TN 13 (11-11)
GN 01010.315 Relationship of Adverse Actions to Rules of Administrative Finality
A. Procedure for adverse actions
Follow the procedures below for the effect of administrative finality on adverse actions. See GN 01010.310 for the definition of adverse actions.
1. Adverse claims
Consider the rules of administrative finality when processing an adverse claim that results in the non-entitlement of an earlier claimant. In such cases, the earlier claimant's entitlement determination may be reopened under the rules of administrative finality regardless of how long ago it was made (see GN 04020.020A.).
Do NOT consider the rules of administrative finality on an adverse claim which results in the termination of benefits to a previously entitled beneficiary (i.e., after the first month of election (MOEL)). In such cases, a new initial determination is involved for the late filer's entitlement, not a reopening of the initial determination that entitled the earlier claimant.
EXAMPLE: Prior to 1991, the termination of benefits to a deemed spouse due to the entitlement of a legal spouse was possible. This is a new initial determination regarding the legal spouse's entitlement. There is no reopening of the original determination that initially entitled the deemed spouse. Therefore, the rules of administrative finality do not apply to the adverse claim (i.e., process the termination for the deemed spouse per GN 00305.055).
2. Adverse adjustments
Do NOT consider the rules of administrative finality on claims when the entitlement of a subsequent claimant(s) results in the downward adjustment of the past or future benefit rates of a currently entitled or previously entitled beneficiary (see GN 04020.020C.). In other words, there is no 1-year or 4-year retroactive time restriction on these adjustment actions. Such an adjustment results from a new initial determination on the late filer's entitlement, not from a reopening of the initial determination that entitled the earlier claimant(s).