I-1-2-7.Past-due Benefits

1. Title II

In claims arising under Title II only of the Social Security Act (Act), past-due benefits are the amount of cash benefits that have accumulated for all beneficiaries because of a favorable administrative determination or decision (hereinafter referred to as “decision”), up to but not including, the month the Social Security Administration (SSA) effectuates the primary beneficiary's decision. Therefore, for most fully favorable decisions, the end date of the past-due benefits period is the month before the month SSA effectuates the decision.

If SSA issues a decision that pertains to more than one Title II claim (e.g., disability insurance benefits and disabled widow's/widower's insurance benefits), and those claims are not effectuated in the same month, the past-due benefits period will be different for each claim because the past-due benefits period will end the month before the month SSA effectuates the decision on each claim.

When calculating past-due benefits based on a partially favorable decision, with a closed period of disability, SSA uses the beginning and ending dates shown in the partially favorable decision. In later onset date cases, the past-due benefits period begins with the month of entitlement shown in the favorable decision, up to but not including the month SSA effectuates the decision.

If, on appeal, SSA issues a decision that changes the dates of entitlement, SSA will use the past-due benefits that flow from that decision to recalculate past-due benefits for the entire period of entitlement.

Refer to POMS GN 03920.030 for a detailed discussion of past-due benefits policy. For the definition of past-due benefits in federal court cases, see POMS GN 03920.060B.

2. Title XVI

In a Title XVI only claim, past-due benefits are the total amount of federal and federally administered state payments accumulated because of a favorable decision through the month of effectuation, including any amounts sent to a state/subdivision under an interim assistance reimbursement agreement, minus any continuing benefits, interim benefits, presumptive disability or blindness payments, and emergency advance payments. See POMS GN 03920.031 for information on Title XVI past-due benefits for calculating fees and POMS GN 03920.033 for a discussion of Title XVI past-due benefits payable.

3. Concurrent Titles II and XVI

The past-due benefits amount in the Title XVI portion of concurrent claims is the same as the amount in Title XVI only claims, except for the purpose of calculating fees for representation. When calculating fees for representation for concurrent claims, SSA reduces the Title XVI past-due benefits amount by the Title II benefits received for the same period. This reduction occurs regardless of whether the actual offset, as provided under section 1127 of the Act, reduces the Title II or Title XVI benefits. This means that the amount of past-due benefits is calculated after the benefit offset, as opposed to Title II only claims, in which SSA determines past-due benefits before any applicable reduction under section 1127 of the Act.

1. Fee Agreement Cases

Because a fee agreement is limited to no more than 25 percent of past-due benefits (in addition to other statutory limitations as defined in Hearings, Appeals, and Litigation Law (HALLEX) manual I-1-2-12 A), the fee amount under an approved fee agreement for services a representative provided in proceedings before SSA depends on SSA's calculation of the past-due benefits. In general, however, the fee amount is determined after a decision maker approves the agreement, when the favorable decision is effectuated.

2. Fee Petition Cases

The fee authorizer does not need past-due benefits information to authorize a fee amount in a fee petition case. Although direct payment of fees to representatives or eligible entities based on a valid assignment (see POMS GN 03920.021) is limited to 25 percent of past-due benefits, the amount of the fee authorized under the fee petition process is not subject to such a limit and is determined using the criteria in HALLEX I-1-2-57 A.