When multiple claimants are involved on different claims and multiple errors are involved
affecting multiple claimants, consider the initial determinations on each claim as
separate and independent determinations and apply administrative finality to each
determination separately.
EXAMPLE – Multiple Claimants Involved on Different Claims Involving Different Benefits
Pat, a parent of two children, is entitled to Retirement benefits effective 03/2001.
The initial award notice was sent 03/13/2001 to both Pat and the two children. Pat's spouse is entitled to disability benefits
and also receives Workers’ Compensation. The spouse has been entitled to disability
since 02/2000. The spouse's initial disability award notice
was sent 02/22/2000 to the spouse and the two children. Both of the children have simultaneous entitlement
on both records. Currently, they are being paid on Pat’s record since Pat has a higher
PIA.
In 10/2005, an AERO is received on Pat’s record and it becomes apparent that Pat's
retirement benefit was figured incorrectly because their military service for 1957-1960
was not included in their initial entitlement even though it was in file at the time
of the initial determination in 03/2001. Pat has been being underpaid since 03/2001.
In 11/2005, new worker’s compensation information is received on the spouse’s disability
benefit going back to the date they became entitled to disability, 02/2000. There
was a change in the spouse's WC amount in every month since 02/2000, the date they
became entitled to disability. The spouse has been receiving too much Social Security
disability benefits because their offset was computed incorrectly and to their favor.
In summary:
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Pat’s retirement benefit was too low from 03/2001 until 10/2005
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Spouse’s disability benefit was too high from 02/2000 until 11/2005
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Children’s benefits paid on the spouse’s disability benefits were too high from 02/2000
until 02/2001 (Pat's retirement benefit is higher than spouse’s disability)
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Children’s benefits paid on Pat’s retirement were too low from 03/2001 until 10/2005
In 11/2005, these errors were discovered when reviewing the case in the PSC. Since
the errors on Pat’s record were obvious and it is absolutely clear that the determination
was incorrect, this is an example of an error on the face of the evidence (GN 04010.020). Determinations may be reopened within 4 years of the date of the initial determination
if that determination was favorable to the claimant or at any time if it was unfavorable
to the claimant.
Because the spouse’s Workers’ Compensation has changed, we can make a new initial
determination to the spouse's benefit with each change in the amount of the spouse's
Workers’ Compensation amount (see GN 04030.080B.1.).
Since the initial determinations of the Disability, Retirement and Child’s benefits
are separate initial determinations to different benefits, consider each of these
initial determinations to Disability, Retirement and Child’s benefits to be independent
determinations. Apply administrative finality separately to each claim based on the
date of their initial determination notice.
In this case, the spouse’s Disability determination can be recomputed because there
were changes in the WC amount (GN 04030.080B.1.).
Pat’s RIB determination could be revised because correction would be favorable. As
a result, Pat’s RIB claim should be corrected beginning 03/2001 and an increase is
due for the children on Pat's record as well, effective 03/2001.
Since there was a change in the WC amount in every month, the spouse’s disability
benefit can be adjusted going back to the month the amount first changed as well as
the children’s benefits since there were changes in the WC after the date of the initial
determination of entitlement to auxiliary benefits. We can make a new initial determination
and impose offset against the auxiliaries using the full amount of the WC effective
with the date of the change (see GN 04030.080B.6.). Since the children are also entitled on Pat’s retirement record and revising Pat's
and their records would be favorable to them, the children’s benefits on Pat’s record
can be reopened and revised.