363            CLAIMS

A Senior Benefits Program recipient may occasionally receive more or less assistance than he or she is entitled to.

363-1         UNDERPAYMENTS

If DPA(Division of Public Assistance) discovers that a recipient has been underpaid, it will issue a corrective payment. However, a corrective payment will not be issued if the underpayment was caused by the recipient's failure, without good cause, to report, or to report accurately, a change in circumstances which caused the recipient to be underpaid.

363-2         OVERPAYMENTS

An overpayment means that a recipient has received Senior Benefits to which he or she was not entitled.  If a Senior Benefits worker becomes aware that a recipient is being overpaid, he or she must take action to correct the Senior Benefits.

The State statutes governing the Senior Benefits Program provide that an individual is liable for the value of assistance or benefits improperly paid to that individual, but only if the improper payment was based on inaccurate or incomplete information provided by the individual. 

The Division will pursue the collection of Senior Benefit overpayments received by both current and former recipients.

363-2 A.    DEFINITION OF A SENIOR BENEFIT OVERPAYMENT

For Senior Benefit purposes, an "overpayment" means the amount of Senior Benefit benefits to which a recipient was not entitled.  It includes the amount of assistance paid to a recipient pending a fair hearing decision, if the hearing authority renders a decision requiring that the assistance be repaid.

363-2 B.    TREATMENT OF A SENIOR BENEFIT OVERPAYMENT

The requirement to repay a Senior Benefit overpayment depends on whether the overpayment is agency-caused or client-caused.  Repayment is requested but not required for an agency-caused overpayment.  Repayment is required for a client-caused overpayment.

1. Agency-caused Overpayment

An overpayment is agency-caused when the overpayment occurs solely as the result of an administrative error or oversight by the Division.  Agency-caused overpayments include situations where the agency:

•  Fails to take timely action on a reported change;

•  Calculates income, deductions, or payment incorrectly; or

•  Makes any other error which results in an incorrect payment.

2. Client-caused overpayment

An overpayment is client-caused when the overpayments are the result of an action or inaction by the recipient, or by an individual acting on the recipient’s behalf. Client-caused overpayments include situations where the client:

•  Fails to provide the agency with correct or complete information;

•  Fails to report a change; or

•  Fails to report a change in a timely manner.

363-2 C.         ESTABLISHING A CLAIM

When a case worker discovers that a Senior Benefit overpayment has occurred, he or she will determine the amount of the overpayment, complete a Report of Claim Determination (Gen 95Report of Claim Determination Form) form, and send the Gen 95Report of Claim Determination Form form to the Benefit Issuance & Recovery Unit (BIRUBenefit Issuance & Recovery Unit).  The BIRUBenefit Issuance & Recovery Unit will establish the overpayment claim on EIS(Eligibility Information System) and pursue collection of the claim against the current or former recipient.  See Chapter 111 of the Administration Procedures manual for more information about program losses and claims collection.

363-2 D.         NOTICE REQUIREMENT

After being advised of the overpayment, the BIRUBenefit Issuance & Recovery Unit is responsible for sending the current or former recipient a written request for repayment.  The overpayment notice must:

• State the amount of the overypayment;
   
• Give the reason for the overpayment;
   
• Advise the individual whether repayment is being requested or required.  If payment is being requested, the notice must specify what further actions will be taken if repayment is not made.

363-2 E.         REPAYMENT OPTIONS

A former or current recipient may choose to repay an overpayment by:

1. 1. Assigning the individual’s Permanent Fund Dividend through a valid legal assignment to the Division.
       
   2. Making a quarterly installment payments of at least 30 percent of the last monthly assistance payment received by the individual; or
       
   3. Making monthly installment payments of at least 10 percent of the last monthly assistance payment received by the individual;
       
   4. Making a single payment;

An individual may choose any combination of the payment options listed above as long as the total annual repayment amount is at least equal to the amount that would be collected by monthly installment if only that option were chosen.  An individual who chooses to repay an overpayment with their Permanent Fund Dividend must execute a new valid assignment of each year’s Permanent Fund Dividend until the overpayment is recovered in full.

363-2 F.         HARDSHIP PROVISION

Repayment of a client-caused overpayment may be suspended or adjusted if it will cause extreme economic hardship to the individual.  The BIRUBenefit Issuance & Recovery Unit is responsible for deciding whether to suspend or reduce collection due to hardship as follows:

1.  Current Recipients.

If a current recipient can demonstrate that the loss of assistance will cause extreme economic hardship, repayment may be suspended for up to three months.

2. Former Recipients

If a former recipient can demonstrate that repayment will result in extreme economic hardship; the BIRUBenefit Issuance & Recovery Unit may:

•  Allow the former recipient to repay less than the required amount; or

•  Temporarily suspend repayment for up to three months