TN 14 (02-98)

Policy

A person who is overpaid because he/she elected benefit continuation (see DI 40515.100) and the initial cessation is upheld can be found without fault for the overpayment if the cessation determination was appealed in good faith.

The instructions in this section apply only to the portion of an overpayment resulting from a period of benefit continuation.

1. Full waiver development required

Do not automatically waive an overpayment resulting from a period of benefit continuation. Complete full waiver development before waiving any overpaid amounts even when a person is found without fault because he or she appealed the disability cessation determination in good faith. For more information about determining fault or without fault, see GN 02250.005.

2. Benefit Continuation Elected

Assume that all such appeals are made in good faith unless the individual failed to cooperate in the appeal or there is evidence to the contrary.

1. Failure to cooperate with an appeal is entirely different from failure to cooperate with a continuing disability investigation. If the person who was not cooperative during the continuing disability investigation appeals the cessation determination, elects payment continuation and cooperates with the appeal, the appeal is made in good faith and the right to waiver consideration is not prejudiced.

2. Evidence against good faith will exist in situations where the person knew he/she was no longer disabled. For example, it would be difficult to find without fault when the person had been told by his/her doctor that he/she had recovered or was released to return to work.

3. If a good faith determination is needed, be sure to consider any physical, mental, educational, or linguistic limitations the person has which affects his/her ability to act in good faith. See GN 02250.005C.

3. Continuation as Result of Class Membership

Without fault can be established for class members of suits against SSA under the guidelines described above.

4. Unnamed Class Member

If the FO determined that a person was a class member and resumed benefits, but ODIO later reversed the class membership determination, the person is overpaid. If that person requests waiver, without fault can generally be established under the guidelines for misinformation (see GN 02250.061) since the FO told the person that he/she was eligible for benefit continuation.