GN 02335: Underpayments Due to Medical Services Received
TN 1 (07-87)
A. Definition of Legal Representative
The term “legal representative” of the deceased means the executor or administrator of his estate, and includes an individual who qualifies under a “small estate” statute (i.e., one which does not require formal probate proceedings) of the State in which the beneficiary was domiciled at the time of his death. If an individual claims the underpayment as legal representative under a small estate statute, see GN 02315.001. If the claimant qualifies under these procedures, include a statement to this effect when the claim is forwarded to the carrier. Questions concerning the small estate laws and other questions relating to the appointment and authority of a legal representative should be referred to the regional attorney in accordance with GN 02315.025.
If it is expected that a legal representative will be appointed within a few days, development may be deferred. However, when there may be an indefinite delay in appointment, the claim may be filed by a surviving relative of the deceased based on the priority listing in GN 02335.025.A.2.
B. Evidence Requirement
In addition to the general provisions in GN 02335.030, a copy of the order of appointment should be submitted with the request for payment filed by a legal representative under the following circumstances:
Where the physician has died before an SMI payment due him is completed, and the legal representative of his estate is claiming payment (see GN 02335.020 D.);
Where services have been paid for by the beneficiary before his death or with funds of the beneficiary's estate, and the legal representative of his estate is claiming payment (see GN 02335.025 A.l). A copy is not required if the proof has already been submitted to the carrier or DO in connection with another claim (including a claim for monthly benefits). If a copy of the appointment was previously received in the DO and receipt of the proof annotated on an SSA-250, this fact shown over the signature of a staff member on a report of contact will suffice in lieu of a copy of the appointment papers.