TN 12 (09-21)

DI 42010.205 Interim Benefits in Cases of Delayed Final Decisions — Title II


Social Security Act, Section 223(h)
20 CFR § 404.969(d)

A. Payment of disability interim benefits (IB)

If the Appeals Council (AC) initiates review of an administrative law judge’s (ALJ) favorable disability decision and the agency does not issue a final decision within 110 days from the ALJ’s decision, we will pay the claimant interim benefits.

NOTE: To process interim benefit payments for Title XVI Supplemental Security Income (SSI) cases, see SI 02007.000.

B. Who is entitled to Title II disability IB

We pay IB to disabled wage earners, disabled widow(ers), and childhood disability beneficiaries.

IB are payable only to the claimant filing for disability benefits. Defer payment of auxiliary benefits until receipt of a final decision.

C. When IB begin and end

1. When IB begin

We pay interim benefits under Title II beginning the month before the month in which the 110th day falls.

EXAMPLE: If the 110th day after the ALJ’s favorable disability decision is October 5, 2015, IB begin September 2015. Begin processing IB once the start order is received from the Office of Appellate Operations (OAO).

2. When IB end

Terminate Title II IB effective the month before the month of the final decision. For guidance on when a decision becomes final, refer to GN 03101.060. Do not consider IB as an overpayment even if SSA stopped IB late, unless fraud is involved. For more information see DI 42010.205G.

EXAMPLE: The Commissioner issues a final decision on December 15, 2015 after AC's own motion review. IB would terminate November 2015.

REMINDER: The date on the ALJ decision becomes the final decision date if the claimant does not appeal or the AC does not initiates its own motion review. The Office of Appellate Operations (OAO) sends a stop order once the decision becomes final.

D. Claimant does not meet Title II insured status requirement

IB are payable even if the claimant does not meet Title II insured status requirements. Compute the monthly IB amount using the onset date established in the ALJ decision for the disabled individual based on the earnings record for the social security number on which the ALJ's favorable decision was issued. If the informational/certified earnings records system (ICERS) is unable to determine the primary insurance amount, use the interactive computation facility program (ICF). ICF will calculate the beneficiary’s PIA, ignoring the insured status requirement. See ICFT2 001.001 for more information on ICF.

E. Retroactivity of IB

If we did not process the IB payments timely, and the agency ultimately issues an unfavorable final decision, IB are still payable. Pay IB the month before the month in which the 110-day falls, and terminate IB effective the month before the month of the final decision.

EXAMPLE: In November 2015, SSA receives an IB start order dated March 2015 with a start date of February 2015, after a final decision dated October 2, 2015. A closed period of IB would be payable beginning February 2015 and terminate September 2015.

F. Suspension and reduction events for IB

Prior to initiating IB payments, verify that proof of US citizenship or lawful presence is on record. See RS 00204.010 for lawful presence payment provisions.

Do not pay IB if the claimant is subject to non-payment provisions due to prison conviction and confinement, or if lawful presence is not resolved. See GN 02607.160 and RS 00204.010.

IB payments are subject to reduction due to workers’ compensation (WC), public disability benefit, and windfall elimination provision offset. If you are unable to verify WC data and no payment amount is alleged, use the State’s maximum weekly WC rate based on the year of the date of injury listed in DI 52150.045 to determine offset amount.

Annotate form SSA-5002 (Report of Contact) with any pertinent payment information, e.g., WC offset. For electronic folders, create a barcode coversheet and fax the SSA-5002 into eView. For paper folders, fax the complete form SSA-5002 into the non-disability repository for evidentiary documents system (NDRED).

IB are not payable in cases where we certify payments to the Railroad Retirement Board (RRB). SSA cannot certify payment to the RRB in the absence of a final decision.

G. Overpayment situations involving IB

If the final decision is unfavorable, do not consider IB to be an overpayment, unless fraud is involved. Do not establish an overpayment because SSA stopped IB untimely.

If SSA erroneously processed an ALJ decision that was pulled for AC’s own motion review, see DI 42010.220C.

If we did not apply suspension timely based on any suspension provision, and the claimant was otherwise eligible to receive IB, do not consider any IB paid for those months to be an overpayment. See, DI 42010.205F.

EXAMPLE: SSA begins paying IB August 2015. In December 2015, we find that the IB should have been suspended as of August 2015 due to the prisoner provisions. Because we did not apply the prisoner suspension timely, we cannot consider the IB paid from August 2015 through December 2015 to be an overpayment. Suspend IB beginning January 2016. For more information on prisoner suspension, see GN 02607.160.

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DI 42010.205 - Interim Benefits in Cases of Delayed Final Decisions — Title II - 08/18/2021
Batch run: 09/20/2021