Following a Favorable Decision

AuthorThomas E. Bush
Chapter 4
Following a Favorable
§400 Check the Decision and Contact Your Client
§410 Peculiar Problems in Concurrent Cases
§420 SSI Issues
§430 Calculating the Amount of Back Benefits
§440 Payment Issues
§450 Fleeing Felons
§460 Post-Entitlement Issues
§470 Overpayments
§480 Continuing Disability Review and Termination of Eligibility for Disability Benefits
§400 Check the Decision and Contact Your Client
§401 Favorable Decision Checklist
§402 Form: Favorable Decision Summary/Worksheet
§403 Sample: Letter to Title II Claimant After Receipt of Favorable Decision
§404 Sample: Letter to Concurrent Claimant After Receipt of Favorable Decision
§404.1 Sample: Letter to Concurrent Claimant After Receipt of Favorable Decision — SSI Stops
§404.2 Sample: Letter to SSI-Only Claimant After Receipt of Favorable Decision
§405 Sample: Letter to Social Security Office Requesting Copies of SSI Notices
§406 Sample: Letter to ALJ re: Failure to Issue Order Approving or Disapproving Fee Agreement
§407 Sample: Notice of Intent to File Fee Petition
§408 The Bad Address Problem
§409 Amending the Decision
§410 Peculiar Problems in Concurrent Cases
§411 The Odd Way That SSA Processes SSI When There Are Concurrent Applications
§412 Check for SSI Eligibility During the Five-Month Waiting Period During Which No Social Security Disability
Benefits Are Payable
§413 Determining SSI Eligibility After the Five-Month Waiting Period
§414 Consider the State Supplement
§415 The Impact of Welfare Recoupment
§416 The Strange Case of the SSI Eligible Couple
§417 What Is the Lawyer’s Duty to Advise Withdrawing an SSI Application?
§418 Form: Request for Withdrawal of Application (SSA-521)
§419 SSI Benefits Should Be Recalculated After Payment of Attorney Fees
§420 SSI Issues
§421 SSI Income: Anything in Cash or In-Kind
§422 In-Kind Support and Maintenance
§423 The One-Third Reduction Rule: Living in Another Person’s Household
§424 The Presumed Value Rule
§425 Informal Cash and In-Kind Loans
§426 POMS SI 01120.220D — Policy — Requirements for a Bona Fide Informal Loan
§427 POMS SI 00835.482A and B — Loans of In-Kind Support and Maintenance
§428 Retrospective Budgeting
§429 Installment Payment of SSI Back Benefits
§430 Calculating the Amount of Back Benefits
§431 Form: Past-Due Benefits or Attorney Fees Worksheet
§432 Date of Entitlement
§433 Claimant’s Benefit Amount
§434 Auxiliary Benefits
§435 Closed Period
§436 Disabled Widow(er)’s Benefits
§437 Workers’ Compensation and Public Disability Benefit Offset
§438 Only Certain Public Disability Benefits Are Included in the Offset Calculation
§439 Suspension of Payment When the Claimant Goes to Jail
§440 Payment Issues
§441 When It Takes Too Long for Benefits to Be Paid
§442 Dealing With SSA by Telephone
§443 Underpayments
§444 Chart: OCO Manager and Deputy Telephone and Fax Numbers
§445 Chart: Program Service Center Addresses and SSN Jurisdiction
§446 Chart: Program Service Center Phone Numbers
§450 Fleeing Felons
§460 Post-Entitlement Issues
§461 Memorandum to Claimant Re: Working Part-Time After You’ve Been Found Disabled by SSA
§470 Overpayments
§471 A Legal Challenge to the Overpayment — Appeal
§472 Request Waiver of the Overpayment
§473 Fault
§474 Defeat the Purposes of Title II/Title XVI
§475 Against Equity and Good Conscience
§476 Overpayment Recovery Questionnaire
§477 Form: Request for Waiver of Overpayment Recovery or Change in Repayment Rate (SSA-632)
§478 Adjustment or Recovery of Overpayment
§479 Compromise Payment
§480 Continuing Disability Review and Termination of Eligibility for Disability Benefits
§481 Benefit Continuation
§482 Face-to-Face Reconsideration Hearings
§483 The Continuing Disability Review Evaluation Process — Overview
§484 Chart: CDR Evaluation Process Summary Chart From POMS DI 28005.010
§485 Points of Comparison and Cessation Month
§485.1 Chart: Cessation Month POMS DI 28005.205
§486 Is There Medical Improvement?
§487 Is Medical Improvement Related to Ability to Work?
§488 Exceptions to Medical Improvement
§489 When Medical Improvement Is Found Related to Ability to Work
§489.1 Chart: Is DAA Material? From POMS DI 28005.040
§490 Cessation of Benefits Because of Performance of Substantial Gainful Activity
§491 Recipient Eligible for Trial Work Period?
§492 Will SSA Conduct Medical Review During Trial Work Period?
§493 At Conclusion of Trial Work Period
§494 Extended Period of Eligibility/Reentitlement Period
§495 Expedited Reinstatement
§496 Working SSI Recipients
§400 Check the Decision and
Contact Your Client
When you receive any favorable decision, check it
against your file to make sure it really is “fully favorable.”
Don’t rely on the cover sheet of the decision. Sometimes
a cover sheet will identify a partially favorable decision
as fully favorable and vice versa. If the decision is less
than fully favorable, that is, it fails to give the claimant
everythin g for which the claimant asked and to which the
claimant is entitled, you will need to evaluate the appeal
possibilities. See §508, infra, on appealing the partially
favorable decision. But before you launch an appeal, make
sure that the problem you perceive with the decision is not
the product of a simple error by someone in the hearing
office. It is not uncommon for an error to appear in a
decision which, if caught early, can be corrected before the
error affects receipt of benefits without a formal appeal.
If you wait, sometimes a simple error can turn into a
monumental delay. For this reason, it is imperative that
all decisions be reviewed carefully when you receive
A typographical error in the final paragraph of
the decision, known as the “decisional paragraph,”
concerning the onset date or sometimes even the date of
application can result in your client getting an incorrect
amount of back benefits. Such errors can also delay
payment of benefits. The error may be caught just as a
payment center is getting ready to pay benefits, causing
the payment center to request an amended decision
from the ALJ before processing payment. Or worse
yet, the payment center may refer a case to the Appeals
Council “because it contains a clerical error affecting
the outcome of the claim.” 20 C.F.R. § 404.969(b)(2).
If, for example, the body of the decision consistently
discusses one onset date but the decisional paragraph
states another date, the decisional paragraph contains
a typographical error that can be corrected simply by
bringing it to the attention of the ALJ. It is not reasonable
to assume that the error will be caught when back benefits
are calculated and an order is issued to pay benefits,
called “effectuating” the decision by SSA. And if the
error is detected at the payment center, payment will
be held up while the ALJ is contacted for clarification.
Something as seemingly minor as an incorrect
claimant’s address on the face of the decision has been
known to delay receipt of back benefits for months in
Title II cases. If the check for back benefits is sent to
a wrong address, it may be returned to the Treasury. It
may be a long time before it is reissued.
Section 401, infra, is a checklist for making sure
there are no errors affecting benefits and to trigger
further action as required. Section 402 contains a
worksheet for identifying payment and attorney fee
issues and summarizing actions taken. In §431, infra,
is a worksheet for calculating back benefits to double-
check SSA’s calculations.
§401 Favorable Decision Checklist
1. Check the claimant’s address. See §408, infra, if
the address is wrong.
2. Check the date of application recited in the
decisional paragraph.
a. Does the file contain an application that
corresponds to that date?
b. Was there an earlier protective filing date that
should have been used? See §205.1 of this book on
protective filing date.
i. Title II cases: protective filing date matters
only if a claimant became disabled more than 17 months
before the date of application.
ii. SSI cases: protective filing date frequently
matters. (It doesn’t matter for applications filed after
August 22, 1996 when the protective filing date is in
the same month as the actual application date or when a
claimant becomes disabled after the actual filing date.)
c. Did the ALJ overlook a request to reopen an
earlier application? Note that a request to reopen can be
implied. See §376, supra.
3. Check date of onset of disability in the decisional
a. Is it the same as the onset date alleged in the
claimant’s application?
b. Did the ALJ overlook a request to amend the
onset date to a date different from that alleged in the
c. If the onset date in the decisional paragraph is
different from that alleged, does it represent a deliberate
finding or a typographical error? Does it coincide with
the discussion in the body of the decision?
4. If the decision is not fully favorable, calendar it
for 45 days to evaluate appeal to the Appeals Council.
See §508, infra.
5. If the decision contains any errors that may affect
payment, immediately request that the ALJ issue an
amended decision. See §409, infra.
6. Calculate the date of entitlement to benefits. See
§432, infra.
7. Check your client’s earnings record to find out the
PIA, which is the benefit amount. See §205.4, supra,
and §433 of this book.
8. Check your file to see if your client has children
who will be entitled to auxiliary benefits. If so, advise
your client to see that applications are submitted. See
§435, infra.

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