I-3-6-40.Interim Disability Benefits in Cases of Delayed Final Decisions (“8001” Cases)
Last Update: 4/1/16 (Transmittal I-3-135)
A. When Interim Disability Benefits Apply
Section 8001 of Public Law 100-647 (The Technical and Miscellaneous Revenue Act of 1988) added subsections 223(h) and 1631(a)(8) to the Social Security Act. Under these provisions, the Social Security Administration (SSA) will pay a claimant interim benefits if:
The claimant receives a hearing decision that finds the claimant is or continues to be disabled under title II, or is or continues to be disabled or blind under title XVI;
The Appeals Council (AC) initiates review of the hearing decision on its own motion pursuant to 20 CFR 404.969 and 416.1469, or, before payment has been effectuated, the AC reopens a favorable hearing decision pursuant to 20 CFR 404.987 and 416.1487 (see generally Hearings, Appeals and Litigation Law (HALLEX) manual I-3-6-1);
It has been at least 110 days since the date of the hearing decision; and
The Commissioner has not issued a final decision.
When SSA will pay a claimant interim disability benefits on this basis, staff will check for, and add, if not already present, the “PYMNTS CONT UNDER PL 100-647 (8001)” case characteristic to the Appeals Review Processing System (ARPS) record.
For detailed information about field office payment and processing issues relating to interim disability benefits, see Program Operations Manual System DI 42010.205 (title II) and SI 02007.001 (title XVI).
Interim benefits apply to hearing level decisions from an administrative law judge (ALJ) or attorney advisor. Additionally, interim benefits apply when the issue is whether the claimant continues to be disabled under title II or disabled or blind under title XVI.
In situations where the AC reopens a favorable hearing decision and SSA has already effectuated payment, see the instructions in HALLEX I-3-9-84.
B. When Interim Benefits Begin and End
1. When interim benefits begin
SSA will pay the claimant interim benefits:
Under title II, beginning with the month before the month in which the 110th day after the date the hearing decision falls, and
Under title XVI, beginning with the month in which the 110th day after the date of the hearing decision falls.
2. When interim benefits end
If SSA begins paying a claimant interim benefits, SSA will stop paying the interim benefits:
Under title II, in the month before the month in which the Commissioner issues a final decision, and
Under title XVI, in the month in which the Commissioner issues a final decision.
The regulations in 20 CFR 404.955 and 416.1455 explain when an ALJ's decision is final and binding. See also HALLEX I-2-8-5. When a claimant who is receiving interim benefits receives a subsequent unfavorable decision from an ALJ, the Office of Appellate Operations (OAO) does not send a stop benefits alert until the 60-day appeal period ends (without an appeal), or until action is taken on appeal of the unfavorable decision. This is because the ALJ's decision is not yet final under the regulations.
The AC expedites review when a claimant who is receiving interim benefits appeals an ALJ decision. OAO branch chiefs (BC) are responsible for ensuring cases involving interim benefits pending within a branch are promptly processed. BCs and designated interim benefits staff will monitor these cases on a regular basis to ensure that all cases receive prompt attention and processing.
When the AC reviews a hearing decision covered under section 8001 (either on its own motion or when reopening before benefits are effectuated), it must include notice of interim benefits in any reopening notice, remand order, or own motion review notice. When preparing one of these notices for AC review, the analyst will ensure that the following language is included as the closing paragraph of the notice:
Section 8001 of Public Law 100-647 requires the payment of interim benefits in cases where we make a favorable hearing decision about your disability and no final decision is issued within 110 days after the date of the hearing decision. Because the Appeals Council has exercised its [(own motion review)(reopening)] authority in this case, interim benefits may be payable if a final decision is not issued within 110 days after the date of the hearing decision. You will receive interim benefits until we issue a final decision. Another Social Security Administration office will notify [(the claimant)(you)] at the appropriate time as to the amount and the effective date of any interim payments.
When forwarding an own motion or reopening recommendation that involves interim benefits to the AC, an analyst must clearly identify the issue for the AC. For a paper claim(s) file, the analyst will annotate in the remarks section of the route slip, in red ink, “POTENTIAL 8001 CASE.”
In addition, assisting staff will route the paper claim(s) file through the interim benefits staff immediately after the AC releases its own motion or reopening notice. Interim benefits staff will request that the effectuating components initiate or terminate interim benefit payments, using the same general guidelines in HALLEX I-3-1-16.