(a) Worker responsibility.  A worker is responsible to restore lost benefits when the loss was caused by Oklahoma Department of Human Services (OKDHS) error.  Benefits cannot be restored if they are lost more than 12 months prior to the most recent of the:

• (1) month the worker was notified by the household, by another person, or an agency in writing or orally of the possible loss to the specific household;
• (2) month the worker discovered in the normal course of business that a loss to a specific household has occurred;
• (3) date the household requested a fair hearing to contest the adverse action which resulted in the loss; or
• (4) date the household initiated court action.

(b) Error discovered by human services center (HSC) staff.  If HSC staff determines that a loss of benefits has occurred and the loss was not caused by the household, the worker takes action to restore any benefits that were lost.  No action by the household is necessary.

(c) Disputed benefits. 

• (1) If HSC staff determines a household is entitled to restoration of lost benefits but the household does not agree with the amount to be restored, the household may request a fair hearing.  If a fair hearing is:
  • (A) requested prior to or during the time lost benefits are being restored, the household receives the lost benefits as determined by the worker pending results of the fair hearing; and
  • (B) favorable to the household, the worker restores the lost benefits in accordance with that decision. 
• (2) If the household believes it is entitled to restoration of lost benefits and after reviewing the case file the HSC staff does not agree, the household has 90 days from the date of the HSC decision to request a fair hearing.  The HSC restores lost benefits to the household only if the fair hearing decision is favorable to the household.

(d) Computing amount to be restored.  After correcting the loss for future months and excluding the months for which benefits have been lost prior to the 12-month time limit, the worker calculates the amount to be restored.

• (1) If the loss resulted in an incorrect allotment but the household was determined eligible, the loss of benefits is calculated only for those months the household participated.
• (2) If the loss was caused by incorrect delay, denial, or termination of benefits, the months affected by the loss are calculated according to subparagraphs (A) or (B) of this paragraph.
  • (A) If an eligible household's application was erroneously denied, the month the loss initially occurred is the month of application, or, for an eligible household filing a timely reapplication, the month following the expiration of its certification period.
  • (B) If a household's benefits were erroneously terminated, the month loss initially occurred is the first month benefits were not received as a result of the erroneous action.
• (3) Lost benefits are computed beginning with the month the loss initially occurred and ending either the first month the error is corrected or the first month the household is found ineligible.

(e) Offsetting claims.  If the household has an unpaid overpayment or an overpayment held in suspense, the amount to be restored is offset against the amount of the overpayment.  The balance, if any, is restored to the household.  Benefits received at initial certification or because of retroactive certification are not used to offset claims against a household.  • 1

(f) Lost benefits to persons disqualified for willful misrepresentation.  A person disqualified for willful misrepresentation is entitled to restoration of any benefits lost during the months the person was disqualified only if the decision which resulted in disqualification is subsequently overturned or reversed.  A person is not entitled to restoration of lost benefits for the period of disqualification based solely on the fact that a criminal conviction could not be obtained, unless the person successfully challenged the disqualification in a separate court action. 

• (1) For each month the person was disqualified, the amount to be restored, if any, is determined by comparing the allotment the household received with the allotment the household would have received had the disqualified member been allowed to participate. 
• (2) The disqualification period cannot exceed 12 months prior to the date OKDHS was notified of lost benefits. 
• (3) If the household received a smaller allotment than it should have received, lost benefits is the difference between the amount the household was entitled to receive and what they actually received.

(g) Method of restoration.  Whether the household is currently eligible or ineligible, the worker restores benefits equal to the amount of benefits that were lost.  The amount of restoration is issued in addition to the allotment currently eligible households are entitled to receive.  • 2