In a title XVI only claim, "past-due benefits" are the total amount of Federal and Federally administered State payments accumulated to the claimant and his or her spouse (i.e., Supplemental Security Income (SSI) couples case) because of a decision favorable to the claimant, through the month of effectuation (GN 03920.030D defines "month of effectuation") of a favorable administrative decision, including any amounts sent to a State/subdivision under an interim assistance reimbursement (IAR) agreement, minus any benefits listed in GN 03920.031C. (See GN 03920.060 for policy on past-due benefits in court level cases.)

In a title XVI couples case, each member of the couple must establish whether he/she is blind, aged or disabled. In addition, the couple is considered jointly eligible and the income and resources for both members are considered in determining eligibility and payment for both. The couples SSI benefit is computed as one amount, but divided equally between the members of the couple for payment. Therefore, SSA includes in the claimants title XVI past-due benefits those payments accumulated to the claimant (first member of the couple) and his/her spouse (second member of the couple) if:

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  SSA finds the second member of the couple eligible and subsequently finds the first member eligible and the first members eligibility results in an increase in the second members benefits; or

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  SSA finds the second member ineligible due to an income/resource issue, and later finds the second member eligible due to the first members eligibility.

Refer to GN 03940.052 for guidance on calculating past-due benefits in fee agreement SSI couples cases.

The past-due benefits amount in the title XVI portion of concurrent claims is the same as the amount in title XVI only claims, except for the purposes of withholding and calculating fees for representation, SSA reduces the title XVI past-due benefits amount by the title XVI offset amount for the same period, regardless of whether the actual offset, as provided under 1127 of the Act, reduces the title II or title XVI benefits. (See GN 02610.053 for an explanation of offset and representative's fees. See GN 03940.050B for an explanation of how to calculate the title XVI past-due benefits in concurrent fee agreement cases. GN 03920.030 defines title II past-due benefits.)

SSA calculates past-due benefits for withholding for direct fee payment and for authorizing a fee under the fee agreement process using the beginning and ending periods shown in the partially favorable decision. If on appeal SSA makes a more favorable or less favorable decision, SSA will adjust the past-due benefits for purposes of withholding for direct fee payment and authorizing a fee under the fee agreement process.

SSA will adjust past-due benefits by the amount of any overpayment that occurred between the date of eligibility, and

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  For administratively decided cases, the month before the month SSA effectuates the favorable decision or determination; or

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  For court cases, the month before the month of the courts judgment.

In a post-eligibility action, a current overpayment is an overpayment that occurs during the period encompassed by the issue for which the claimant was represented.

SSA will adjust only the past-due benefits of the claimant or the claimants eligible spouse, if the spouses eligibility resulted from the claimants eligibility or if the spouses benefit increased as a result of the claimants eligibility. If the spouse is currently overpaid, SSA will adjust only the spouses past-due benefits amount, not the claimants past-due benefits.

SSA will not adjust title XVI past-due benefits for overpayments arising during a period of time not adjudicated by the favorable determination or decision.