TN 13 (11-11)

GN 01010.330 Field Office (FO) Procedures for Handling Adverse Adjustments

A. Definition of adverse adjustment

An adverse adjustment results when a claim meets the following criteria:

  1. The family maximum provision results in a reduction in the past or present benefit payment rates of an earlier entitled beneficiary due to:

  2. The claim involves a “late filer” who is not part of the same household as the adversely affected beneficiary.

    For more information about adverse adjustments, see GN 01010.310.

B. Advance Due Process Notification

  • When a new claim results in an adverse adjustment in the benefits of a currently entitled or previously entitled beneficiary, provide the affected beneficiary advance due process notification either in person, via telephone or in writing.

  • If you give notification by person or telephone, annotate the claims file using the report of contact (RPOC) in the Modernized Claims System (MCS) to annotate the information provided to the claimant. If the electronic RPOC is not available, use the paper SSA-5002 and fax it into the Non-Disability Repository (NDR).

  • When notification is given in writing, prepare the appropriate notice using the Document Processing System (DPS) to explain the effect that the new claim has on his or her benefits and other pertinent information as provided in GN 01010.330A.

    NOTE: Do not extend appeal rights in the advance due process notification for an adverse adjustment. This is only a notice of proposed adjustment action. The processing center (PC) will issue a formal written notice with appeal rights when the adjustment action is processed.

C. Content of notice for future and past benefits affected

Any currently entitled beneficiary whose future and past benefits (outside of a protected period see RS 00615.760B.3) can be adversely affected, must receive an advance due process notification. Include the following in the dialogue or notice:

  • The name of the new claimant(s) and the basis for his or her entitlement (for adopted children see GN 01010.330A.4.);

  • NOTE: If any of the new claimants are in delayed status, include their names in the advance notice.

  • A summary of the evidence supporting the new claimant's entitlement;

  • The effect the entitlement will have on the beneficiary's monthly benefit amount, including the approximate date the adjustment will be made;

  • Statement that the adversely affected beneficiary will have 10 calendar days in which to protest the proposed action and present rebuttal evidence;

  • That if the beneficiary protests and elects to continue to receive benefits at the unadjusted rate, he or she may do so until a formal determination is made;

  • That if the adverse adjustment is sustained, the continued unadjusted rate will also be subject to the O/P recovery provisions including waiver, reconsideration, etc.; and

  • Statement that, if we do receive the protest within the allowed time period, we will send another notice with more information about our action.

See NL 00703.121 for the advance due process exhibit notice for Adverse Claims.

D. Content of notice for only past benefits affected

Any previously entitled (i.e., terminated) beneficiary whose past benefits (outside of a protected period see RS 00615.760B.3) will be adversely affected must also receive advance due process notification. This also applies when we will reduce his or her past benefits and the currently entitled beneficiary's ongoing rate is not affected (i.e., a closed period award for the late filer). Include the following in the dialogue or notice:

  • The name of the new claimant(s) and the basis for his or her entitlement (for adopted children see GN 01010.330A.4.);

    NOTE: If any of the new claimants are in delayed status, include their names in the advance notice.

  • A summary of the evidence supporting the new claimant's entitlement;

  • The effect the entitlement will have on the beneficiary's past benefits;

  • That the adversely affected beneficiary will have 10 calendar days to protest the proposed action and present rebuttal evidence; and

  • Explanation that, if we do not receive a protest within the time period, we will send another notice with more information about our action.

See the adverse adjustment exhibit in