Entitlement overpayments can occur when an individual receives a benefit payment they are not eligible for or receives a payment exceeding the amount they are entitled to.
This blog post aims to clarify the concept of “without fault” in entitlement overpayments, according to § 404.510a, and explain the circumstances under which an individual may be deemed “without fault.”
What is “without fault”?
An individual is considered “without fault” in the case of an entitlement overpayment if they accept the overpayment due to reliance on erroneous information from an official source. This source could be within the Social Security Administration or another governmental agency reasonably believed to be connected to the administration of benefits under title II or title XVIII of the Social Security Act.
Instances when an individual is deemed “without fault”:
- Erroneous information from an official source: If an individual or someone on their behalf accepts an overpayment because they relied on incorrect information from an official source regarding the interpretation of a relevant Social Security Act provision or its regulations, the individual will be considered “without fault.”
- Adjustments under the family maximum provision: An individual may also be deemed “without fault” if they are overpaid due to an upward adjustment of their benefits under the family maximum provision (section 203 of the Act). This situation may arise when one or more beneficiaries on the same social security record are terminated, and the individual’s benefits are subsequently reduced due to the reentitlement of the terminated beneficiary(ies) following a change in the law.
Note that for the purposes of this section, governmental agency also includes intermediaries and carriers under contract, as per sections 1816 and 1842 of the Social Security Act.
Example: Jane’s Entitlement Overpayment and the “Without Fault” Clause
Jane, a 62-year-old retiree, started receiving her Social Security benefits under title II of the Social Security Act. She was informed by a Social Security Administration (SSA) representative that she was eligible for a certain monthly benefit amount based on her work history and contributions. However, due to an error in the calculation by the SSA, Jane began receiving a higher benefit amount than she was actually entitled to.
After a few months, the SSA discovered the error and informed Jane that she had been overpaid. Since Jane had relied on the erroneous information provided by the SSA representative, she would be considered “without fault” in this entitlement overpayment situation. As a result, Jane may not be required to repay the overpaid amount, or she might be eligible for a more favorable repayment plan.
This example demonstrates how the “without fault” clause offers protection for individuals like Jane, who accept overpayments due to incorrect information from an official source. In such cases, they may not be held responsible for the overpayment, as they acted in good faith based on the information provided to them.
Conclusion: The “without fault” clause provides some protection for individuals who accept overpayments due to erroneous information from an official source or certain adjustments in their benefits. By understanding the concept of “without fault” in entitlement overpayments, individuals can better navigate the complexities of the Social Security system and ensure that they are treated fairly in the event of an overpayment.
https://www.ssa.gov/OP_Home/cfr20/404/404-0510a.htm
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