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HOME / SUPPORTS FOR ISLANDERS AND FAMILIES / SOCIAL ASSISTANCE POLICY MANUAL /

7-2 Overpayments - In Pay

PURPOSE

1. To identify, account for, and recover social assistance benefits received in excess of eligibility by an applicant and the applicant continues to be eligible to receive social assistance benefits.

DEFINITIONS

2. Overpayments

(a) Cash and/or material benefit which an applicant was not entitled to receive.

(b) Advance of funds to assist an applicant in securing or preventing the loss of living accommodations or basic utilities.

3. Applicant:

(a) A recipient of social assistance benefits

(b) A past or former recipient of social assistance benefits

(c) An applicant's estate

(d) A trustee for an applicant

4. In-Service Client: An applicant who is currently receiving social assistance benefits.

5. Out-Of-Pay Client: An applicant who is no longer eligible for social assistance benefits.

6. Withhold: Any amount payable to an applicant that is held back from the entitlement paid and is applied to the applicants outstanding overpayment balance.

7. Deliberate Misrepresentation: Any action, inaction or omission which, in the opinion of the department, is a wilful attempt to obtain benefit payments or service to which the applicant is not entitled.

PRINCIPLES

8. Every effort will be made to minimize overpayments and pursue recovery.

9. Overpayments should be prevented by accurate information gathering, careful calculations, correct application of regulation and policy, and timely reviews.

10. Assistance must not be granted with the intention of recovering the amount as an overpayment. Exceptions granted pursuant to Social Assistance Act - General Regulation 16 and 17.

11. An applicant has the right to appeal to the Social Assistance Appeal Board pursuant to 5.1 of the Social Assistance Act.

12. The level and method of recovery will be appropriate to the amount of the debt and the means of the debtor.

13. Every attempt shall be made to recover overpayments regardless of whether the applicant continues to receive social assistance benefits or not.

14. Overpayments identified on joint applicants are the responsibility of both parties. If the joint applicants cease to be partners and they either terminate service or file independently or some combination of the two, the overpayment will be split equally and assigned accordingly.

POLICY

Documentation/Notification

15. All overpayments must be recorded in the applicant’s electronic file. An explanation of the circumstance and a description of the calculation must be included.

16. An applicant must be notified of the overpayment amount, circumstance and repayment terms. Every attempt should be made to provide an applicant with an "Overpayment Acknowledgment Form". Applicants should sign the form and a copy kept in the applicant's file.

Appeal

17. Applicants identified as accumulating overpayments will be provided with appeal information upon request.

18. If an applicant disputes an overpayment, they can elect to have their dispute heard by the Social Assistance Appeal Board. Pursuant to the Financial Assistance Act 5.1(2) the Appeal Board will make a determination on whether or not the client was eligible to receive the funds the department identified as an overpayment.

Recovery

19. Overpayment recoveries from “In-Pay” clients may be negotiated as follows:

(a) Repayment in lump sum;

(b) A withhold from the monthly entitlement;

(c) Suspension of assistance until the applicant has expended an amount equivalent to the overpayment, considering both basic and special need expenses; or

(d) Some combination of the above.

20. Calculation of Withhold Recovery Rates:

(a) Recovery rate should be between 5%-10% of the overpayment amount.

(b) Minimum rate of $25 to a maximum of $100 with discretion given to Overpayment Coordinator to adjust based on consultation with worker and considering the clients circumstances.

(c) Amounts are withheld from an applicants monthly entitlement until overpayment is fully recovered or service is terminated, whichever occurs first.

21. Upon termination or discontinuation of social assistance benefits, an “out-of-pay” applicant with an outstanding overpayment is contacted by the department, notified of the outstanding amount and a mutually agreeable repayment schedule is negotiated. Refer to Policy 7-2-1 Overpayment - Out-Of-Pay.

No Recovery Action

22. No recovery action (withhold) will be taken when excess benefits are paid to an applicant as the result of a system error, an interpretation of information, or a judgement lapse by the worker AND it is reasonable to assume the applicant would not have recognized the error.

PROCEDURE

Roles

23. The "Case Worker" is responsible to minimize the occurrence of overpayments by adhering to legislation and policy requirements and by accurate application of case management procedures.

24. The Department will designate an "Overpayment Coordinator" in each office to supervise and monitor "In-Pay" client’s overpayments and to make first contact with "Out-Of-Pay" clients with outstanding overpayment balances.

Process

25. In-Pay Clients

(a) Worker notifies Overpayment Coordinator of new overpayment.

(b) Worker notifies client of overpayment - amount, circumstances, repayment obligation.

(c) Overpayment Coordinator sets up withhold on client file.

(d) Worker obtains clients signature on "Acknowledgment of Overpayment" form.

(e) Withhold amount continues until client overpayment is paid in full or client=s service is terminated, whichever occurs first. If client terminates before debt is paid, refer to Policy 7-2-1 Overpayments - Out-Of-Pay.

26. Where it appears an overpayment has resulted from deliberate misrepresentation by a social assistance recipient, refer to Policy 7-5 Prosecution.

CROSS REFERENCES

5-1 Shelter - Rent/Mortgage

6-2 Utility Installation and Deposit

6-13 Arrears - Shelter/Utility

7-1 Misappropriation of Assistance by Beneficiaries

7-3 Appeals

7-5 Prosecutions