CLAIMS HANDBOOK - Department of Human Services

BENEFIT RECOVERY (CLAIMS) HANDBOOK
Overview of Benefit Recovery
Benefit errors occur when an Assistance Unit (AU) receives an incorrect benefit amount
in the Food Stamp, Temporary Assistance for Needy Families, Child Care or Refugee
Assistance Program.
Federal and State regulations provide for the mandated recovery of over-issued benefits or the
restoration of under-issued benefits.
Benefit errors are generally caused by:
• A customer unintentionally providing inaccurate or incomplete information
• A customer deliberately providing incomplete or inaccurate information
• A case manager failing to take action on known information
• A case manager miscalculating benefit entitlement
In the programs supported by SUCCESS, errors must be corrected by:
• Invalidating the benefit error if unsupported by verification, case
documentation, policy or if it meets fiscal criteria
• Validating the error by issuing an underpayment (UP) or establishing a claim
• Referring the suspected program violation to the Office of Program Integrity and
Compliance (OPIC)
The Office of Family Independence Policy Manual provides policy to determine the validity
of benefit errors.
The Benefit Recovery portion of the Office of Family Independence Policy Manual (Volume
IV) is a specific guide to the management of benefit errors.
The SUCCESS User Manual provides instructions for the automated tracking and reporting of
benefit errors and recoveries.
The Field Fiscal Services Policy and Procedures Manual provides guidelines for managing
the recovery of and ensuring the fiscal integrity of recovered funds in the county.
The Claims Handbook provides the County and State with established procedures for claims
management.
Claims management includes monitoring the management reports produced by SUCCESS as
well as claims file maintenance and customer service to those whose claims we manage. It
also includes working with state and other county personnel to assure that we recover all that
is due but no more, and that we complete this task while allowing the debtor to maintain
dignity.
Rev December ‘10 5