607-2          RESTORED BENEFITS

Restored benefits are issued when a household is wrongfully denied benefits or received less benefits than it was entitled as a result of agency error.

Restored benefits are not given to households for client-caused underpayments such as unreported deductible expenses, unreported household members, and unreported decreases in income.

Benefits will not be restored if lost more than 12 months prior to the month the loss was discovered.  Individuals disqualified for an intentional program violation ( IPV Intentional Program Violation ) are entitled to benefits lost during the months that they were disqualified only if the IPV Intentional Program Violation decision is reversed.

The caseworker will document the reason for the restored benefits, the months affected and the amount due to the household.

607-2 A.     WHEN TO ISSUE RESTORED BENEFITS

1. When benefits are erroneously denied or terminated the household must first be determined eligible for the period of time affected.
    

   1. If the application is denied in error, calculate the loss from the date of application or the first month of the new certification period.
       

   2. If delayed, refer to policy at MS 601-5F.
       

   3. If the case is closed in error, calculate the loss from the month the loss initially occurred.
       

2. Calculations for lost benefits are determined up to the date the error is corrected or the end of the certification period, whichever occurs first.  If there is inadequate information to determine if restored benefits are due, the household must provide necessary information for the period in question before benefits are restored.
    

3. The caseworker will issue the restored benefit via the EIS Eligibility Information System Underpayment Authorization (UNAU) screen.  Restored benefits in the amounts of $1, $3 or $5 will be rounded up to the next whole dollar, i.e., $2, $4, or $6.
    

4. If the household has an outstanding claim balance, restored benefits will be applied to the claim before benefits are issued.  Initial allotments cannot be reduced to offset claims, even if the benefits are issued retroactively.  The caseworker will contact the Claims Unit prior to issuing any restored benefit to determine whether an outstanding claim balance exists.  If a claim exists, the caseworker will notify the household that the underpayment occurred and the restored benefit was all or partly applied as payment to the claim.
    

5. If the caseworker finds the household has an overpayment in addition to an underpayment, the caseworker will complete one Report of Claim Determination form (GEN 95) for both the overpayment and the underpayment and submit it to the Claims Unit.  The Claims Unit will establish the overpayment on EIS Eligibility Information System and authorize the restored benefit.   EIS Eligibility Information System will apply the restored benefit as payment to the newly established overpayment claim.

607-2 B.     NOTIFICATION OF RESTORED BENEFITS

Households will be notified of their right to restored benefits when the agency becomes aware of the error.  The notice will include the amount of benefits to be restored, and explain any offsetting for a claim.

607-2 C.     CHANGES IN HOUSEHOLD COMPOSITION

If a household's composition has changed since the loss occurred, restore benefits to the majority of the household members still together.  If the majority of the household cannot be located or are no longer living together, restore benefits to the household containing the head of household at the time the loss occurred.

607-2 D.     DISPUTED BENEFITS

Households entitled to restored benefits that disagree with the amount or any other action to restore lost benefits, have 90 days from the date of notification of the entitlement to request a fair hearing.  

If a fair hearing is requested prior to or during the time lost benefits are being restored, benefits will be restored as determined by the agency pending the hearing decision.  If the decision is favorable to the household, benefits will be restored in accordance with the decision. If a household claims it is entitled to restored benefits but the district office disagrees, benefits will not be restored pending the hearing decision.

All parties will comply with the fair hearing decision within 10 calendar days after receipt.