Up to 41% of “miscellaneous” denied Social Security benefits not being reviewed

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Many, if not most, applications for Social Security benefits are approved without any issues. But often, an application is denied, for legitimate reasons. Maybe you don’t have the requisite number of credits on your account for benefits, or something similar. But also, many times, benefits are denied without a specified reason. When this happens, the Social Security Administration staffer working on the case will apply a code of “miscellaneous suspense” to the record.

The suspension of benefits can happen either at the point of initial application, or upon a review of the record at some point. For the latter, the individual may have been receiving benefits for quite a while, and then suddenly the benefit is suspended. Apparently quite often, this happens because there is a piece of information missing from the file (or what’s on file is incorrect). In such cases there is a followup process in place to generate a letter or some communication with the benefit recipient to clarify and correct the information on file so that benefits can be resumed.

This “miscellaneous suspense” code is problematic, for a couple of reasons: first, because it is not regularly audited, this code can be used in cases where it is not the appropriate code; second, and more important, the “miscellaneous suspense” code does not have an automatic followup process to make sure that whatever the reason for the suspension of benefits is being addressed (if it can be).

Recently the SSA published the results of an audit by the Office of Inspector General (OIG), who regularly audits various components of the federal government. This particular audit was focused on the “miscellaneous suspense” code and whether follow-up had been performed appropriately on those records with this suspense code.

Background

As briefly described above, SSA employees are tasked with keeping information in benefit recipients’ records up-to-date. Sometimes a beneficiary no longer meets the criteria to receive benefits, and when this is the case, SSA suspends benefits to the recipient. When benefits are suspended, the SSA employee identifies the issue to be resolved (to resume benefits) by inputting one of dozens of situation-specific suspense codes on the beneficiary’s record. From the audit report:

For example, when SSA does not have a beneficiary’s correct address, an employee suspends benefits using a code that indicates SSA must obtain the correct address and update its records.

As mentioned previously, there is also a “miscellaneous suspense” code which can be applied if there is not a specifically-identified code for the situation. The purpose of the “miscellaneous suspense” code is for the very limited situations where no other suspense code could apply to the case.

For all other suspense codes, since they are for a specific type of situation, there is a systematic follow-up process. If an address is incorrect, the SSA has a process to reach out via all available means to determine what the correct address information should be.

However, since the miscellaneous suspense code is for “unknown” situations, it is incumbent on the SSA employee to manually create a follow-up alert to resolve whatever the situation is that created the suspense.

To create a group for auditing, OIG identified 2,525 total records in the Social Security beneficiary records that had had benefits suspended using the miscellaneous suspense code (between the dates of January 2015 and December 2018). From those 2,525 records, 100 were chosen at random to review in-depth.

The Audit

First the good news: out of the sample of 100 records reviewed, 59 had been properly followed-up, and either benefits resumed or continued suspense if the problem was not able to be resolved. So nearly 60% of the time, the system is working the way it should.

However (and now the bad news): this means that 41% of the cases had not been properly followed-up on. This resulted in an estimated $748,000 in benefits that had been continued in suspense for these beneficiaries. When that is extrapolated to all possible date ranges, OIG estimated that 21,000 beneficiaries have had approximately $378 million in benefits in suspense that have not been properly followed-up on. This is a very big deal if you’re one of those 21,000.

Further information from the audit indicates that, of those 41 of 100 that were not followed-up on, 22 of them had the miscellaneous code applied improperly, and some other specific code (with an automatic follow-up) should have been used.

As of the writing of the report, only 10 of the 41 records had been resolved; that is, 31 of the 41 have not been followed-up on yet. Presumably these will be reviewed soon. For the complete report, follow this link to the OIG Audit report.

SSA notes that there are two issues at play here: 1) There is no automatic follow-up process to ensure that miscellaneous codes are reviewed and resolved; and 2) There are no management reports to determine if the “miscellaneous suspense” code is being mis-used by SSA employees.

So it’s in your hands if you’ve been affected by this.

What should you do?

If you have had your benefits denied or suspended and you don’t know exactly why, you should follow up with Social Security to find out why. It’s possible that you’re one of these 21,000 people who have had the “miscellaneous suspense” applied, which was either never followed up on or was erroneously coded in the first place.

You need to find out the actual reason why your benefits were suspended. If it turns out that your situation is correctly identified and you are not eligible for the benefit, then you’re only out the time to check into it. But it could be that it’s a matter of record-keeping or updates to information, incorrectly coded as “miscellaneous” and never followed up on. In that case, work with SSA to correct the record as you can and (maybe!) get your benefits resumed.