TN 1 (12-11)

DI 27525.020 Reinstating Benefits When a Beneficiary Alleges Improper or No Due Process

A. Beneficiary alleges improper or no due process

If the beneficiary or his or her representative alleges that we did not give due process, or we gave it improperly, review the case. If review of the case confirms the allegation, the FO should reinstate benefits from the date of the original suspension or termination action. The beneficiary remains in payment status pending the final determination made on his or her claim, in accordance with the due process procedures in DI 27525.000.

Process the case as if we gave no due process and provide remedial due process as in DI 27525.020B in this section if:

  • due process documentation is not in the official claims folder; or

  • the case contains a copy of the due process notice we sent, but the case also reflects a bona fide reason for the beneficiary not receiving the notice (e.g., change of address, recent hospitalization).

NOTE: Failure to reinstate benefits could result in a court action to redress a denial of the beneficiary's rights. The Disability Determination Services (DDS) may also receive cases from SSA central office for corrective action under this section.

B. DDS actions for providing remedial due process

  1. Begin remedial due process action immediately after discovery of the error.

  2. If the case is electronic, use the electronic assistance request in eView to send the request to the field office (FO). For paper cases, email, fax, or telephone the FO or program service center (PSC) to request reinstatement of benefits (if the field office has not already done so).

    NOTE: Request that the FO reinstate Supplemental Security Income (SSI) payments. Do not contact the Program Service Center (PSC) to reinstate SSI cases.

    The contact must contain the following:

    • Title -- title reinstatement (i.e., title II or title XVI)

    • Claim Account Number (CAN) (i.e., the SSN for the claim in question)

    • Beneficiary Identification Code (BIC) that is assigned to the beneficiary (include BICs for auxiliaries, if applicable, see SM 00550.010 Beneficiary Identification Codes (BIC) and Payment identification Codes (PIC))

    • · Surname followed by the beneficiary’s given name

    • Event date (the month of reinstatement) same as month of suspension or termination

      Example:

      Title II reinstatement-please reinstate title II payments for: CAN 000-00-0000, BIC-A, Name Jackson, Thomas, Event Date 10/98.

  3. Send a notice, prepared on DDS letterhead or the appropriate blank SSA letterhead, to the beneficiary and auxiliaries informing them of the error and corrective action. Include the following statements:

    • We will resume benefits to correct a processing error and we will send the beneficiary a check; and

    • We will contact him or her later about continuing entitlement to benefits.

The FO or PSC reinstates benefits shortly after receipt of the electronic action request, email, fax, or telephone contact. Assume that payments resumed by the 15th day. On the 15th day after making the contact, send the remedial due process letter. Follow the same pre-determination notice requirements and procedures outlined in DI 27525.005A.

C. Office of Disability Operations (ODO) action for providing remedial due process

The claimant or his or her representative may allege improper suspension or termination actions. If it is found that benefits were suspended or terminated without proper due process or if there is some other issue regarding the advance notice sent, reinstate benefits from the date of the suspension or termination action and return the beneficiary or recipient to current payment status pending correction of the due process element using the due process procedures. After reinstating the benefits, transfer the case to the DDS or FO for remedial due process action. See DI 81001.045.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427525020
DI 27525.020 - Reinstating Benefits When a Beneficiary Alleges Improper or No Due Process - 12/06/2011
Batch run: 12/06/2011
Rev:12/06/2011