TN 7 (07-23)
Claims-related initial determinations(e.g., insured status, PIA, MBA, post-entitlement issues) are reopened and revised based on the rules of administrative finality.
Determinations relating to revision of an E/R are made:
Within the time limits provided by the statute of limitations for correction of earnings records (see RS 02201.001); or
After expiration of the time limits provided by the statute of limitation for correction
of earnings records, provided an exception to the time limits permits revision of
the E/R (see RS 02201.008).
Where an E/R cannot be correctedbecause the time limitation under the statute of limitations has expired and no exception
applies, we must use the E/R as establishedin taking any award or disallowance action.
If the E/R can be revised under the statute of limitations but the determination on
the claims issue cannot be reopened under administrative finality:
Any increase in the PIA and benefit amount based on the revised E/R can be paid effective
with the month the question was raised which resulted in the E/R being revised (i.e.,
rather than reopening and revising the prior determination, we make a new initial
determination effective with a later date).
Any decrease in the benefit amount will not be made.
Example:B. Jones attained age 62 and filed a claim for retirement benefits in September 1984.
In processing the claim, it was noted that there were no postings for 1979 in an E/R
that otherwise showed consistent postings. Upon questioning, B. Jones insisted that
they were paid wages in that year. However, B. Jones' employer was no longer in business,
and B. Jones was unable to furnish any evidence of wages for that year. B. Jones received
notice of the determination on their claim in November 1984, and that determination
became final. That determination, which established the monthly benefit rate, was
based in part on the earnings determination that B. Jones was not paid any wages in
1979. In September 1989, B. Jones discovered old records which included evidence establishing
that they were paid $1500 in wages in 1979, and they presented the evidence to SSA
in that month.
The initial determination of November 1984 with respect to B. Jones' application for
benefits has become final and may not be reopened under the rules of administrative
finality because, even though good cause can be shown to exist and new and material
evidence is furnished, more than 4 years have elapsed since the notice of the initial
determination and there is no indication that the claim can be reopened under the
unrestricted reopening provisions. However, B. Jones' E/R may be credited with wages
of $1500 in 1979 since one of the exceptions to the time limitation is applicable
(see RS 02201.016). Inclusion of these wages increases their PIA. While the initial claims determination
may not be reopened, an amended award may be prepared to pay their the increased PIA
effective with September 1989, the month they questioned the amount of their benefit
by furnishing additional evidence of wages paid in 1979. If the initial claims determination
could be reopened, the increased PIA could be paid retroactively to the initial month
If new evidence of earnings is submitted but the E/R cannot be revised under the statute
of limitations, the E/R as posted is considered to be correct, and any benefit amount
based on it is considered correct.
Since we cannot reopen correct determinations (GN 04001.070), we would not reopen the initial determination on the claims issue.
There is no basis for changing the benefit amount prospectively.
EXAMPLE:A RIB award was approved for D. Smith on 9/19/84 based on their E/R which included
wages of $5,400 for 1982. In April 1988, we learned that the wages reported for 1982
were based on domestic services performed in the employ of their child in the child's
private home. In the absence of fraud or an error apparent on the face of the earnings
record, the statute of limitations does not permit us to remove the wages reported
for 1982 from the E /R. Since the E/R cannot be changed, we consider D. Smith to be
receiving the correct benefit amount. Therefore, reopening does not apply.