Effective Dates: 11/28/2023 - Present Previous | Next

TN 16 (11-23)

DI 42010.045 Erroneous Payment or Notice After an Administrative Law Judge Decision

A. Introduction to erroneous payment or notices

Fully and partially favorable administrative law judge (ALJ) title II decisions are effectuated for payment in the jurisdictional processing center see DI 42010.001B. An incorrect payment notice, issued following an ALJ decision, gives the right to appeal he benefit amount awarded or paid, but it does not allow for challenging the ALJ’s decision on disability finding or duration. The issue that can be appealed concerns ongoing monthly payments.

As stated in DI 11010.350, even if issued in error, the receipt of an award notice or payment establishes a substantive right upon which the beneficiary can rely . Because of the rights conferred by an erroneous award notice or payment, the Social Security Administration (SSA) must offer appeals rights and administrative finality protections when it issues an erroneous award notice or payment.

B. Processing center (PC) mistakenly handles a closed period award as ongoing entitlement

1. Error found and SSA is within the time for reopening

If the ALJ issues a closed period award and the processing center erroneously establishes ongoing payments and the error is found within the time limits for reopening, take the following actions before stopping current payments and establishing an overpayment:

  1. a. 

    Send a due process notice as explained in GN 03001.005 and GN 03001.015.

  2. b. 

    After releasing the due process notice, diary the case for 15 days (10 days plus 5 days for mailing) for possible rebuttal before SSA takes the adverse action.

  3. c. 

    After the rebuttal period ends, the claimant must receive a final notice for all events that result in an adverse action after the action is taken. The notice must provide sufficient information for the beneficiary to make an informed appeal decision, such as the:

    1. 1. 

      action taken,

    2. 2. 

      basis for the action,

    3. 3. 

      appeal rights, and

    4. 4. 

      waiver provision if the adverse action results in an overpayment.

2. Error found and SSA is not within the time for reopening

If the ALJ issues a closed period award and the PC erroneously establishes ongoing payments and the error is not found within the time limits for reopening, forward the case to the field office (FO) using the Modernized Development Worksheet to initiate a continuing disability review.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0442010045
DI 42010.045 - Erroneous Payment or Notice After an Administrative Law Judge Decision - 11/28/2023
Batch run: 12/19/2024
Rev:11/28/2023