The role of the PC is generally limited to payment effectuation activities. However, other PC technicians conduct limited reviews. Any PC review, either pre- or post-adjudicative, is limited to the issue or evidence in question. If there is an error on the face of the evidence, see GN 04010.020.

Refer to GN 01010.285 for cases where the Benefit Authorizer (BA) refers a claim to a claim authorizer (CA). The CA review is limited to the resolution of the issue identified. However, the CA can take corrective action within the rules of reopening; see GN 04001.010 for more information.

NOTE: Remember that a full PC review is required if the claim is a non-DOFA case.

The FO review is limited to the last adjudicative action, including any subsequent action taken or the related evidence. Therefore, you must retrieve the prior claims file if electronic documentation does not exist or the claimant fails to supply the needed information and telephone contacts are unsuccessful. After the review, correct any errors detected within the rules of Administrative Finality.

When reviewing the last adjudicative action for completion and consistency with the current claim, follow the guidelines in GN 01010.007 and GN 01010.285.

Limit the review to actions taken since the date of the last adjudicative action to identify factors that might affect the current claim.

Review evidence in the prior claims file only if any of the following issues apply:

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  The prior determination was an abatement, disallowance or withdrawal;

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  The previously submitted evidence is needed to adjudicate the subsequent claim;

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  The current claim contains material that raises a question about the accuracy of the prior determination;

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  The material filed on the prior claims file raises a question about the current claimant's right to benefits;

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  In the adjudicator's judgment, a review is necessary to ensure the accuracy of the current decision;

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  Material is submitted with the current claim for the purpose of questioning the prior award (see GN 01010.320 if an adverse claim is involved);

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  Wage credits, possibly creditable to a World War II (WWII) or post-WWII veteran under Section 217 of the Act are identified;

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  The Number Holder (NH) worked in the railroad (RR) industry after 1936 and there is no determination as to whether SSA can use the RR compensation as wages;

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  The prior determination did not establish a factor of entitlement for the current award. The complete file requires review to resolve the particular factor(s).

  Example: While converting a young spouse to widow(er) benefits, the adjudicator discovers that the prior determination did not establish the young spouse's date of birth (DOB). The adjudicator will review the file to establish the DOB, but will not review the file with respect to unrelated factors.