GN 02613.865: Title II Post-2006 Martinez Settlement Relief Processing

changes
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~~Effective Dates: 10/07/2016 - Present~~
Effective Dates: 10/30/2017 - Present
TN 13 (05-11)
GN 02613.865 Title II Post-2006 Martinez Settlement Relief Processing
The settlement agreement provides retroactive benefits for beneficiaries whose benefits were suspended (S9 HRFST FUGFEL or had an open FUGITIVE data event on the MBR) on or after January 1, 2007. It also provides retroactive benefits for beneficiaries who would have been suspended (S9 HRFST FUGFEL or had an open FUGITIVE data event on the MBR) if a lower priority suspension was applied (e.g., no current address). We list class members eligible for post-2006 relief on the Civil Action Tracking System (CATS) with a Court Case Identifier (CCID) of F1. We resumed most of these class members’ benefits retroactively to the first month of fugitive felon suspension.
An exhibit of the Title II (TII) post-2006 informational notice is in GN 02613.867A. Language for use in automated relief and resumption notices is listed in GN 02613.867A.1.
A. Processing Center (PC) post-2006 resumption exception processing
1. Post-2006 exception relief processing
Some automated resumption actions excepted or resulted in a Title II Redesign (T2R) processing limitation (PROC LIM) thereby requiring manual processing. When an exception occurred, the class member’s case went to Processing Center Action Control System (PCACS) with a FELRESU TOEL date of 12/21/09 or 12/22/09. For information about PCACS, refer to MSOM PCACS 001.001 - PCACS 014.008.
PCs should make it a priority to process the PCACS cases with TOEL of FELRESU. If the field office (FO) determines a Martinez case requires immediate action by the PC, the field office should use the Manager-to-Manager system to notify the PC. PCs should make every effort to prioritize Martinez cases in Manager-to-Manager and work them immediately.
NOTE: In some instances, a higher priority suspension event may supersede the fugitive felon suspension issue (e.g., prisoner suspension LAF S7, etc.) You must still close out the FUGITIVE data line on the Master Beneficiary Record (MBR) for offense codes other than 4901, 4902, 4999, 8101, 8102, 5011, or 5012 to ensure unwanted future fugitive felon suspensions actions will not occur. You will find more information about higher priority suspension actions in GN 02602.025.
2. Multiple warrants
Review and process each outstanding warrant suspension determination independently based on the date of the SSA initial or administrative review decision made on each warrant decision.
NOTE: The Martinez settlement does not affect SSA policies and procedures on cases involving unsatisfied arrest warrants for violation of probation or parole. You can find a list of the warrant offense codes that are not covered by the Martinez settlement retroactive relief process in GN 02613.885B.4.
3. No social security benefits for prisoners
A new provision of the Social Security Act prohibits paying retroactive payments to recipients or beneficiaries while they are subject to nonpayment because of prisoner suspension, fugitive felon suspension (offense codes 4901, 4902, or 4999), or for violating a condition of their probation or parole (offense codes 5011, 5012, 8101, or 8102). For all initial claims and post entitlement Martinez relief actions, review the Prisoner Update Processing System Data (PUPS) or the Fugitive Felon System Control File (FFSCF) to determine the recipient’s or beneficiary’s status prior to releasing any retroactive benefits. Refer to EM-10013 SEN, No Social Security Benefits for Prisoners, for instructions.
4. Applying other statutory suspension events
There is a priority order for applying terminations and nonpayment, reduction, deduction, and withholding events to monthly title II benefit amounts. For more information on the priority of applying terminations and nonpayment, reductions, and withholding events, go to GN 02602.025.
5. Prior overpayment waiver approvals
Carefully review the ROAR segment of the MBR to check for prior overpayment waiver approval actions for fugitive felon (TOE 73) suspension overpayments incurred after 01/01/07. Do not release any retroactive benefits for the fugitive felon suspension period insofar as we have previously waived an uncollected overpayment.
B. PC instructions for resuming benefits when an exception occurs
Review the PCACS action with the FELRESU TOEL and process as follows:
* Resume benefits via MACADE. The FFEL data input via the automated processing updates to TII Shared. Therefore, when the FFEL screen appears, the updated data propagates to the screen. Verify this data before processing the MACADE transaction. Do not delete the FFEL data.
* Release the Martinez underpayment without regard to the presence of a Windfall Offset data (WOD) line on the MBR.
* Do not prepare a fugitive felon good cause determination.
* Send a resumption notice via MADCAP. Add to the notice the additional post-2006 Martinez relief caption and paragraph in GN 02613.867A.3.
C. Processing of post-2006 TII Martinez class members who have a representative payee
1. Policy
Current policy requires that before reinstating benefits to a representative payee following a period of suspense of six months or more, SSA must contact the representative payee on the beneficiary’s record. Determine the beneficiary’s current situation and the representative payee’s continued suitability to serve as representative payee. The instructions for developing a suitable payee are in GN 00504.160. Contact the beneficiary to verify that the representative payee and beneficiary still have a relationship that suggests this representative payee is still suitable.
2. Identification of Martinez settlement cases with a representative payee
The Office of Systems identified title II post-2006 Martinez cases and automated the payment for most cases. Beneficiaries in S9 FUGFEL status, who have representative payees on the MBR, had their payment status converted from S9 FUGFEL to S8 RPFUGF effective with the current operation month (COM). T2R placed any payable retroactive benefits due for the period of S9 FUGFEL in the Special Pay Accrual (SPA) field on the MBR pending development of the suitability of the current representative payee for the beneficiary.
SSA identified and monitored the Martinez settlement cases involving representative payees by using the S8 Tracking Application. The Office of Systems identified monthly cases that were in S8 status on the MBR and posted them to the Management Information Services Facility (MISF). The New York Regional Office’s management information (MI) staff extracted the data and posted it to the S8 Tracking Application (website). Each FO is responsible for monitoring the website and resolving cases in its jurisdiction. Once we removed the beneficiary or recipient from S8 status, we did not identify the case in the next month's run.
3. Process for developing continuing suitability of representative payee
Process the S8 alerts as follows:
Step
Action
1
* Review the MBR to verify that the beneficiary or recipient is still in S8 status. Check to be sure that there are not open events on the MBR in the FUGITIVE or PRISON data lines. If the beneficiary is still in S8 and there are no open events on the MBR in the FUGITIVE or PRISON data lines, then go to step 2.
* If there is an open event in the FUGITIVE data line or the PRISON data line, leave the beneficiary in S8 status and do not develop for continuing suitability of the current representative payee until the open event on the MBR for the FUGITIVE or PRISON data line is closed.
* If the payment status is now current pay and we released the retroactive payments, no action is necessary.
2
Query the Representative Payee System (RPS) to determine the status of the record.
3
If there is a current pending representative payee (RP) application, process it to completion.
If you approve the payee application, once the RPS system updates the new RP information to the MBR, the payment system will automatically release the underpayment to the new RP.
If you deny the payee application, go to step 4.
4
If there is no current pending RP application in the RPS system:
* Review the information to make sure there are no negative indicators that would suggest the payee of record is no longer suitable to serve.
* Use the information from the MBR, contact the payee of record to determine if he or she still has a relationship with the beneficiary and to obtain the current residence of the beneficiary.
* Contact the beneficiary to verify the beneficiary and representative payee relationship.
* Consider whether the beneficiary continues to need a payee or not. You can locate the instructions in GN 00502.020A.
* If the need for a representative payee continues and you determine that the current representative payee is suitable, document your findings in the Relationship Special Text (RLST) screen of the RPS. See MSOM RPS 002.022. Reinstate the TII benefits using the instructions in GN 00504.160C.2.
* If the need for a representative payee continues and you determine that the current representative payee is not suitable, or there is no longer a relationship with the beneficiary or the current representative payee does not know the whereabouts of the beneficiary, develop for a new representative payee per GN 00502.100.
* Record on the RP Report of Contact (RPRC) screen (MSOM RPS 003.006) the results of the investigation and the recommendation.
* Develop for a successor payee, as necessary.
Processing of a new RP within the RPS system updates the MBR and automatically releases the underpayment.
5
If you are unable to find a suitable representative payee and direct payment is not permissible, leave the beneficiary in S8 status while you continue efforts to locate a suitable representative payee.
Document your efforts in the Special Message field of the MBR (MSOM T2PE 007.008) or institute direct payment per GN 00504.105 and GN 00504.185.
6
If you determine that a representative payee is no longer necessary, secure a Request to Be Selected as a Payee Application, SSA-11, from the beneficiary.
Follow instructions in GN 00504.105.
Once this action processes through RPS, the system automatically releases the underpayment.
4. Reinstating monthly TII benefits from suspension
Instructions for reinstating monthly TII benefits from representative payee development suspension are in GN 00504.160C.2.
D. PC processing of closed period post-2006 Cases
1. Identifying class members eligible for relief
The settlement agreement provides for payment of retroactive benefits to beneficiaries whose benefits were:
* suspended (S9 HRFST FUGFEL) for some period between 01/01/05 through 12/31/06; and
* who were notified of the fugitive felon nonpayment decision on 1/1/07 or later.
We listed these class members on CATS with a Court Case Identifier (CCID) of F1.
2. Notifying class members of potential relief
Send a manual informational notice to the class members eligible for post-2006 relief based on a closed period of fugitive felon suspension relief. The informational notice is available in AURORA, Exhibit Number E4002. The instructions for generating the informational notice via AURORA are in GN 02613.867B.
Shortly after release of the informational notice (E4002), resume benefits for the closed period of fugitive felon suspension to these class members.
3. Resuming benefits for a closed period of post-2006 relief
We annotated these class members on CATS with a CCID of F1. PC management distributed the list of closed period post-2006 relief cases to ensure that PC personnel would take the following actions.
a. Review of SSA records for the closed period of fugitive felon suspension
For each closed period record:
* Review the closed period of fugitive felon suspension annotated to the MBR. The period of S9 with the HFRST of FUGFEL should appear on the MBR any time between 01/01/05 through 12/31/06. The FUGITIVE data line on the MBR should reflect that the warrant has a stop date equal to 12/2006 or earlier.
* Check the warrant data on the FUGITIVE data line on the MBR and on the FFSCF to ensure that the warrant offense code is other than 4901, 4902, 4999, 5011, 5012, 8101, or 8102.
NOTE: In some instances, a higher priority suspension event may supersede the fugitive felon suspension issue (e.g., prisoner suspension LAF S7, etc.) Close out the FUGITIVE data line on the MBR for offense codes other than 4901, 4902, 4999, 5011, 5012, 8101, or 8102 to ensure unwanted future fugitive felon suspensions actions will not occur. You will find more information about higher priority suspension actions in GN 02602.025.
* Determine the date that we notified the beneficiary of the fugitive felon suspension decision. The initial suspension determination notice will be on the Online Retrieval System (ORS).
If the date on the notice is before 01/01/07, the case is a pre-2007 case. You can find the instructions for processing pre-2007 Martinez relief cases in GN 02613.868.
If the date on the notice is 01/01/07 or later, you can locate the case processing instructions in GN 02613.865D.3.b. in this section.
If you cannot find the notice in ORS, review the record and find the MADCAP/MACADE entry that placed the beneficiary in fugitive felon suspension. This processing action will provide the notice information that we automatically added on the beneficiary notice. The notice date for this action will be five days from the date of the MADCAP/MACADE processing date for the fugitive felon suspension action.
b. Reinstating benefits for the closed period of fugitive felon suspension
Process the actions for reinstatement of benefits for the closed period as indicated in the chart below:
Steps
Required Actions
1
Send the class member a post-2006 informational notice. Prepare a manual information notice via AURORA (E4002). Instructions for issuing the notice are in GN 02613.867B.
Once the notice is prepared, date and then release the notice.
Send a copy of the notice to ORS.
2
Hold the case for two days to allow for mailing and delivery of the manual informational notice.
Do not prepare a fugitive felon good cause determination.
3
From the FFSCF:
Annotate the new warrant disposition to the FUGITIVE FELON WARRANT DUE PROCESS/ GOOD CAUSE (FFDG) screen. In the update mode, enter the mandatory entries and then enter the: GOOD CAUSE DETERMINATION section of the screen:
GOOD CAUSE ESTABLISHED(Y/N): Y
IF YES, GOOD CAUSE REASON: CRT
good cause decision date (mmddccyy): 99999999 (place current date in this date field)
REMARKS: Post-2006 Martinez settlement Relief. Post-2006 relief applies for closed MM/YY to MM/YY.
4
Use MADCAP/MACADE to resume benefits for the closed period of post-2006 Martinez settlement relief.
Select the dates for the closed period of fugitive felon suspension that you will now resume for the beneficiary (MM/YY to MM/YY) for MACADE history accrual.
From the MACADE HST screen:
* Enter ENT in the TRANSFER TO field
* Select function #31 FUGITIVE FELON (FFEL) on the ENTITLEMENT AND ELIGIBILITY MENU
5
On the FFEL screen in MACADE, annotate the following entries:
GOOD CAUSE ESTABLISHED (Y/N): Y
If YES, GOOD CAUSE REASON: CRT
Good cause decision date (mmddccyy): 99999999 (place current date in this field)
Annotate SP MSG Remarks for the MBR: Martinez Post-2006 Closed Period Relief. Post 2006 relief applies for closed period of MM/YY to MM/YY.
6
Send a closed period resumption notice via MADCAP. Add to the notice the additional post-2006 Martinez relief caption and paragraph in GN 02613.867A.3. Follow the instructions for processing requests for special notices for blind or visually impaired claimants and beneficiaries as indicated in EM-09088 SEN dated 12/31/09 and EM-10021 SEN dated 03/17/10.
4. Multiple warrants
Instructions for processing cases with multiple warrants are in GN 02613.865A.2. in this section.
5. Processing cases that show current prisoner, fugitive felon, or probation or parole violation status
Do not pay underpayments to beneficiaries who are in prisoner, fugitive felon or probation or parole violator suspension. Instructions for processing these cases are in GN 02613.865A.3. in this section.
6. Other case processing items
Information regarding other case processing issues (e.g., Medicare, CDRs, etc.) is in GN 02613.870.
E. Appeals Case Processing
Beneficiaries who were suspended for “fleeing to avoid prosecution or custody or confinement after conviction” for a felony (arrest warrants with offense codes other than 4901, 4902, 4999, 5011, 5012, 8101 or 8102) prior to 01/01/07, but who had a pending appeal or an administrative appeal determination related to the fugitive felon suspension issue on or after 01/01/07, are included in the post-2006 Martinez class. For more information on the terms of the Martinez Settlement for administrative appeals, see GN 02613.860B.3.
1. Identifying class members
The Office of Systems identified appeals cases. The identification of beneficiaries was over-selective to capture every beneficiary requesting any type of fugitive felon suspension or overpayment appeal.
We listed these class members on the CATS with a CCID of F3 Title II Appeals. Processing Center (PC) management distributed the list of F3 Martinez settlement appeals cases so PC personnel could take the following actions.
2. Queries on fugitive felon suspension or overpayment appeal issues
a. Review the MBR data
Review the following data on the MBR for these selected cases:
MBR Data
Review of MBR Data
CO MSG1 line
MARTINEZ COURT CASE APPEALS REVIEW
HISTORY line
S9 payment history months with the HFRST of FUGFEL anytime between 01/01/05 through 12/31/06. See GN 02613.868B.3. for more information on reviewing the MBR.
FUGITIVE line
Check the warrant data. The warrant offense code must not be 4901, 4902, 4999, 5011, 5012, 8101, or 8102. See GN 02613.868B.3. for information on reviewing the MBR.
b. Review the Recovery Overpayment Accounting Record (ROAR) data
Review the ROAR record on the bottom of the MBR to determine the appeal history of your case and the date the beneficiary requested his or her appeal.
ROAR
Review Action
BENEFIT line
Find the current balance due for all overpayments for the beneficiary in BBAL-$$$$$ field.
EVENT line
Find the Event Identifier (EI) for the fugitive felon overpayment (e.g., 01, 02) for fugitive felon warrant in the administrative appeal fields.
Find the Type of Event (TOE) for the fugitive felon overpayment on the EVENT data line, (e.g., T2 FUF SUS/FEL WAR, OTHER OR CONSOLIDATED LDO).
Find the STATUS of the current recovery effort for the fugitive felon overpayment (e.g., BEN ADJ, DUE PROCESS).
HISTORY line
Determine when ROAR received the fugitive felon overpayment amount and the administrative appeal in these fields. Check:
RUN DATE = date of administrative appeal at the field office.
TRANS = 23
AMOUNT = fugitive felon overpayment amount
SRC = 3—DO DOCXXX
WRI-W--WAIVER REQUEST,
or
WRI - R – RECON REQUEST
WRI – H –HEARING REQUEST
NOTE: The RUN DATE must be 01/01/07 or later.
Example of a waiver request on ROAR:
RUN DATE = date of the administrative appeal (waiver request on the fugitive felon overpayment) at the field office.
TRANS = 23
AMOUNT = fugitive felon overpayment amount
SRC 3—DO DOCXXX
WRI- WAIVER REQUEST
Then followed by the personal conference date:
(ROAR data same as above example except for the following items.)
WRI-P- PERSONAL CONF
SOURCE-XXX WHLD-100.00 COM – 01/07
NOTE: The final decision (e.g., personal conference) HISTORY RUN DATE entry must be 01/01/07 or later to qualify for post-2006 Martinez settlement relief. The HISTORY RUN DATE entry must be 01/01/07 or later if the WAIVER REQUEST is the only action annotated to ROAR for the T2 FF SUS/FEL WAR overpayment to qualify for post-2006 Martinez settlement relief.
NOTE: An entry of INFORMAL WAIVER or PART W/H REQUEST on ROAR means the person inquired about waiver but did not request a waiver, or the person asked about recovery through partial withholding. Neither effects an administrative appeal. If that entry is the last entry, give the beneficiary pre-2007 Martinez relief. Process the pre-2007 Martinez relief for this CCID F3 case following the instructions under GN 02613.865E.7.e. in this section.
Example of ROAR History:
Example 1
RUN DATE TRAN AMOUNT SRC
12/23/05 12 $6705.40
08/11/06 23 $6705.40 3--DO DOC-C51
WRI-N--INFORMAL WAIVER
09/14/06 43 $0.00 SOURCE-C51 WHLD-775.00 COM-10/06
SSC-2
10/19/06 23 $6705.40 3--DO DOC-C51
WRI-W--WAIVER REQUEST
01/03/07 23 $6705.40 3--DO DOC-C51
WRI-P--PERSONAL CONF HLD – 100.00 COM – 01/07
The last administrative appeal decision on this case on 01/03/07.
Example 2
RUN DATE TRAN AMOUNT SRC
11/15/06 12 $9515.00
11/29/06 23 $9515.00 3--DO DOC-927
WRI-N--INFORMAL WAIVER
01/29/07 41 $250.00 SOURCE-927 WHLD-250.00 COM-03/07
LST WH-03/07 SSC-2
04/09/07 23 $9265.00 3--DO DOC-927
WRI-A--PART W/H REQUEST
04/10/07 41 $1350.00 SOURCE-927 WHLD-30.00 COM-05/07
LST WH-01/11 SSC-2
07/01/09 22 $584.00 SSC-T
The beneficiary did not administratively appeal. The final determination made on the T2 FF SUS/FEL WAR issue was an overpayment determination on 11/15/06. This case qualifies for pre-2007 Martinez settlement relief instead. Process cases similar to this situation following the instructions under GN 02613.865E.7.e. in this section.
Carefully review the HISTORY line on the ROAR record for all periods of administrative appeal. Determine the last level of appeal that the beneficiary requested (i.e., waiver or reconsideration request, Administrative Law Judge (ALJ) hearing or Appeals Council (AC) review) for the fugitive felon overpayment based on your review of the ROAR record.
Next, determine the last date of the administrative appeal request:
Status of Administrative Appeal Decision
Determination for Appeal Date
closed (PC, ALJ or AC decision on appeal) or
closed (FO decision on waiver) (no higher administrative appeal requested)
Appeal date equals the date of the determination for the last highest level of appeal of the fugitive felon suspension overpayment.
pending (no PC, ALJ or AC decision) or
pending (no final waiver decision) (no higher administrative appeal requested)
Appeal date equals the date that the beneficiary filed his or her latest request for administrative review, but there is no final decision on the administrative review now.
Then, process the information for the beneficiary’s last level of appeal per the instructions in this section for that particular level of appeal.
Waiver or PC Reconsideration appeal cases
Process waiver or reconsideration appeal cases under GN 02613.865E.3. in this section.
NOTE: If the last administrative appeal is at the ALJ level, obtain an administrative appeal query before processing the case to learn the status of the administrative appeal. Review the administrative appeals query system in GN 02613.865E.2.c. in this section.
ALJ hearings
To process ALJ cases, see GN 02613.865E.4. in this section.
AC cases
To process AC appeal cases, see GN 02613.865E.5. in this section.
c. Review the Case Processing and Management System (CPMS) or Appeals Review Processing System (ARPS) data
* Obtain a CPMS query or an ARPS query via the Intranet. Review the GENERAL INFORMATION on either query to determine if the beneficiary requested an administrative appeal for the fugitive felon suspension or the fugitive felon suspension overpayment. If the administrative appeal information on the query does not relate to the fugitive felon suspension or overpayment, do not use this information. Evaluate the next lower level of appeal associated with the fugitive felon suspension or overpayment issue.
If the ALJ or AC administrative appeal request is associated with the fugitive felon suspension or overpayment issue on which you are granting post-2006 Martinez settlement relief, determine if the appeal is closed or pending using the chart below:
Status of Appeals Decision
Action on Appeals Decision
closed (unfavorable ALJ or AC decision, fugitive felon suspension is still on record)
If there are no other pending administrative appeals on the case, provide Martinez post-2006 Settlement relief without vacating the ALJ or AC decision. Process the post-2006 Martinez relief for cases per the chart in GN 02613.865E.3.c. in this section.
pending (no decision made on appeal request)
Notify the specified contact for the ALJ or AC that the beneficiary is eligible for post-2006 Martinez settlement relief. Inform the specified ALJ or AC contact of the Martinez relief per GN 02613.865E.4. and GN 02613.865E.5., respectively in this section.
3. Waiver and PC reconsideration appeal processing
a. Pending and closed PC appeals—fugitive felon issue only
If the last level of appeal on the record is waiver or PC reconsideration after 2006, use the chart to determine what action to take.
Status of Appeal
Status of Post-2006 Martinez relief
PC Processing Action
closed (PC RECON decision) or
closed (FO denied waiver)
None for the warrant
Process the closed period post-2006 Martinez settlement relief per GN 02613.865E3.c. in this section.
closed (PC RECON decision) or
closed (FO denied waiver)
Relief given
Take no action.
pending (no final PC RECON decision) or
pending (no final FO waiver decision)
None for the warrant
Process the closed period post-2006 Martinez settlement relief per GN 02613.865E.3.c. in this section.
pending (no final PC RECON decision) or
pending (no final FO waiver decision)
Relief given
Take no action.
b. Pending PC reconsideration appeals with multiple issues
If the appeals request that is pending also concerns issues other than those related to a fugitive felon suspension or overpayment issue, resolve all appeal issues at the same time.
c. Processing closed period post-2006 Martinez settlement relief for administrative appeals cases
Resume benefits for the closed period as indicated in the chart below:
Steps
Required Actions
1
Send the class member a post-2006 informational notice. Prepare a manual information notice via AURORA (E4002), per GN 02613.867B. Date and then release the notice. Send a copy of the notice to ORS.
2
Hold the case for two days to allow for mailing and delivery of the manual informational notice.
Do not prepare a fugitive felon good cause determination.
3
On the FFSCF, annotate the warrant disposition to the FUGITIVE FELON WARRANT DUE PROCESS/ GOOD CAUSE (FFDG) screen. In the update mode, enter the mandatory entries and then enter on the GOOD CAUSE DETERMINATION section of the screen:
GOOD CAUSE ESTABLISHED(Y/N): Y
IF YES, GOOD CAUSE REASON: CRT
good cause decision date (mmddccyy): 99999999 (use current date)
REMARKS: Martinez Appeals case. Post-2006 relief applies for closed period MM/YY to MM/YY.
4
USE MADCAP/MACADE to resume benefits for the closed period of fugitive felon suspension. Select the dates for the closed period of fugitive felon suspension that you will now resume for the beneficiary (MM/YY to MM/YY) for the MACADE history accrual.
From the MACADE HST screen:
Enter ENT in the TRANSFER TO field
Select #31 FUGITIVE FELON (FFEL) on the ENTITLEMENT AND ELIGIBILITY MENU.
5
On the FFEL screen in MACADE, annotate the following entries:
GOOD CAUSE ESTABLISHED(Y/N): Y
IF YES, GOOD CAUSE REASON: CRT
good cause decision date (mmddccyy): 99999999 (use current date)
REMARKS: Martinez Appeals case. Post-2006 relief applies for closed period MM/YY to MM/YY.
6
Send a closed period resumption notice via MADCAP. Add to the notice the additional post-2006 Martinez relief caption and paragraph in GN 02613.867A.3. Follow the instructions for processing requests for special notices for blind or visually impaired claimants and beneficiaries as indicated in EM-09088 SEN dated 12/31/09 and EM-10021 SEN dated 03/17/10.
~~d. Office of Disability Adjudication and Review (ODAR) appeal~~
d. Office of Hearing Operations (OHO) appeal
If there is an administrative appeal pending in Office of Disability Adjudication and Review (ODAR), (either at the Office of Appellate Operations (OAO) or Office of the Chief Administrative Law Judge (OCALJ)) you must notify the appropriate administrative appeal organization of the post-2006 Martinez settlement relief. Process ALJ appeal cases using GN 02613.865E.4. in this section. Process OAO appeal cases using GN 02613.865E.5. in this section.
If there is an administrative appeal pending in Office of Hearings Operations (OHO), (either at the Office of Appellate Operations (OAO) or Office of the Chief Administrative Law Judge (OCALJ)) you must notify the appropriate administrative appeal organization of the post-2006 Martinez settlement relief. Process ALJ appeal cases using GN 02613.865E.4. in this section. Process OAO appeal cases using GN 02613.865E.5. in this section.
4. Administrative Law Judge (ALJ) appeal processing
a. Pending and closed ALJ appeals—Fugitive felon issue only
Use the chart to process ALJ appeals as follows:
Status of Appeal
Status of Post-2006 Martinez Relief
PC Processing Action
closed (ALJ decision)
None for this warrant
Process the closed period post-2006 Martinez relief per GN 02613.865E.3.b. in this section.
closed (ALJ decision)
Relief given
Take no action
pending (no final ALJ decision)
None for this warrant
Calculate the benefits due the beneficiary for the closed period of fugitive felon suspension that we are removing. Take no action to process the post-2006 closed period Martinez settlement relief at this time.
Contact the Hearing Office (HO)
* Obtain the HO code (3-position code) from the beneficiary’s CPMS /ARPS query.
* Use the Detailed Office/Organization Resource System (DOORS) on the Mainframe to locate the HO’s email address.
* Email the HO the following information:
Subject: Martinez Settlement Case
Message to HO for the ALJ
SSN
Name of Beneficiary/BIC
Name of ALJ Assigned to Hearing from the CMPS/ARPS Query
* Explain that the beneficiary is eligible for post-2006 Martinez settlement relief. Provide the facts found in the MBR, ROAR, CPMS or ARPS or on ORS and indicate the period of time for which we will resume the monthly benefits. If payment should remain suspended because of other higher priority suspension or payment issues that will occur once the fugitive felon suspension event is closed, explain this.
* Send the completed email message to the HO. The HO will refer the Martinez settlement email to the appropriate ALJ for consideration.
Do not provide post-2006 Martinez settlement relief for this beneficiary’s record until the HO forwards the case to the PC for subsequent action on the post-2006 Martinez relief. The HO will place an alert in the Alert and Message section in eView to notify the PC technician of Martinez settlement involvement.
When the HO forwards the case to the PC for action, process the closed period post-2006 Martinez settlement relief per GN 02613.865E.2.b. in this section.
pending (no final ALJ decision)
Relief given
Contact the HO
* Obtain the HO code (3-position code) from the beneficiary’s CPMS /ARPS query.
* Use the Detailed Office/Organization Resource System (DOORS) on the Mainframe to locate the HO’s email address.
* Email the HO the following information:
Subject: Martinez Settlement Case
Message to the HO for the ALJ
SSN
Name of Beneficiary/BIC
Name of ALJ Assigned to Hearing from the CMPS/ARPS Query
Notify the ALJ that we already gave the beneficiary post-2006 Martinez settlement relief. Provide the ALJ with the date we gave the relief (MM/DD/CCYY). Give the dates for the period involved for the post-2006 Martinez settlement relief.
* Send the completed email message to the HO. The HO will refer the Martinez settlement email to the appropriate ALJ for consideration.
After the ALJ makes a decision, the HO will forward the case to the PC. The HO will place an alert in the Alert and Message section in eView to notify the PC technician of Martinez settlement involvement.
* No action is necessary by the PC technician on the Martinez relief.
b. Pending ALJ appeals with multiple issues
If the appeals request that is pending with the ALJ concerns issues other than those related to a fugitive felon suspension or overpayment issue, the case will remain with the HO, even if the beneficiary is due relief under the Martinez settlement.
Provide the HO with information on the post-2006 Martinez settlement relief due the beneficiary, per the chart in GN 02613.865E.4.a. in this section. Process the ALJ decision in accordance with the chart in GN 02613.865E.4.a. in this section.
5. Appeals Council (AC) appeal processing
a. Pending and closed AC Appeals—Fugitive felon issue only
The chart provides instructions for processing AC appeal cases for a Title II beneficiary for the fugitive felon suspension or overpayment.
Status of Appeal
Status of Post-2006 Martinez Relief
PC Processing Action
closed (AC decision)
None for this warrant
Process the closed period post-2006 Martinez settlement relief for the beneficiary per GN 02613.865E.3.b. in this section.
closed (AC decision)
Relief given
Take no action.
pending (no final AC decision)
None for this warrant
Calculate the benefits due for the closed period of fugitive felon suspension that we are removing. Take no action to process the post-2006 closed period Martinez settlement relief at this time.
Contact the specified AC contact via email.
* Email Roni Lasher in OAO and provide the following information:
Subject: Martinez Settlement Case
Message for the AC
SSN
Name of Beneficiary/BIC
Name of Appeals Council Judge assigned to the hearing from the CMPS/ARPS Query
* Explain that the beneficiary is eligible for post-2006 Martinez settlement relief. Provide the facts found in the MBR, ROAR, CPMS or ARPS, or on ORS and indicate the period of time for which we will resume the monthly benefits. If payment should remain suspended because of other higher priority suspension or payment issues that will occur once the fugitive felon suspension event is closed, explain this.
* Roni Lasher of OAO will refer your email request to the appropriate AC for consideration
Do not provide post-2006 Martinez settlement relief for this beneficiary’s record until OAO forwards the case to the PC for subsequent action on the post-2006 Martinez relief.
* OAO will send the case back to the PC after the AC makes a decision regarding all appeal issues. OAO will return the case to the PC via form HA-505, “Transmittal by Office of Disability Adjudication and Review,” identified as “Martinez Settlement Case.” OAO also adds a red “Special” label to form HA-505 prior to remanding the case to the jurisdictional PC.
* When receiving the HA-505, process Martinez relief per GN 02613.865E.5. in this section. Add the following message to the MBR - “Martinez Settlement Appeal Post-2006 Relief Processing.”
pending (no final AC decision)
Relief given
Contact the specified AC contact via email.
* Send an email to Roni Lasher in OAO and provide the following information:
Subject: Martinez Settlement Case
Message
SSN
Name of Beneficiary/BIC
Name of Appeals Council Judge assigned to the hearing from the CMPS/ARPS Query
* Notify the AC that we already gave the beneficiary post-2006 Martinez settlement relief. Provide the AC with the date we gave relief (MM/DD/CCYY). Give the dates for the period involved for the post-2006 Martinez settlement relief.
* Roni Lasher in OAO will refer your email request to the appropriate AC for consideration.
* OAO will send the case back to the PC after the AC makes his or her decision on the appeal issue. OAO returns the case to the PC via form HA-505 “Transmittal by Office of Disability Adjudication and Review” identified as “Martinez Settlement Case.” OAO also adds a red “Special” label to form HA-505 prior to remanding the case to the jurisdictional PC.
* No action is necessary by the PC center technician on the Martinez relief.
NOTE: A beneficiary or recipient who has received a final Federal court decision about a fugitive felon suspension may not be a class member. If you learn of such a decision, refer the case to your PC Coordinator who will contact the Office of General Counsel (OGC) for advice.
b. Pending OAO AC appeal case, multiple appeal issues
If the appeals request that is pending with the AC concerns issues other than those related to a fugitive felon suspension or overpayment issue, the case will remain with OAO, even if the beneficiary is due relief under the Martinez settlement.
Provide the AC with information on the post-2006 Martinez settlement relief due the beneficiary. Use the chart in GN 02613.865E.5.a. in this section to email the Martinez settlement relief information to the AC. When the AC makes a decision on all issues on the appeal, process the AC decision in accordance with the chart in GN 02613.865E.5.a. in this section.
6. Notifying class members of potential relief
Martinez class members eligible for post-2006 relief based on a pending or closed unfavorable administrative appeal must receive notice of the terms of the Martinez settlement, if they did not already receive a post-2006 Martinez settlement informational notice. The informational notice is available in AURORA as exhibit number E4002.
For instructions on generating the informational notice via AURORA, see GN 02613.867B. Shortly after your release of the informational notice (E4002), resume benefits for the closed or pending administrative appeal periods of fugitive felon suspension to these Martinez class members.
7. Miscellaneous case processing items
a. Processing multiple warrants
To process multiple warrant cases, see GN 02613.865A.2. in this section.
b. Processing cases that show current prisoner or fugitive felon status
We cannot pay underpayments to beneficiaries who are in prison, or have a warrant record with an offense code of 4901, 4902 or 4999. To process these cases, see GN 02613.865A.3. in this section.
c. Processing concurrent cases (entitlement or eligibility to both title II and title XVI monthly benefits)
* Process the Martinez settlement actions on concurrent cases (i.e., title II and title XVI) independently under each title.
* Process title II Martinez cases in accordance with instructions in GN 02613.860D.2. (chart, CCID Codes F1, F2, F3), and process title XVI Martinez cases as indicated in the instructions in GN 02613.860D.2. (chart, CCID Codes F4, F5, F6 and F7)
d. Other case processing items
For information regarding other case processing issues (e.g., Medicare, CDRs, etc.) is in GN 02613.870.
e. Processing pre-2007 Martinez Relief for CCID F3 cases
If you find the computer over-selection includes a beneficiary who did not have a pending administrative appeal for a fugitive felon suspension or overpayment on or after January 1, 2007, give the beneficiary pre-2007 Martinez settlement relief. Information on pre-2007 Martinez settlement relief is in GN 02613.868. Process the pre-2007 Martinez settlement relief for CCID F3 identified cases as indicated in the chart below:
Steps
Required Actions
1
Send the class member a pre-2007 informational notice. Prepare a manual information notice via AURORA (E4003). Instructions for issuing the notice are in GN 02613.869C. Once the notice is prepared, date and then release the notice.
Send a copy of the notice to ORS.
2
Hold the case two days to allow for mailing and delivery of the manual pre-2007 Martinez settlement informational notice.
3
Continue to process the case per the instructions in GN 02613.868B.2. for pre-2007 Martinez settlement relief.
4
Add a new SP MSG field to the MBR and enter REMARKS: “Martinez Appeals case. Pre-2007 overpayment relief applies for closed period MM/YY to MM/YY.”

POMS Reference

GN 02613.865: Title II Post-2006 Martinez Settlement Relief Processing