Benefits Based on Appeal Decision

A. Introduction

When a decision at the first level of appeal is rendered on all issues, FOs must remove protected payment status and adjust benefits to the proper amount reflected in the appeal decision. Sometimes before FOs can adjust benefits, subsequent changes occur that affect continuing benefits. FOs may also have to correct erroneous benefit amounts issued in notices of appeal decisions to recipients.

B. Procedure - Appeal Decisions

When a decision at the first level of appeal is rendered on all issues, follow these steps to adjust benefits and correct the record:

STEPACTION
1Obtain a current SSIRD. Do the DPD entries show an appeal pending (GK status codes P, I or S) and payment continuation?
 IF YES, go to Step 2.
 IF NO, go to Step 3.
2Input GK status code R to remove protected payment status, correct the data on the record, and adjust benefits as necessary. Follow systems instructions in SM 01305.570. Go to Step 5.
 NOTE: A DPD entry of status codeRautomatically deletes all other DPD entries on a record.
3Does the record properly reflect the determinations in the appeal decision? For example, a record in payment statusN01shows the correct amount of excess income in the appeal decision.
 IF YES, go to Step 5.
 IF NO, go to Step 4.
4Correct the data on the record and adjust benefits as necessary. Go to Step 5.
5Input the appeal decision and the date of the decision in MSSICS via direct input. Refer to MSOM BUSSR 002.007, Direct Build Appeals, Part 4 MSSICS or MSOM MSSICS 020.001, Appeals Part 4 MSSICS.
Go to Step 6.
6Determine and resolve any overpayments resulting from payment continuation. These instructions are in SI 02201.005 ff., SI 02220.001 ff. and SI 02260.001 ff.

NOTE: After the system terminates a record, FOs must establish a start date (SD) record to reinstate benefits. These instructions are in SM 01801.001 ff.

C. Procedure - Subsequent Changes

When a subsequent change occurs that may affect continuing benefits before they have been paid, follow these steps:

STEPACTION
1Determine if the change results in an adverse action. Do this by manually recomputing benefits and comparing the new monthly amount with the proper amount reflected in the appeal decision, not with the last payment on the record.
2Issue the appropriate manual notice.

D. Procedure - Errors in Appeal Decisions

Use this chart to determine the proper notice to send when correcting an erroneous amount in an appeal decision:

If...then send...
the incorrect amount has not b