In Title II cases and Title XVI couple’s cases, the user fee cap applies to the total
fee we pay to the primary claimant’s representative from past-due benefits withheld
from the primary claimant and any affected auxiliary beneficiary or Title XVI eligible
spouse who is not independently represented. To the extent possible, we pay the authorized
fee to this representative from the primary claimant's withheld past-due benefits
and deduct the user fee from that payment.
If we deduct a user fee of less than the cap from the fee payable based on the primary claimant's past-due benefits, we will deduct
6.3 percent of the direct payment amount or the amount of the cap remaining, whichever
is lower, from any fee we pay from the affected auxiliary beneficiary’s or eligible
spouse's past-due benefits. We will deduct a user fee from each successive fee payment
until the total user fee we have collected equals the cap in effect on the date of
the payment.
EXAMPLE 1: Stacy filed a concurrent Title II and Title XVI claim. Stacy appointed Robert as
her representative. At the reconsideration level, we issue a favorable determination.
At the same time, we process the claim for Stacy’s child, who lives in the same household
as Stacy and who was not independently represented. Robert timely submits a fee petition
requesting $7,000. We evaluate Robert’s fee petition and approve $4,000.
Description
|
Amount
|
1. Amount of Stacy’s past-due benefits |
$12,000
|
2. Amount of Stacy’s child’s past-due benefits
|
$6,000
|
3. Total amount of Stacy’s and her child’s past-due benefits we withheld for direct
payment of Robert’s fee:
-
•
25% of Stacy’s past-due benefits: $3,000 plus
-
•
25% of Stacy’s child’s past-due benefits: $1,500.
|
$4,500
|
4. Amount we authorized after evaluating Robert's fee petition
|
$4,000
|
5. Amount we pay Robert after we deduct the full user fee of $97.00 from 25% of Stacy’s
past-due benefits ($3,000)
|
$2,903
|
6. Remaining amount of the authorized fee we pay Robert from Stacy’s child’s past-due
benefits. We do not collect an additional user fee.
|
$1,000
|
EXAMPLE 2: Chris files a Title II only claim. Chris appoints Matt as his representative. Chris
and Matt sign a fee agreement. At the hearing level, the ALJ issues a favorable decision,
resulting in $3,200 in past-due benefits for Chris. The ALJ reviews and approves the
fee agreement.
Description
|
Amount
|
1. Amount of Chris’ past-due benefits
|
$3,200
|
2. Amount of Chris’ past-due benefits we withhold for direct payment of Matt’s fee
(25% of $3,200)
|
$800
|
3. Amount of the user fee (6.3% of $800)
NOTE: As noted in GN 03920.019A, we cap the user fee at a flat-rate dollar amount or 6.3 percent of the fee payment,
whichever is lower, effective September 1, 2004
|
$50.40
|
4. Amount we directly pay Matt from Chris’ withheld past-due benefits ($800 - $50.40)
|
$749.60
|
We subsequently process the claims for Chris’ two children, who live in separate households
and who were not independently represented. Each of Chris’ children is due $400 in
past-due benefits.
Description
|
Amount
|
5. Amount of each child’s past-due benefits we withhold for direct payment of Matt’s fee (25% of $400)
|
$100
|
6. Amount when we deduct 6.3% of the direct payment amount (6.3% of $100)
|
$6.30
|
7. Amount we directly pay Matt from each child ($100 - $6.30)
|
$93.70
|
EXAMPLE 3: Rachel filed a Title XVI only claim. At the hearing level, the ALJ issued a favorable
decision and approved the fee agreement between Rachel and Adam, her representative,
who is eligible for direct payment. Because of Rachel’s Title XVI eligibility, her
unrepresented husband, Mike, who had been receiving Title II and Title XVI benefits
for several years, receives an additional Title XVI retroactive payment.
Description
|
Amount
|
1. Amount of the couple’s past-due benefits resulting from Rachel’s Title XVI eligibility
|
$2,176
|
2. Amount of the couple’s past-due benefits we withheld for direct payment of Adam’s
fee (25% of $2,176)
|
$544
|
3. Amount when we deduct 6.3% of the direct payment amount (6.3% of $544)
|
$34.27
|
4. Amount we directly pay Adam ($544 - $34.27)
|
$509.73
|