SSR 78-25: Rescinded 1986

SSR 78-25

PURPOSE:

To provide an explanation of due process considerations relating to

reduction, suspension, and termination of SSI payments.

CITATIONS:

Sections 416.1336 and 416.1337 of Subpart M, Regulations No. 16; Civil

Action No. 74-930 Catherine Cardinale v. David Mathews , U.S.

District Court for the District of Columbia.

PERTINENT HISTORY:

On August 26, 1975, the U.S. District Court for the District of Columbia

issued an order in the case of Cardinale v. Mathews which, in

effect, defined the SSI beneficiary's right to procedural due process

under the Fifth Amendment to the U.S. Constitution in the area of

reduction, suspension, and termination of SSI payments. The court order

validated all exceptions to advance notice and continuation of payment

procedures except where the Social Security Administration has factual

information confirming the death of the beneficiary. Two exceptions to

procedures involving continuation of payment at the previously established

level are allowable under the order, however. These are applicable when:

(1) the SSA has established that the payment amount exceeds the level of

payment possible under the law, and (2) the SSA has determined that an SSI

beneficiary is receiving multiple payments.

POLICY DIRECTIVE STATEMENT:

Under the revised regulations, SSA will provide advance notice and

continuation of payment until the initial appellate decision in all cases

before reduction, suspension, or termination of SSI payments in all

circumstances except those involving the death of the beneficiary.

Continuation of payment is available to beneficiaries who appeal within 10

days of notice. In addition, there will be two exceptions to continuation

of SSI payments at the established rate pending the initial appellate

decision on the merits. Both continuation of payment exceptions cover

situations in which there is no doubt that the continued payment would be

incorrect.

1. Dollar Limitations

uation of payment is available to beneficiaries who appeal within 10

days of notice. In addition, there will be two exceptions to continuation

of SSI payments at the established rate pending the initial appellate

decision on the merits. Both continuation of payment exceptions cover

situations in which there is no doubt that the continued payment would be

incorrect.

1. Dollar Limitations

(a) Under the first exception, monthly payment limitations for three

categories of recipients are set. Continuation of payment in excess of

such limitations pending the initial appellate decision is not required.

(i) Recipients Eligible for Federal SSI Benefits Only

A payment ceiling of $200 per month is placed on this category. This

figure insures that payments exceeding the statutory maximum for Federal

SSI payments by any substantial amount will not have to be continued at an

obviously incorrect level in the event of an appeal.

(ii) Recipients Eligible for Federal SSI Benefit and Optional State

Supplementation or Optional State Supplementation Only

A payment ceiling of $700 per month is placed on this category since the

highest possible benefit involving optional supplementation is less than

this amount.

(iii) Recipients Eligible for Federal SSI Benefits and Mandatory or

Other Supplementation or Mandatory Supplementation Only

A payment ceiling of $2,000 per month is set since this amount covers a

correct payment situation which could occur involving the types of

payments listed above.

(b) The dollar limitations apply in the following manner. If a payment is

generated which exceeds the particular dollar limitations, initially a

10-day notice of planned action will be generated and payment for the next

month will be correctly computed as reflected in the notice. If the

individual appeals within the 10-day period and the appeal cannot be

disposed of prior to the first of the next month, then the following rules

will apply in determining the amount of the continuing payment:

ticular dollar limitations, initially a

10-day notice of planned action will be generated and payment for the next

month will be correctly computed as reflected in the notice. If the

individual appeals within the 10-day period and the appeal cannot be

disposed of prior to the first of the next month, then the following rules

will apply in determining the amount of the continuing payment:

(i) Generally, a payment will be issued for the actual amount paid in the

month immediately preceding the month in which the incorrect payment was

first made;

(ii) If an intervening action or event would have increased the benefit

amount for the month in which the incorrect payment was made, the

recipient will be paid the intervening higher payment rather than the

amount paid for the prior month;

(iii) If, in the month prior to the month in which the limitation is

first exceeded the individual was in suspense status, SSA will pay the

amount which actually was due the recipient for the amount in which the

payment limitation was exceeded. For example, if a person in suspense in

4/76 is due to receive a Federal SSI payment only of $157.70 in 5/76 but

is incorrectly paid $1,577, the payment continuation upon appeal would be

limited to $157.70;

(iv) If the individual should have remained in suspense status, but was

incorrectly paid a benefit which exceeded the dollar limitation, payment

will not be continued to him or her during an appeal and the 10-day appeal

information will not be given in the notice.

2. Multiple Payments

Under the second exception, if SSA determines that the recipient has

received two or more regular monthly payments in one month, a

determination as to the correct amount of benefits for the next month will

be made; at the same time, a notice will be sent to the recipient. This

advance notice explains:

(a) That multiple payments have been made;

(b) The correct amount of benefits payable to the recipient;

exception, if SSA determines that the recipient has

received two or more regular monthly payments in one month, a

determination as to the correct amount of benefits for the next month will

be made; at the same time, a notice will be sent to the recipient. This

advance notice explains:

(a) That multiple payments have been made;

(b) The correct amount of benefits payable to the recipient;

(c) The recipient's appeal rights.

If the recipient appeals within 10 days of receipt of notice of the

action, the highest of the multiple check amounts (or the correct amount,

if higher) will be paid until the initial appellate decision is made.

In order for SSA to determine that multiple checks are being sent to the

same individual, all of the following factors must be present:

(a) Two or more checks are being sent to individuals with the same name

or a similar name (i.e., a common, logical spelling variation of the

name);

(b) The checks contain the same social security number, or one contains a

pseudo number;

(c) The checks go to the same address;

(d) The recipients are of the same sex;

(e) The recipients have the same date of birth.

If all these factors are present, the multiple payment exception may be

used. If any one of the factors is not present, the usual due process

procedures regarding continuation of payment must be followed.

Multiple payment situations are also subject to the dollar limitation

provision. Where one or more of the checks, separately, exceed one of the

dollar limitations, the rules for determining the continuing payment under

the dollar limitation provision will apply in the following manner:

(a) If one or more, but not all, of the multiple payments exceed the

applicable dollar limitation, payments will be continued at the rate of

the highest of the multiple payments that falls within the dollar

limitation, or the amount determined to be correct, if higher;

(b) If all of the multiple payments exceed the applicable dollar

limitations:

vision will apply in the following manner:

(a) If one or more, but not all, of the multiple payments exceed the

applicable dollar limitation, payments will be continued at the rate of

the highest of the multiple payments that falls within the dollar

limitation, or the amount determined to be correct, if higher;

(b) If all of the multiple payments exceed the applicable dollar

limitations:

(i) Payment will be continued at the rate of the highest of the payments

that did not exceed the applicable dollar limitation, or at the amount

determined to be correct, if higher, in the latest prior month in which

all multiple payments did not exceed the dollar limitation;

(ii) If all the multiple payments exceeded the applicable dollar

limitation, both currently and for all prior months, the amount determined

to be correct will be paid.

CROSS-REFERENCES:

Claims Manual Section 13300ff.