TN 3 (12-13)
GN 00210.400 Same-Sex Marriage - Benefits for Surviving Spouses
The Windsor court decision allows us to process some widow’s and widower’s (i.e., surviving spouse) claims and appeals involving same-sex ceremonial marriages, including Medicare-only claims. These instructions include procedures for approving, denying, or holding claims and appeals for benefits based on a ceremonial same-sex marriage. In addition to the instructions below, applicants must meet all factors of entitlement before we approve a claim. For other eligibility requirements for surviving spouse and surviving disabled spouse benefits, see RS 00207.001 and DI 10110.001. For surviving spouse Medicare-only benefits, see HI 00801.006, HI 00801.191, and HI 00801.405.
IMPORTANT: Review spouse claims and appeals that have been on hold for possible processing now.
B. Instructions for processing surviving spouse claims involving same-sex marriage
This section provides instructions for processing claims for surviving spouse benefits involving a same-sex ceremonial marriage. Follow the instructions in GN 00210.005 to hold surviving spouse claims that cannot be processed using the instructions in this section.
1. Confirm the validity of the same-sex marriage
a. Ceremonial marriage occurred in the U.S.
If the ceremonial marriage occurred in the United States (U.S.) (including the 50 states, the District of Columbia, the U.S. Virgin Islands, Puerto Rico, Guam, American Samoa, and the Northern Mariana Islands), determine whether the couple entered a same-sex marriage after the date the issuing state permitted same-sex marriage using instructions in GN 00210.100B.1.
If the couple entered a same-sex marriage after the date the issuing state permitted same-sex marriage, determine domicile following instructions in GN 00210.400B.2. in this section.
If the couple entered a same-sex marriage before the date the issuing state permitted same-sex marriage, deny the claim following the instructions in GN 00210.400E in this section.
b. Ceremonial marriage occurred outside the U.S. (foreign marriage)
If the same-sex marriage occurred outside the U.S., follow instructions in GN 00210.006 to request a legal opinion and process in accordance with the opinion.
2. Confirm domicile of deceased number holder (DNH)
Determine the DNH’s domicile at the time he or she died by using the instructions in GN 00305.001A.2. Refer to the chart in GN 00210.100 for a list of states that recognize same-sex marriage.
If the DNH was domiciled at the time of his or her death in a state that recognizes same-sex marriage, determine whether the marriage meets the duration requirement following the instructions in GN 00210.400B.3. in this section.
If the DNH was domiciled, at the time of his or her death, in a state that does not recognize same-sex marriage, hold the claim following instructions in GN 00210.005. For examples of cases to hold, see GN 00210.400F.2. in this section.
If the DNH was domiciled at the time of his or her death outside the United States, refer the claim for a Regional Chief Counsel (RCC) opinion following the instructions in GN 01010.815 and process in accordance with the opinion.
3. Confirm the duration requirement
A claimant for surviving spouse benefits must meet the duration of marriage requirement prior to adjudication of the claim. To develop duration of marriage, see the instructions in RS 00207.001A.1. and GN 00305.100. Continue to hold claims in which the claimant may meet the exceptions to the duration of marriage requirement in RS 00207.001A.1.a.3. through RS 00207.001A.1.a.7., following instructions in GN 00210.005. Also, see examples for determining marriage duration at GN 00210.400F in this section.
NOTE: Do not consider the date of the Windsor decision in determining the duration of marriage. Use the date the couple had a ceremonial marriage in a state that permits same-sex marriage on or after the effective date in that state. For instructions on determining marital status, see GN 00210.100B.1.
If the marriage between the claimant and the NH meets the duration requirement, then determine the marital status of the claimant in GN 00210.400B.4. in this section.
If the marriage between the claimant and the NH does not meet the duration requirement, deny the claim following the instructions in GN 00210.400E in this section.
NOTE: If the marriage does not meet the duration requirement and the claimant alleges a prior non-marital legal same-sex relationship (e.g., civil union) to the NH, hold the claim as set out in GN 00210.005.
4. Confirm the marital status of the claimant
The claimant must be unmarried to become entitled.
If the claimant alleges that he or she is not married then process per GN 00210.400D in this section.
If the claimant alleges a marriage after the NH’s death, then hold the claim per instructions in GN 00210.005.
C. Date of filing and month of entitlement for same-sex marriages
For new and pending claims, follow the procedures for determining month of entitlement based on the application filing date as described in GN 00204.007. Do not consider the date of the Windsor decision when determining month of entitlement. Follow established policy on protective filing in GN 00204.010 if needed. For policy about retroactivity on surviving spouse claims, see GN 00204.030B.2.
D. Procedure for processing allowances
When all entitlement factors listed in RS 00207.001 and described in this section are met, use the following instructions to approve the claim.
1. In the field office (FO) and workload support unit (WSU)
· Take the claim in the Modernized Claims System (MCS).
· Enter 626M in the first four positions of the unit field on the DW01 screen.
· Add Listing Code 626 on the DECI screen.
· Process the claim using an A101/EF101 and annotate “626 Case” on the BCRN/EFBCRN screen.
NOTE: The claim will not process through earnings computation (EC) in MCS, and you will receive the edit “SPOUSE SEX EQUALS NH SEX.”
· Enter a “Y” in the Critical Case field on the Account Data (ACCT) screen of the A101/EF101.
NOTE: For HI/SMI enrollment entries, see SM 00850.000 and MSOM MCS 014.011- MSOM MCS 014.016. For disabled widows who might be eligible for Medicare, see RS 00207.020.
If the case has not been processed timely (within 15 days) based on Month of Election (MOE) and Current Operating Month (COM), the FO manager must use the Manager to Manager program to follow-up with the corresponding Processing Center (PC) manager. The FO manager should identify the claim as a critical case request (PR Problem) and annotate "Windsor Case" in the description of problem section in Manager-to-Manager. For instructions on the Manager-to-Manager web application and establishing follow-up dates, see GN 01070.228A.5. and GN 02606.150.
2. In the processing center (PC)
The A101/EF101 is routed to the BA for review (following established local procedures for routing).
Establish a PCACS listing code “626.”
If there are no discrepancies or issues, the benefit authorizer (BA):
If there are discrepancies or issues:
the BA routes the claim to the claims authorizer (CA) for review and resolution,
the CA resolves the discrepancies or issues,
the CA routes the claim to the BA,
the BA propagates the A101/EF101 into MACADE,
the BA processes the claim, and
sends a notice.
E. Procedures for processing denials
Deny claims in which:
the same-sex marriage occurred before the date when the state in which the couple married permitted same-sex marriages, or
the marriage does not meet the duration requirement, or
a legal opinion finds that a foreign same-sex marriage was not valid.
1. In the FO and WSU
Take the claim in MCS.
Enter 626M in the first four positions of the unit field on the DW01 screen.
Add Listing Code 626 and enter 02 (RSHI DISAL) in the DEC STAT field on the DECI screen.
IMPORTANT: DO NOT access the INTE screen.
Enter disallowance code 30 (Not the spouse/widower under State law or deemed marriage provision) on the Benefit Data (BEN) screen. Disallowance code 31 (Does not meet the duration of marriage requirement) is automatically generated.
NOTE: These are the only two disallowance codes based on relationship that are appropriate for denying a claim under this section.
NOTE: The claim will not process through earnings computation (EC) in MCS, and you will receive the edit “SPOUSE SEX EQUALS NH SEX.” Do not change the SEX code in the claim path.
Acquire a second review by a TE, MSS, or equivalent to assure accuracy and document that the case was cleared for denial processing on the Report of Contact screen.
Suppress the notice (MSOM MCS 009.010 Notice 3(NOT3)).
Complete the SSACCS Update (1418) screen in MCS.
MANCLR the claim to your own field office (FO). Do NOT enter the "N" PROC Code or the claim will be stuck on the FO list.
Exit MCS and enter MACADE (#10 On the SSA Main Menu).
Enter the SSN and select #5=Disallowance on the MADCAP Data Entry System Menu in MACADE. For coding instructions, see SM 00380.508 and SM 00380.515.
NOTE: The Beneficiary Identification Code (BIC) entered must be a code that corresponds to the gender of the surviving spouse (e.g., use BIC D for an aged female spouse and BIC D1 for an aged male spouse).
Enter 5=trans-SSN, to transmit the case for MACADE batching.
Use Document Processing System (DPS) to send the appropriate manual denial notice (e.g., MAR002 Disallowance - Marriage not Valid, MARR013 Medicare disallowance - marriage, MAR007 Disallowance Due to Remarriage - Widow(er), or REL023 Disallowance - Claimant Does Not Meet Duration of Marriage or Alternative). See SM 00380.110 and NL 00601.020.
Save the notice in the Online Retrieval System (ORS).
Monitor the case to ensure the process is complete once the MBR updates. If the denial is not posted to the MBR, it will except to the PC for processing.
2. In the PC
PC technicians should follow local procedures to process any MACADE or DUMAS exceptions generated from the FO’s/WSU's MACADE Disallowance input and verify that the DPS disallowance notice is in ORS and refer the case to a claims authorizer for Aurora notice instructions if the notice is not present.
F. Examples of cases that can be approved, denied or held
1. Examples of approvals
The following are examples of claims that you can allow under the rules in this section.
Nancy and Jean Marie married in Connecticut (CT) on December 15, 2008, (after CT permitted same-sex marriage). Jean Marie died on September 15, 2012, while domiciled in CT. On July 1, 2013, Nancy files for surviving spouse benefits on Jean Marie’s record. The claimant meets all other factors of entitlement. Approve the claim.
Emily and Hannah married in California (CA) on July 5, 2008 (while CA permitted same-sex marriage). Hannah died on August 14, 2013, while domiciled in CA. Emily files for surviving spouse benefits on Hannah's record on September 1, 2013. The claimant meets all other factors of entitlement. Approve the claim.
Lisa and Beth married in CT on December 15, 2008 (after CT permitted same-sex marriage), and Beth died on September 15, 2011, while domiciled in CT. Lisa filed a claim for surviving spouse benefits in May 2013, and the claim was pending final determination on June 26, 2013. The claimant meets all other factors of entitlement, approve the claim.
NOTE: The date of filing in May is the determining factor when considering month of entitlement.
John and David married in CT on January 15, 2009 (after CT permitted same-sex marriage), and John died on October 15, 2011, while domiciled in MA and after MA recognized same-sex marriage. David filed a claim for surviving spouse benefits in May 2013, and the claim was pending final determination on June 26, 2013. The claimant meets all other factors of entitlement, approve the claim.
NOTE: The date of filing in May is the determining factor when considering month of entitlement.
Jenna and Charlene married in Connecticut (CT) on December 15, 2008, (after CT permitted same-sex marriage). Charlene died on September 15, 2012, while domiciled in CT. On July 1, 2013, Jenna, who has end stage renal disease and is not insured on her own record, filed for Medicare on Charlene's record. She meets all other factors of entitlement. Approve the claim.
NOTE: For more information on R-HI, see HI 00801.201C.2.a.
2. Examples of claims to hold
Erik and Bob married in Washington, DC (DC), on December 1, 2008. Bob died in Texas, where they were domiciled, on June 2, 2013. Although they meet the duration of marriage requirement and the other factors of entitlement, hold the claim as instructed in GN 00210.005 because Texas does not recognize same-sex marriage.
Jim and Derek married in Massachusetts (MA) in January 2009 (after MA permitted same-sex marriage). They are domiciled in DC, when Jim dies on July 25, 2011. Derek marries Ray in DC on January 12, 2012. In August 2013 Derek (age 61) files for widower’s benefits on Jim’s record. Hold the claim pending instructions for determining the validity of subsequent same-sex marriages.
3. Example of denial
Tom and Mark state that they married in Minnesota on July 15, 2013 (before Minnesota permitted same-sex marriages). Tom died in Minnesota, where they were domiciled, on September 20, 2013. Mark files for widower's benefits on October 1, 2013. Deny the claim because the marriage is invalid, as it occurred before Minnesota permitted same-sex marriages.
GN 00210.005 Holding Claims, Appeals, and Post-Entitlement Actions Involving Same-Sex Marriages or Legal Same-Sex Relationships other than Marriage
GN 00210.100 Same-Sex Marriage – Benefits for Aged Spouses
GN 00305.001 Determining Family Status
GN 00305.020 Preferred Proof of Ceremonial Marriage
GN 00305.025 Secondary Proof of Ceremonial Marriage
GN 00305.100 Marital Relationship Duration
GN 01010.815 Request for Legal Opinion
GN 01070.228 Modes of Requesting Assistance
RS 00207.001 Widow(er)'s Benefits Definitions and Requirements
RS 00207.003 How Marriage Affects Widow(er)’s Benefits
RS 00207.004 Widow(er)'s Benefits - Table of Proofs and Development - Policy
RS 00207.020 Health Insurance (HI) for Disabled Widow(er)s
DI 10110.001 Requirements for Disabled Widow(er)’s Benefits (DWB)
HI 00801.006 Requirements for Entitlement – Regular Insured Provision
HI 00801.191 Requirements for Entitlement to R-HI
HI 00801.405 HI Entitlement for Auxiliaries and Survivors based on MQGE
SM 00380.040 Non-Disability Disallowance, Abatement, and Withdrawal Codes - Exhibit
SM 00380.508 Entering an Initial Disallowance
SM 00380.515 How to Complete the Account Data (ACT) Screen
SM 00385.445 Item 7 – HI/SMI Enrollment Entries