GN 03930.035: Title II - Adjudicating Claims Involving Representatives Who May Petition - Overview

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~~Effective Dates: 02/20/2013 - Present~~
Effective Dates: 04/04/2018 - Present
TN 8 (02-05)
GN 03930.035 Title II - Adjudicating Claims Involving Representatives Who May Petition - Overview
A. Introduction
The claims representative (CR) in the field office (FO) and the claims authorizer (CA) in the processing service center or the claims technical examiner (CTE) in the Office of Central Operations adjudicate title II claims involving representatives who may petition to obtain SSA's approval of fees for their services. The procedures below, and in the two succeeding sections, highlight the key CR and CA/CTE responsibilities based on the processing system: the Modernized Claims System (MCS) or the Manual Adjustment, Credit, and Award Processes (MADCAP) system. (Refer to GN 03930.015, Responsibility for Authorizing Fees Under the Fee Petition Process for Services Provided in Proceedings Before SSA – Jurisdiction.)
For those cases in which the representative is eligible for direct fee payment and did not waive a fee or the right to direct payment of a fee, MCS and MADCAP propagate representative information into the Single Payment System (SPS) for creation of a payment record. For fee petition cases, the action will hold (i.e., pend) payment in SPS until action is taken to release the representative payment (i.e., the fee is authorized and input). (See GN 03920.017C., Direct Payment to Representatives – Title II Cases.)
The CR or CA/CTE must refer to POMS or Modernized System Operations Manual (MSOM) sections for complete instructions about processing limitations or exclusions and coding required entries.
B. Policy
The CR and CA/CTE (or other processing center (PC) position designated to perform these functions) must:
* prepare any forms and make data entry necessary to use the most expeditious processing system available;
* ensure that SSA withholds from past-due benefits for possible direct payment, when required;
* provide correct notice to the claimant and the claimant's representative; and
* set the diary for receipt of the fee petition or fee authorization when SSA is withholding past-due benefits for possible direct payment to a representative.
NOTE: Although a representative who was discharged by the claimant may file a fee petition, SSA may not release a copy of the claimant's award notice or any award information to a discharged representative without the claimant's written consent. In addition, SSA does not make direct fee payment to a representative whom the claimant discharged or who withdrew from representing the claimant.
C. Procedure - Identify MCS Processing Limitations
Some characteristics currently prevent final claims processing through MCS using its earnings computation (EC) screens. Refer to MSOM MCS 004.002, MSOM MCS 004.003 , and SM 00834.900 for MCS processing limitations.
D. Procedure - Determine Representative's Eligibility For Direct Fee Payment
Determine representative's eligibility for direct fee payment as follows:
* Review GN 03920.017 to determine if the attorney or non-attorney representative is eligible to receive direct payment.
* If the representative is a non-attorney, verify that the effectuation date of the favorable decision is on or after February 28, 2005. If yes, go to GN 03930.035D.3. If no, go to GN 03930.035E.
* If the representative is a non-attorney, check the list of eligible non-attorneys at: Non-Attorney Representatives List to determine if the representative is listed as of the date SSA effectuates the favorable decision.
* If the representative states that he/she is eligible for direct payment, but is not listed on that date, take the action in GN 03930.035D.5.
* If the representative did not state he/she is eligible for direct payment and is not listed, go to GN 03930.035E.
* If the representative is listed, go to GN 03930.035D.4.
* If the non-attorney representative is on the list and has not waived direct payment, verify that the claimant and the representative signed the appointment of representative or a supplemental statement of representation on or after February 28, 2005. If yes, go to GN 03930.035E. If not, request the representative to submit a supplemental appointment document.
NOTE: The claimant does not need to sign the supplemental appointment of the representative in all supplemental appointment situations. See GN 03920.017C.2.b. to determine when the claimant needs to sign the supplemental appointment.
* If the non-attorney, who states he/she is eligible for direct payment, is not eligible for direct payment, notify the representative that SSA can not make direct payment (see model language below), send a copy to the claimant, and go to GN 03930.035E.
Model language to use in these situations follows:
You advised your client, (Beneficiary's name), and indicated on the appointment of representative that you are eligible to have your approved representatives' fees withheld and paid directly from the claimant's past-due benefits. However, [Select the conclusion that describes the status]
* you are not eligible to receive direct payment of your fees from the claimant’s past-due benefits or
* you did not become eligible to receive direct payment of your fees from the claimant’s past-due benefits until after we effectuated the favorable decision on your client's claim or
* you failed to maintain your eligibility to receive direct payment of your fees from the claimant’s past-due benefits, and were no longer eligible on the date we effectuated the favorable decision on your client's claim.
The law does not permit us to make direct payment of a fee in this case. Accordingly, SSA is not withholding (claimant's name)'s past-due benefits for fee payment purposes and will not pay any authorized fee directly to you. You should look to the claimant for payment of the fee authorized in this case.
(See GN 03920.017C, Policy – Direct Payment to Representatives in Title II Cases.)
E. Procedure - Claims Processing
1. MCS
a. MCS Check/Notice 2 Screen
Use the MCS Check/Notice 2 (NOT2) screen to provide the data to tell the system whether to withhold from past-due benefits. For complete coding of representative data on the MCS clearance screens, see MSOM MCS 009.009 . (Note that court cases are an MCS exclusion.)
When the representative is eligible for direct fee payment and has not waived a fee or the right to direct payment, SSA must withhold past-due benefits for that purpose. To withhold from past-due benefits, complete the MCS NOT2 screen as follows:
* Authorized Representative Type: 1 or 4
(Use “1” for an attorney or 4 direct pay non-attorney)
* Fee Waived: N
* Direct Payment Waived: N
* Last Withholding Date: Calendar month and year before the calendar month and year you are adjudicating the claim.
NOTE 1: The last withholding date for auxiliaries is the same as that of the number holder's, if protective filing exists, regardless as to when the auxiliaries' claims are adjudicated.
* Attorney/Rep Name: Enter the primary representative's name, address and phone information. If the representative is an attorney, include “ATTY FOR” or “ATTORNEY FOR” in the first line of the address field. If the representative is a non-attorney eligible for direct payment, include “REP FOR” in the first line of the address field. Then, include the full name of the number holder or primary claimant.
* Pending Fee Agreement Amount: Do not complete.
* Fee Agreement Type: Do not complete this field on the NOT2 screen for petition cases, unless the claim involves a disapproved fee agreement.
Completing the MCS NOT2 screen as described above will result in fee withholding and establish the Legal Payment Deduction Amount (LPDA) on the Master Beneficiary Record (MBR). The SPS will build a representative payment record whenever the LPDA field is established or increased.
NOTE 2: If a non-attorney alleges that he/she is eligible for direct payment but is not listed at: Non-Attorney Representatives List , code the Authorized Representative field on the NOT2 screen with a “2,” non-attorney and do not code the Direct Payment Waived field. Refer to GN 03930.035D for language to include in a notice if SSA has not previously communicated with the representative about his/her status.
b. DW01 Screen
If the representative is an attorney or a non-attorney eligible for direct payment, include the Attorney Issue code ATY04, which means “Petition Awaiting Authorization,” on the MCS Development Worksheet (DW01) screen. The Attorney Issue Code ATY04 will “pend” the payment in SPS until the petition/authorization is complete.
c. DECI Screen and Diary
For MCS cases awaiting a fee petition (i.e., no fee agreement submitted or fee agreement disapproved) or fee authorization, and past-due benefits are being withheld, enter diary code 98 on the DECI screen. Diary code 98 establishes a 60-day diary from the date SSA releases the award notice.
NOTE: In the Office of Central Operations (OCO), in processing an Office of Disability Adjudication and Review (ODAR) level case, the CTE prepares a 60-day Processing Center Action Control System (PCACS) diary related to the existing “ATFEE FEEPAY” action control record (ACR) and routes the claims file to the development holding file (DHF PAY) pending receipt of the petition/authorization. In cases with Federal court involvement, the CTE prepares a 120-day diary related to the existing “ATFEE COURT” ACR.
NOTE: In the Office of Central Operations (OCO), in processing a Hearing Office (HO) level case, the CTE prepares a 60-day Processing Center Action Control System (PCACS) diary related to the existing “ATFEE FEEPAY” action control record (ACR) and routes the claims file to the development holding file (DHF PAY) pending receipt of the petition/authorization. In cases with Federal court involvement, the CTE prepares a 120-day diary related to the existing “ATFEE COURT” ACR.
d. Claims Transmittal Sheet
When completing the claims transmittal, show one of the following remarks:
* If you are withholding, show: “FEE WITHHOLDING CASE - Fee Petition Expected.”
* If you are not withholding, show: “NON-ATTORNEY INELIGIBLE FOR DIRECT PAYMENT OR WAIVER OF DIRECT PAYMENT FEE CASE - Fee Petition or Waiver Expected.”
2. Withholding With MADCAP
a. A101 or EF101
When completing the A101 or EF101, which MADCAP processing requires, take the actions shown if you are withholding past-due benefits for possible direct payment.
* Code the BCF fields on the BCRN screen following instructions in MSOM MCS 014.006 .
* Show in the REMARKS field on the BCRN screen the following remarks: “FEE WITHHOLDING CASE - Fee Petition Expected”; and “Withhold 25 percent of (HA's, HB's, HC1's, or other appropriate entry) past-due benefits for possible direct payment to representative.”
* Enter the fee petition paragraph (ATY055, ATY056, ATY057, or ATY058, as appropriate) and paragraph 160 in the NOTICE field on the BCRN screen per POMS NL 00708.100 and POMS NL 00720.050.
b. Transmittal Sheet
When completing the transmittal sheet for the EF101, also show the remark: “FEE WITHHOLDING CASE - Fee Petition Expected.”
3. No Withholding With MADCAP
a. A101 or EF101
When completing the A101 or EF101, which MADCAP processing requires, take the actions shown if you are not withholding past-due benefits for possible direct payment.
* Add the remark to the BCRN screen. See MSOM MCS 014.006 .
* Show the appropriate paragraph (981.1, 981.2, 981.3, or 983) to indicate whether the representative has waived a fee or just waived direct payment of the fee. If the fee itself has not been waived, include paragraph 160 per POMS NL 00708.100.
b. Transmittal Sheet
If the representative has not waived a fee, show the remark: “REP FEE CASE - Fee Petition or Waiver Expected – No Withholding.”
4. Manual Adjustment Credit and Award Data Entry (MACADE) Cases
a. Coding to Withhold Past-Due Benefits When Representative Eligible for Direct Payment
Input direct data entry through Manual Adjustment, Credit and Award Data Entry (MACADE). Enter the following special coding:
* In the HST screen “MR” column, the 25 percent withholding amount.
* In the HST screen “TO” column, the “AD” special entry. We use the special entry AD to withhold the legal payment and post the amount withheld to the PHUS.
NOTE: See SM 00842.013 and SM 00848.360 for further instructions.
* Enter the Attorney Payment Indicator (API) of “04” on the MACADE ATT screen. The API of 04 will pend the payment in SPS until the petition/authorization is complete.
* On MACADE REM screen, show “Fee Petition Case.”
b. Diary
For MACADE processed claims, the benefit authorizer (BA), Benefit Technical Examiner (BTE), or CA/CTE must establish a Processing Center Action Control System (PCACS) ATFEE PETPAY diary. The diary period should begin when the notice is released, which is usually 5 days after the MACADE action. To determine the length of the diary for a specific case, refer to GN 03930.045.
NOTE: In OCO, in processing an ODAR level case, the BTE prepares a 60-day PCACS diary related to the existing “ATFEE FFEPAY” ACR and routes the claims file to the DHF PAY pending receipt of the petition/authorization. In cases with Federal court involvement, the BTE prepares a 120-day diary related to the existing “ATFEE COURT” ACR.
NOTE: In OCO, in processing a HO level case, the BTE prepares a 60-day PCACS diary related to the existing “ATFEE FFEPAY” ACR and routes the claims file to the DHF PAY pending receipt of the petition/authorization. In cases with Federal court involvement, the BTE prepares a 120-day diary related to the existing “ATFEE COURT” ACR.
(See GN 03930.090 for the follow up procedure when no fee petition or fee authorization is received before the diary matures.)
c. Windfall
If possible windfall (title II or title XVI) offset is involved, refer to SM 00815.100 through SM 00815.500 for required MADCAP coding.
d. Notice Paragraphs
Designate necessary paragraphs for inclusion in the fee notice and instruct the notice preparation reviewer (NPR) or typist to prepare additional copies. Refer to GN 03930.040. Or, if trained in AURORA, complete the necessary paragraphs and do not refer to the NPR or typist.
5. Prepare Special Message
Prepare a message for the MBR stating a fee petition/authorization is pending. Include in the message:
* the representative's name, address and phone number;
* the fee-withholding period and the amount withheld; and
* the ALJ's name and hearing office number if the case was decided at the hearing level.
For a court case with attorney involvement, code the special message field to read: COURT CASE/REPINVOLVED/DO NOT RELEASE 25% WITHHELD PENDING COURT FEE AND ADMIN FEE
If the case is a court remand, replace “COURT CASE” with “COURT REMAND.”
F. References
The following sections provide specific instructions for related CR or CA/CTE functions.
* FO or PC actions on receiving the claimant's appointment of representative, GN 03910.040H through GN 03910.040J.
* Coding the Atty/Rep/ALJ Name and Address Screen when sending a copy of the MADCAP notice to the attorney/representative, SM 00842.016.
* MCS and MADCAP propagation into SPS, SM 00834.000.
* Entering information through MCS, MSOM MCS 009.009 , MSOM MCS 010.003 (reconsideration request - RCN2), MSOM MCS 010.005 (hearing request - HNG2), and MSOM MCS 010.006 .
* Using SPS, MSOM SPECPAYSYS 001.006 .
* Contacting a represented claimant, GN 03910.050.
* FO or PC action when representative waives a fee, GN 03920.020D.3.
* Receipt and routing of fee petitions, GN 03930.025.

POMS Reference

GN 03930.035: Title II - Adjudicating Claims Involving Representatives Who May Petition - Overview