SSA - POMS: GN 02613.880 - Title XVI Pre-2007 Martinez Settlement Relief Processing

A. Title XVI (T16) pre-2007 Martinez settlement relief types

A Martinez notice dated September 10, 2010 or May 20, 2011, informs systems-identified class members of the agency’s new fugitive felon policy and potential eligibility for T16 pre-2007 Martinez relief. Relief may include:

•

filing a new application with a protective filing date of April 1, 2009,
•

removal of any outstanding balance of a fugitive felon overpayment, or
•

both

An example of the Martinez notice is located in GN 02613.880F in this section.

1. Prospective eligibility with a protective filing date of April 1, 2009

If a recipient contacts us within 6 months from the date of the September 10, 2010 or May 20, 2011, notice, they may file a new application to establish eligibility as of April 1, 2009. Payments may be paid from April 1, 2009, as long as their record was in terminated status on April 1, 2009, and the recipient meets all other SSI eligibility factors. The recipients’ month prior to termination must show N25 status to enable them to qualify for the protective filing date of April 1, 2009. It is also possible for a recipient in current pay (C01) status to receive payments back to April 1, 2009.

Additional processing instructions are located in GN 02613.880C.1. thru GN 02613.880C.3. in this section.

2. Removal of the fugitive felon overpayment (O/P) balance for overpayments incurred between January 1, 2000 to December 31, 2006

If the recipient had an O/P caused by a fugitive felon suspension for offense codes other than 4901, 4902, 4999, 5011, 5012, 8101, and 8102 during the period between January 1, 2000, and December 31, 2006, stop collection of the overpayment and remove any remaining fugitive felon overpayment.

For instructions on removing the fugitive felon overpayment, see GN 02613.880D, in this section.

If the overpayment balance is for one of the seven listed offense codes, do not remove the overpayment from the record.

Do NOT repay the recipient any overpayment amounts already collected.

Systems automatically removed many overpayment balances on September 28, 2010 and April 23, 2011, by placing an NE TAC (Systems applied administrative uncollectible on prior unresolved and undiaried overpayment) on the SSR in the Overpayment Decision Data (OPDD) field. The cases excluded from the automated process were located on a website that is no longer available. The FO removes the overpayment balance by posting an N TAC (uncollectible) for each applicable sequence.

Additional instructions on overpayment removal processing are located in GN 02613.880D in this section.

B. General information on processing pre-2007 cases

If a recipient of the September 10, 2010 or May 20, 2011, notice contacts you and requests Martinez relief, use the following chart for guidance on processing these cases.

Identification	Action
Refer the case to the ^Martinez Settlement mailbox with the Subject “CATS” to find out whether a recipient is listed as an F5 or F7 class member in CATS (an email reply will provide the correct CCID code).	If the reply shows the recipient is listed as an F5 in CATS: Review the Supplemental Security Record (SSR) to determine the current payment status (PSY) code. Is the SSR in PSY C01? If yes, follow processing instructions for cases in pay status in GN 02613.880C.1. in this section. If no, is the SSR in terminated status (i.e., T31, T33, T50, or T51) as of April 1, 2009 and the month prior to termination is N25? If yes, follow processing instructions for cases in terminated status in GN 02613.880C.2 in this section. If no, following instructions in Step 1 in this chart if it is determined after reviewing the PSY and OPSQ fields the recipient is not eligible. If the case is concurrent, follow processing instructions in GN 02613.880C.3. in this section. Determine if a fugitive felon overpayment balance exists by following Step 2 in this chart. If it is determined after reviewing the PSY and OPSQ fields on all records that the recipient is not eligible for Martinez relief, issue a manual denial notice located in the Document Processing System (DPS). The Martinez Settlement Relief Denial Notice for T16 is in DPS Post Entitlement folder. If the reply shows the recipient is F7 in CATS, the recipient has multiple warrants. Follow step 3 in this chart.
2. Review the SSR to determine if there is a fugitive felon overpayment (O/P) and an outstanding O/P balance.	Review the OPSQ field on the SSR to determine if a fugitive felon overpayment exists. Review all SSR records containing N25 nonpayment months to make this determination. Generally, if an NE TAC is present in the overpayment field on the SSR, no further action is required (see “exception” in GN 02613.880D in this section). If a fugitive felon O/P and an outstanding O/P balance exist, remove the fugitive felon O/P following instructions in GN 02613.880D in this section.
3. For F7 Multiple Mixed Warrant Cases Only Access the Fugitive Felon System Control File (FFSCF) to review the offense codes and periods for each of the warrants. For information on accessing FFSCF, see MSOM PRISON 001.002. For obtaining queries in FFSCF, review MSOM PRISON 006.001-PRISON 006.014.	If any N25 period is based on a warrant with an offense code of 4901, 4902, 4999 (felony offense codes) or 5011, 5012, 8101, 8102 (probation or parole violation codes), Martinez relief does not apply to that period. If there are overlapping periods for warrants, and one of the warrants is for an offense code of 4901, 4902, 4999, 5011, 5012, 8101, or 8102, that warrant takes precedence and Martinez relief is not provided for the N25 suspension months. If after reviewing the information for each warrant period you determine the recipient is eligible for pre-2007 Martinez relief, follow processing instructions in GN 02613.880C.1. thru GN 02613.880C.3. in this section. If you determine, after reviewing the PSY and OPSQ fields on all records, that the recipient is not eligible for Martinez relief, issue a manual denial notice located in the Document Processing System (DPS). The Martinez Settlement Relief Denial Notice for Title XVI is located in the DPS Post Entitlement folder.
4. Inquiries from recipients that do not have a notice.	Follow Martinez inquiry instructions in GN 02613.885.

When processing T16 pre-2007 Martinez cases, use the following information as guidance:

•

Martinez relief does not apply to any N25 period based on a warrant with an offense code of 4901, 4902, 4999 (felony offense codes) or 5011, 5012, 8101, 8102 (probation or parole violation codes).
•

Some pre-2007 class members whose SSI payments were suspended or denied before January 1, 2007 are included in the post-2006 group, not the pre-2007, because the period of PSY N25 continued into 2007.
•

If the recipient is in prison, a fugitive felon, or violating a condition of their probation or parole, the No Social Security Benefits for Prisoners Act of 2009 prohibits payment of retroactive benefits. Refer to EM -10013SEN for instructions on how to process these cases.

C. How to process Title XVI (T16) pre-2007 Martinez cases

1. Records in current pay (C01) status

If the criteria in GN 02613.880A. in this section are met, review the current C01 record to determine if the Application Date (AP) field located in the Person Related Segment Identifier (PRSN) field or the Date of Disability Onset (DDO) located in the Disability Data Line (DISB) is equal to April 1, 2009 or later.

a. AP date earlier than April 1, 2009

If the AP is earlier than April 1, 2009, no action is necessary on this Supplemental Security Record (SSR).

b. AP date after April 2009

A case in PSY C01 with an AP date of May 1, 2009 or later requires a medical determination from April 1, 2009 to the month prior to the AP date of the current C01 record to provide the earliest E02 month.

NOTE: Do not take a new application or medical determination for cases with an AP date in the month of April 2009, since it will not result in a change in payment.

To obtain a DDS determination on an existing C01 record, follow instructions in DI 52520.005C.2. For EDCS referrals, follow instructions in DI 52520.005C.3. For non-EDCS referrals, follow instructions in DI 52520.005C.4.

If a recipient filed claims between April 1, 2009, and the month prior to the C01 record and the claims include both medical and technical denials, only obtain a medical determination on the technically denied claims.

EXAMPLE 1: The current C01 record has an AP date and DDO date of August 2009; the recipient filed one prior claim with an AP date of December 2008 (technically denied N25). For Martinez relief, request a medical determination for the period of April 2009 to July 2009.

EXAMPLE 2: The current C01 record has an AP date and DDO date of January 2010; the recipient filed two previous claims between January 1, 2009 and December 2009. Claim 1 – AP dated January 2009 (technically denied N25), Claim 2 – AP dated September 2009 (medically denied). For Martinez relief, request a medical determination for the period of April 2009 to August 2009.

If a recipient filed claims between April 1, 2009, and the month prior to the C01 record and the claims include ONLY technical denials, take the following action:

•

reactivate the last claim in eView,
•

include an SSA-5002 identifying this case as a Martinez settlement case and request a medical determination for the Martinez period, and
•

flag the case as “Court.”

Information on Technical Reactivations is located in DI 81010.110.

NOTE: DDS may reopen a claim prior to April 1, 2009 but the Martinez relief only applies to AP date or DDO date on or after April 1, 2009.

c. Receiving a DDS medical determination

If you receive a favorable medical determination, terminate the current C01 record. Start date the new record with the current operating month (COM) and select the appropriate AP date. Issue an automated one-time payment (A-OTP) for the Martinez relief period as stated in GN 02613.880C.1.d. in this section.

For a closed period of Martinez relief, you may not need to terminate the current record. Calculate the payment due for this closed period and issue a payment via an A-OTP.

If you receive an unfavorable medical determination for the Martinez period, annotate the current C01 SSR “Not disabled for Martinez Pre-2007 relief period.”

d. Issuing a payment via A-OTP

If the AP and DDO are on or after April 1, 2009, take the following action to issue a payment for the eligible months (i.e., no payment made for N01, N04, etc.) by the A-OTP process:

•

Calculate the monthly payment amount from May 1, 2009 through the E02 month on the terminated record. Include the new E02 month of April 1, 2009 in your calculation. Take into consideration income and state supplement payments when computing payments shown on the SSR. For assistance in computing the amount of an OTP, refer to SM 01901.200.

EXAMPLE: There is a favorable medical determination for the Martinez period. The AP date and DDO is April 1, 2009. The current C01 record’s AP date, DDO, and E02 month is August 2009. The technician terminates the current record and establishes a start date record following instructions in GN 02613.880C.1.c in this section. The E02 month is now April 2009 and months paid via an A-OTP are May through August 2009 (August 2009 is the E02 month on the previous record).

•

Go to the MSSICS main menu, select “2” for Update then “19” for Direct SSR Update (UMEN).
•

Select “Payment Menu” on the UMEN screen, then “5” for Special Payments (UPSP).
•

Select “1” on the UPSP screen to Establish, then “3” for One Time Payment (UPOT).
•

Select Payment Reason as “6” for All Other Payment Reasons on the UPOT screen, then enter the Payment Range followed by verifying the address information on the One Time Payment Address (UPOA) screen.
•

Following the UPOT screen, enter the payment data beginning with the earliest month on the UPOA screen. A Claims Representative (CR) or above will approve and transmit the data to the SSR. For additional information on the One Time Payment Amount (UPOP) screen, see MSOM-BUSSR 003-024.

After transmitting the A-OTP, review all SSRs for a fugitive felon suspension or denial between January 1, 2000, and December 31, 2006, to determine if a fugitive felon O/P exists by following instructions in GN 02613.880B, step 2 in this section. If a NE TAC is present in the overpayment field on the SSR, no further action is required. For information on stopping collection of the O/P and removing the remaining fugitive felon O/P balance, see GN 02613.880D in this section.

If the recipient contacts us more than 6 months after the date of the Martinez notice, see GN 02613.880E in this section for additional processing instructions.

e. An appeal filed on the Martinez period

If an appeal is filed during the Martinez period and the initial request sent to DDS was via a paper folder, all appeals remain as a paper folder.

If an appeal is filed during the Martinez period and the initial request was electronic, normal processing procedures apply when filing an appeal.

Information for processing reconsiderations on a medically denied initial disability claim for electronic and paper folders is located in DI 12005.005.

f. Updating the FFSCF when a new application is filed

For a recipient filing a new application with a protective filing date of April 1, 2009, you must update the Martinez warrant(s) on the Fugitive Felon Warrant Disposition (FFWD) screen in the Fugitive Felon System Control File (FFSCF). Updates are not required for the Fugitive Felon Automated Process (FFAP) or in MSSICS.

Take the following steps to update FFSCF:

•

Select “Update” from the Fugitive Felon Warrant Main Menu (FFMN) to access FFWD.
•

On the FFWD, select “1 (Felony Charge/Outstanding Warrant) for “Select Fugitive Felon Status” question.
•

Enter “2 (Closed)” for “Warrant Status.”
•

Enter “03312009 ” as the date the warrant ended.
•

Enter “2 (Dismissed)” as the reason the warrant ended.

If you do not find good cause for late filing recipients seeking to file a new application with the April 1, 2009 protective filing date, AFTER 6 months from the date of the September 10, 2010 or May 20, 2011 notice, follow the same steps to close out the warrant on FFSCF except the date the warrant ended should be the month prior to the application date (AP).

Additional information on the FFWD screen is located in MSOM PRISON 006.006.

2. Records in terminated status

If the criteria in GN 02613.880A in this section are met, take the following action to initiate payments:

a.

Complete an application following instructions in DI 52520.005C.2. For EDCS referrals, follow instructions in DI 52520.005C.3. For non-EDCS referrals, follow instructions in DI 52520.005C.4. Place “ZZZ” in the first three positions of the “unit” field to identify Martinez cases and to exclude from processing time statistics. We must receive a favorable medical decision with a DDO equal to or after April 1, 2009, and the recipient must meet all other SSI eligibility factors in order to receive Martinez relief. If the DDO is after April 1, 2009, relief may begin no earlier than the actual disability onset date.
b.

If you receive a favorable medical decision and the recipient meets all other eligibility factors, place the record in C01.
c.

Review all records for an existing overpayment caused by a fugitive felon suspension or denial between January 1, 2000, and December 31, 2006, by following the instructions in GN 02613.880B, step 2 in this section. For information on stopping collection of the overpayment and removing the remaining fugitive felon balance, see GN 02613.880D in this section.

NOTE: If the recipient is alleging an onset date earlier than April 1, 2009, we can accept their allegation but we can only pay for eligible months beginning with April 1, 2009 under Martinez.

If the recipient contacts us more than 6 months after the date of the Martinez notice, see GN 02613.880E in this section for additional processing instructions. Check the National 800 Number System to confirm if a lead may have been established for the recipient before determining the recipient is outside of their 6-month period.

3. Concurrent cases

A recipient filing a new application with a protective filing date of April 1, 2009 may also be eligible for Title II (T2) benefits under Martinez. Use the following information as guidance for processing your case:

a.

Master Beneficiary Record (MBR) is in current pay (LAF C) status. Verify the new T16 initial claim has the correct T2 benefit amount on the Social Security (ISSA) screen when completing the Pre-effectuation Review Contact (PERC). Use normal processing procedures when a concurrent claim exists.
b.

T2 claim is currently pending at the Disability Determination Services (DDS) for a medical decision; transmit the T16 portion of the case to DDS via Electronic Disability Collect System (EDCS). Inform DDS a medical determination is needed by using the Update-After-Transfer (UAT) utility. For additional processing instructions, see DI 81010.095D, Using the Update-After-Transfer (UAT) Utility.
c.

T2 claim has a prior favorable medical determination or decision and the new T16 disability application is within the same period and disability, adopt the T2 medical decision if all other conditions for adoption are met. For various scenarios when the T2 application involves Trial Work Period (TWP), a Continuing Disability Review (CDR) is pending at DDS or the Disability Quality Branches (DQB), or when a visual impairment is alleged, see DI 11011.000, Collateral Estoppel.
d.

T2 claim has an appeal pending and the T16 application shares an overlapping period with the T2 claim and the same medical issue, seek to escalate the T16 claim to the appropriate appeals level. Additional information on escalating and consolidating claims can be found in DI 11055.025, Pending Title XVI and Title II Claims at Different Levels of Appeal in Common-Issue Cases.
e.

Annotate the SSR with the following remark: “Martinez settlement T16 pre-2007 – New application with protective filing of 4/1/2009.”

D. Remove the remaining fugitive felon overpayment (O/P) balance

If a fugitive felon O/P exists on the current or any prior record with an offense code other than 4901, 4902, 4999, 5011, 5012, 8101, and 8102 during the period between January 1, 2000, and December 31, 2006, remove the remaining fugitive felon overpayment balance. Review all SSRs to determine the combined fugitive felon O/P amount.

Do NOT repay the recipient any overpayment amounts already collected.

Systems automatically removed as many of these O/P balances on September 28, 2010 and April 23, 2011, by placing an NE TAC in the OPDD field on the SSR. If the NE TAC is present, no further action is required for the fugitive felon O/P issue, with one exception:

If there was an uncollected civil monetary penalty, review the record to verify that the uncollected penalty is still on the SSR. The system is not able to differentiate between a civil monetary penalty and any other manually posted overpayment. There may be cases where the uncollected penalty needs to be placed on the record by the FO.

For additional information on civil monetary penalties, see GN 02230.050 through GN 02230.070.

The cases excluded from the automated process were located on a website that is no longer available.

If the recipient contacts you requesting relief and the NE TAC is not present on the SSR, resolve the NE TAC exception, if needed, determine the amount of the fugitive felon O/P, and then N TAC the remaining O/P balance.

1. SSRs without an NE TAC

Any of the following four scenarios may be the result of an SSR without an NE TAC:

a.

there was no overpayment balance at the time of the systems write off.
b.
the case met the criteria that qualified for an automated write off, but the SSR contained one of the exceptions listed below:
- •
  
  Force Flag on the SSR
- •
  
  Excess decision
- •
  
  Embedded excess decision
- •
  
  SSR requires a single record cleanup
- •
  
  SSR has 25 sequences
- •
  
  The State due amount is higher than the State paid amount and the State has ended federal administration of Optional State Supplement.
c.

The case had multiple warrant (MMW – Mixed Multiple Warrants) where there were periods that met the criteria for automated write off and periods that did not meet criteria for write off (F7 listing in CATS).
d.

The claimant contacts the FO before the automated write-off takes place.

2. Action to resolve NE TAC exceptions on the SSRs

Take the following action to resolve the NE TAC exceptions before removing the balance of fugitive felon O/P.

a.

Excess decision (OPX): remove the excess decision
b.

Embedded excess decision and single record cleanup: submit the record to your Regional Office (RO) for cleanup
c.

Record has 25 sequences: force the record to reconcile, then perform the write off on the new record

3. Determine the amount of the fugitive felon O/P

Take the following actions to determine the amount of fugitive felon O/P to remove from the outstanding O/P balance.

a.

Check the Overpayment Sequence Data (OPSQ) on the SSR to determine if an overpayment exists.
b.

If an overpayment exists, query the full history of the record(s) containing an N25 month by entering an “H” in the “SSID = LIMIT:” field on the Supplemental Security Income Queries (SSQM) screen.
c.

Check the Payment Status (PS) field located in the Computation History Segment (CMPH) on the SSR for all N25 months. Calculate the O/P for only the N25 months caused by felony offense code not covered by Martinez to determine the amount of the fugitive felon O/P.
d.

Compare the total fugitive felon O/P amount with the total O/P amount shown in the Overpayment Collect Decision (OPD) on the Miscellaneous Payment Segment (MPMT) line on the most recent SSR.

•

If the total outstanding O/P balance is greater than or equal to the fugitive felon O/P, remove the amount of the fugitive felon O/P, or

•

If the total outstanding O/P balance is less than the fugitive felon O/P, remove the total outstanding O/P balance.

NOTE: The “total outstanding O/P balance” may include O/Ps caused by other SSI eligibility factors such as income or resources, which we must consider when determining pre-2007 Martinez O/P relief.

4. Reviewing Sequence Data for the removal of the fugitive felon O/P

Once you have determined the amount of the fugitive felon O/P to remove, review each sequence data. Be cautious not to remove already collected debt. If a sequence has been partially collected, reduce the decision on the record to the amount already collected and use the N TAC to remove the remaining amount. Take the following steps to place an N TAC on the SSR.

a.

From the MSSI menu, select “2” for Update then “19” for Direct SSR Update (UMEN),
b.

On the UMEN screen, select “Overpayment Menu (UOMN),
c.

On the UOMN screen, place “Y” for “Sequence Actions and Decision Processing”
d.

After entering the “Y”, you will be at the Sequence Selection (UOSS) menu. This menu lets you select a sequence(s) for which an action is to be completed.
e.

After selecting the sequence(s), the Add/Change/Delete Overpayment Decisions (UODC) screen displays O/P disposition decisions associated with the selected sequence(s). You can select to change or delete one or more of these decisions and add a new decision for the sequence. For additional information on the UDOC screen, see MSOM BUSSR 004.007.
f.

After selecting all required sequences, you will see the Overpayment Decisions (UOPD) screen. Select “6” – “Uncollectable” and enter the amount of the O/P removal in the “Decision Amount” field. This action will place an N TAC on the OPDD segment of the SSR. For additional information on the UOPD screen, see MSOM BUSSR 004.008.
g.

Annotate the SSR with the following remark: “Martinez settlement T16 pre-2007 – overpayments removed”.

NOTE: If you are removing an O/P amount for more than $20,000, follow normal processing instructions stated in SI 02220.005.

E. When a recipient responds more than 6 months after the notice date

If a recipient contacts us more than 6 months after the date of the Title XVI (T16) Martinez informational notice to file an application seeking a protective filing date of April 1, 2009, consider good cause for late filing. Use the following instructions once a determination is made on the good cause for late filing request.

1.

If you find good cause, follow instructions for processing an application in GN 02613.880C.1 – C.3 in this section.
2.
If you do not find good cause, take the following actions:
1. a.
  
  Send the recipient an SSA-8165-U2 (SSI Notice of Decision) located in the Document Processing System (DPS) explaining why we do not find good cause for late filing, but that we can consider the request for good cause as protective filing for a new application. In accordance with normal rules, the good cause notice will contain appeal rights since this is an initial determination.
2. b.
  
  Treat the request for good cause as a request for a new application based on SI 00601.020A.2. The protective filing date for the new application is the date we received the good cause request.
3. c.
  
  Include an SSA-L991 (SSI Informal Denial Notice) located in DPS to close out the protective writing. The protective filing date on the SSA-L991 will be the date we received the good cause request.

F. Exhibit of the Title XVI (T16) pre-2007 Martinez notice

The following informational notice released on September 10, 2010 and May 20, 2011, informed the recipient of the Martinez settlement and potential eligibility for relief.

Social Security Administration

Supplemental Security Income

Important Information

Field Office

P.O. Box 2000

Minot, ND 58701

Date: MM/DD/YYYY

Claim Number: XXX-XX-XXXX

Edgar Eight

200 88 Ave SE

Minot, ND 58701

You may be a class member in a recently settled court case called Martinez v. Astrue. The Martinez settlement changes the types of felony arrest warrants that we will use to suspend or deny Supplemental Security Income (SSI) payments. This settlement does not apply to persons whose benefits we stopped because of an arrest warrant for a parole or probation violation.

As of April 1, 2009, we suspend or deny payments for only certain types of felony arrest warrants relating to flight or escape.

Based on this settlement, if we stopped paying you on or after January 1, 2000, and before January 1, 2007, because of certain types of felony arrest warrants:

•

We will remove any remaining fugitive felon overpayment balance on your record. You do not need to contact us about this.
•

We may start payments if you were not getting payments as of April 1, 2009 and you are still eligible for SSI. If you call us within 6 months of the date of this letter and you qualify, we can start payments as far back as April 1, 2009. You may have to file a new application to qualify for SSI payments. For more information about these payments, you must call us at 1-800-772-1213.

If You Have Any Questions

For general information about SSI, please visit our website at www.socialsecurity.gov on the Internet. You will find the law and regulations about SSI eligibility and payment amounts at www.socialsecurity.gov/SSIrules.

For general questions about SSI or specific questions about your case, please call us at 1-800-772-1213. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. If you need assistance for any reason, you can also write or visit any Social Security office. The office that serves your area is located at:

SSA

123 Main St.

Your Town, XX 12345

If you do call or visit an office, please have this letter with you. It will help us answer your questions.

SI USTED HABLA ESPANOL

Si usted habla español y no entiende esta carta, por favor llame o visite su oficina local de Seguro Social. Un representante de la oficina de Seguro Social le explicará esta carta. Debe informarle que usted está respondiendo al aviso, Martinez v. Astrue.

Regional Commissioner

Social Security

Program Operations Manual System (POMS)

GN 02613.880 Title XVI Pre-2007 Martinez Settlement Relief Processing