TN 13 (11-11)

GN 01010.015 Considering possible entitlement to other benefits

A. Policy for entitlement to other benefits

Applications under title II cover all classes of title II benefits, (e.g., the benefit types described in 202(a)-202(l) and 223 of the Social Security Act for which the claimant is eligible on all Social Security numbers (SSNs). In addition, a claimant is "deemed" to have filed an application for both reduced retirement insurance benefits (RIB) and reduced spouse's benefits if eligibility for both exists in the first month of entitlement (MOET). Refer to GN 00204.020 for the scope of the application and GN 00201.005 for determining when a separate application is needed.

B. Adjudicator responsibilities

The claims adjudicator is responsible for reviewing the claimant’s information to determine if multiple entitlements apply. Multiple entitlements refer to claimants who are entitled to more than one Social Security benefit at the same time. For example, a claimant may be entitled (RIB) on his or her own SSN and as a spouse on another SSN (dual-entitlement). In some situations, a claimant may be entitled to benefits on more than two SSNs (i.e., triple-entitlement).

1. Title II

Evaluate the information and consider possible entitlement to other benefits since a title II application is a claim for all benefits on all SSNs unless its scope is restricted. See GN 00204.004 for more information. A title II application may also serve as an oral inquiry for title XVI (see SI 00601.027).

2. Title XVI

A claimant who files a title XVI application must file for all other benefits for which he or she is entitled, including any benefits payable under title II (see SI 00510.001). The adjudicator must explore entitlement to these other benefits and decide if the claimant needs to file an application.

Important: To avoid open applications, properly review the earnings record (E/R), provide closeout language, or take an application if needed (see GN 00204.025).

C. Examples

Example 1:

If a claimant for auxiliary or survivors benefits has an SSN and is within four months of the month of age 62 attainment or older, make a determination concerning entitlement to RIB unless the scope of the application has been restricted. If a claimant is not eligible for benefits on his or her own SSN, the adjudicator must review the records to consider if the claimant is eligible for benefits on another SSN.

Example 2:

When an claimant is within four months of the month of age 65 at the time the claim is to be denied, consider possible entitlement to Hospital Insurance (HI) under the deemed insured Premium-HI provisions or Supplemental Medical Insurance (SMI) (CMS-4040), including a possible deemed enrollment period.

D. Development for second claim pending

  1. Make a determination on all the types of benefits within the scope of any application in file (see GN 00204.020). However, it is not necessary to make these determinations simultaneously. Process the appropriate disallowance or denial after completion of the pending development and delay any other determination until development is completed. See GN 01010.110 and GN 01010.120 on when to partially adjudicate.

  2. If one disallowance or denial has been processed but subsequent development for a separate issue or claim is pending, do not process the second disallowance or denial until all issues are resolved and entitlement is determined not to exist.

    • When development is complete, document the claims file using the report of contact (RPOC) screen with the reason for the second disallowance denial.

    • If RPOC is not available, use a paper SSA-553 Special Determination to annotate the disallowance or denial data and store it in the Non Disability Repository (NDR) or electronic DIB folder (eDIB) as per GN 00301.322.

    • Process the disallowance or denial using Modernized claims system (MCS) whenever possible. If the claim needs manual processing, route the claim to the processing center (PC) via manual adjustment, credit and award process (MADCAP) as “SUBSEQUENT DISALLOWANCE” or “SUBSEQUENT DENIAL.” See SM 00380.001 for input instructions.

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