In representative payee determinations, provide an advance notice to the incapable beneficiary and their representative before you finalize the determination, see GN 00503.100. Do not adjudicate (trigger) representative payee claims requiring the mailing of advance notice until the 15-day “protest” period has elapsed.

NOTE: Disability claims requiring a written advance notice are exclusions to the MCS “Auto-Initiate” (SPORT) program (see DI 11010.030E).

Release the advance notice as soon as the individual's entitlement and incapability are established and you selected a payee to minimize delay. Refer to procedures in GN 00503.120 that includes protest cases and their resolution.

Follow the guidelines in GN 00603.070B and document the method of payment when required in representative payee claims where there are accrued funds. This situation arises more frequently in disability (DIB) claims. If we are paying the total accrued funds in a lump sum, process the claim using the Modernized Claims System (MCS) Earning Computation (EC) process. If we are withholding the accrued funds or in installments, you must exclude the claim from MCS EC, see MSOM MCSEC 001.001.

For complete notice instructions, see GN 00503.130.

Carefully question an individual who inquires about the LSDP to be sure that another individual has not filed or is not eligible, see RS 00210.010. Screen the Master Beneficiary Record (MBR) and the MCS record (cleared or archived), for a possible prior LSDP claim. If the applicant is entitled to the LSDP payment previously paid to another beneficiary, obtain an application using MCS, but process it via automated 101 (A101). Ensure to add the proper instructions for the processing center (PC) indicating overpayment recovery or benefit adjustment. For liability and recovery, see GN 02205.003. In situations where a LSDP award results in an adverse action, follow the instructions for adjudication of adverse claims found in GN 01010.320.

For determining annual earnings test exempt amounts in the year of death, see RS 02501.025B.3.

If, at the time of death, the number holder (NH) was payee for a spouse or child, the death termination program (TATTER) will not convert the auxiliary benefits to survivor benefits because there is no proper payee. If you select a new payee, input the change of payee action before processing the death termination action so the system converts the auxiliaries to survivors with no break in payment.

Ideally, you must process concurrent widow(er) and LSDP claims together as one action. However, if processing concurrently and Supplemental Security Income (SSI) windfall offset applies on the widow(er) award, process the LSDP separately to prevent it from the offset.

Also, if the LSDP can be paid immediately to the Living in the Same Household (LISH) spouse but the widow(er) claim will be delayed (e.g., outstanding development, MCS exclusion, etc.), process the two claims independently. Send a notice to the claimant that includes universal text indicator (UTI) “CLOR05” advising that SSA will contact them later regarding the pending widow(er)'s award. Include the remark “LSDP-ONLY PROCESSED ON (DATE)” on the Benefit Continuity Remarks/Notice (BCRN) screen when processing the widow(er) claim via A101.

NOTE: Do not consider the procedure above as partial award.

Input WC/PDB entries on the offset (WCCL) screen in MCS per DI 52155.001. For manually processed claims, see DI 52155.025. These entries are necessary whenever WC/PDB offset is involved or potentially involved so that you can establish the appropriate identification and control system for future action.

For RR Certified claims that you can process via MCS EC, see RS 01602.000.

For manually processed claims, identify RR Certified cases by entering the proper code on the RR Certification Factor on the Benefit Continuity Factor (BECF) screen for each beneficiary whose monthly benefit are certified by the Rail Road Board (RRB).

NOTE: If the proper RR code does not propagates to the A101 screens, it must be input manually, see MSOM MCS 014.004.

For instructions on the use of the Windfall (WF) Factor (FAC) code to withhold retroactive title II benefits pending a possible title XVI offset, see MSOM MCS 009.003 BECF and GN 02610.010.

For instructions on claim abatement processing, see GN 01010.475. Suppress the notice if the abatement is due to death and the deceased claimant was the applicant.

CAUTION: Only denial codes 67, 68 and 96 apply to abatements (see SM 00380.040 and SM 00510.195). Do not use any other codes for an abatement action.

Approve pre-effectuated withdrawals in the FO. However, withdrawals received after the effectuation of benefit payments are post-entitlement actions that require PC approval. If the claimant is entitled to railroad or veterans benefits, see GN 00206.025. For conditional withdrawals, see GN 00206.055.

CAUTION: Only reason codes 200 - 207 apply to withdrawals (see SM 00380.040). Do NOT use any other codes for a withdrawal.

If the NH withdraws a retirement (RIB) claim and there are unprocessed auxiliary claims still pending that will be disallowed consequently, process the disallowance for the auxiliary claimant(s) using MCS EC (see MSOM MCS 009.013);

For Medicare-only claims when insured status (I/S) is a factor of entitlement (e.g., a BIC “T” or aged claimant - not a BIC “M), and the claimant does not meet the residency requirement, input the disallowance code for residency (i.e., 103) in the MCS Benefit Continuity Factors (BECF) screen. Additionally, use the special message (SP MSG) field in MONET to indicate the disallowance reason, see MSOM T2PE 007.001.

Although the BECF screen in MCS allows up to three disallowance codes to be input, the system does not transmit derived codes to this screen. Therefore, if the claimant subsequently attains I/S and re-files a new claim, the MBR SP MSG annotation will provide a lead about the residency issue at a quick glance during initial contact with the claimant. Otherwise, an incorrect Medicare allowance could result and an unnecessary re-contact with the claimant may be required.

For a list of denial codes and their priority, see SM 00380.090.

CAUTION: Since the MCS action should process immediately, input the SP MSG action at the same time. However, if the disallowance action is delayed and the MONET action is processed before the MBR is established, an MBR no in file “NIF” exception will be generated to the FO. This exception will not reflect the input language.