If a representative's efforts cause the benefits of the claimant and/or anyone else
actually or technically entitled on the record to increase, the PC will use the extra
benefits in its past-due benefits calculation. If the representative's efforts cause
an increase in the family maximum that is combined on another beneficiary's record,
the PC will use the extra benefits to calculate the past-due benefits amount.
EXAMPLE 1 - Increase Due to Representative's Efforts
Jim Smith became entitled to disability insurance benefits (DIB) with a DOE of 12/01.
The claim was effectuated in 4/04. Jim has 3 children entitled on his record.
In 5/04, Mary Smith, Jim's wife, also became entitled to benefits on her own record.
She used the services of an attorney. Mary's DOE is 5/02. The children's benefits
are less on her record so they will continue to be paid on Jim's record. However,
because the family maximum will be combined on Jim's record, the children are due
additional past-due benefits. In its past-due benefits calculation, the PC will include
the increased benefits due the children for 5/02 through the month before the month
Mary's claim is effectuated.
NOTE: In a family maximum situation that involves children who are not entitled on both
records, inclusion of benefits in the past-due benefits amount and withholding would
only apply to the children who are entitled on the record of the represented claimant.
In the example above, if one of Jim's children was not entitled on Mary's record,
the PC would not include that child's benefits in the past-due benefits amounts and
would not withhold from the additional benefits due that child, because that child
is not Mary's beneficiary.
EXAMPLE 2 - Increase Not Due To Representative's Efforts
Bob Jones became entitled to DIB with a DOE of 12/01. The claim was effectuated in
4/04. Bob has three children who are entitled on his record. Bob has a lawyer and
past-due benefits are withheld.
In 5/04, Jane Jones, the children's mother, also becomes entitled to benefits on her
own record. Jane's DOE is 5/02. She did not use a representative. The children's benefits
are less on Jane's record so they will continue to be paid on Bob's record. The children
are due additional past-due benefits because of the combined family maximum. While
the additional benefits from Jane's claim are within the past-due benefits period
on Bob's record, they did not result from the work of Bob's lawyer. Therefore, the
PC would not withhold additional past-due benefits.