Determining Claim Months 430-05-80-27

(Revised 10/01/11 ML3286)

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For administrative errors and inadvertent household errors, the worker must establish a claim for any overissuance for a maximum of 12 months from the date of discovery.

 

Example:

Worker discovers in July 2011 the household failed to report a source of unearned income at the time of initial application in April of 2009.  A client error claim must be established for the months of August of 2010 through July of 2011 and the worker must determine if IPV should be pursued.

 

If a household failed to report a mandatory reportable change, the worker must apply the maximum timeframe of 10-10-10 to determine when the change should have been acted on.   

• The household has until the 10th day of the month following the month the change occurred to report the mandatory change.
• The worker then has 10 days to act.
• In all instances 10-days must be allowed for the 10-day advance notice.  Even though 10-day advance notice may not have been required (change reported in writing and signed by the household), policy requires that 10 days must be allowed.  

 

Exception:

10-10-10 does not apply at initial application or review.

 

If a worker failed to act on a timely mandatory reported change, the worker must apply the maximum timeframe of 10-10-10 to determine when the change should have been acted on.

 

Example:

A household reports on September 9th, their August income exceeds the 130% GIL for their household size, the income results in ineligibility and is going to continue.  The worker discovers in December that this change was not acted on.  In determining the first month of the claim, the full 10-10-10 must be applied.  The household had until September 10th to report the change and the worker had until September 20th to act.  Allowing for a 10-day advance notice, the first month of the agency error claim would be October.  

 

If a worker failed to act timely on a change the household was not required to report but required action by the worker, the household’s 10 days to report does not apply.  The worker must apply 10-10 from the date they became aware of the change to determine when the change should have been acted on.

 

Examples:

1. During a case file review in December, it was discovered that an IEVS UIB alert received on October 5th had not been acted on.    In determining the first month of the claim, the worker must apply 10-10.  The worker had until October 15th to act on the IEVS alert.  Allowing for a 10-day advance notice, the first month of the agency error claim would be November.
2. During a case file review in January, it was discovered the household reported a household member left the home on October 25th and the change had not been acted on.  Since this is not a mandatory reportable change but does meet criteria to decrease benefits, the change was required to be acted on.  In determining the first month of the agency error claim, the worker must apply 10-10.  The worker had until November 4th to act on the change.  Allowing for a 10-day advance notice, the first month of the claim would be December.  

 

If a 10-day advance notice would have been required for the month the claim is being established (individual did not report timely or worker did not act timely), it is assumed, for the purpose of calculating the claim, that the 10-day advance notice period would have expired without the household requesting a fair hearing.