TN 13 (11-11)

GN 01010.335 Processing Center (PC) Procedures for Handling Adverse Adjustments

A. Procedure for domestic claims

1. When to send advance due process notice

The claims authorizer (CA) must provide an advance due process notification for an adverse adjustment when:

  1. The field office (FO) did not provide notice; or

  2. An action takes place after the claim has left the FO (e.g., reconsideration reversal, etc.).

2. How to provide notice

If advance due process notification is necessary:

  1. Notify the adversely affected beneficiary by telephone or in writing using the information provided in GN 01010.330A

  2. If you provided a written notice, hold the new claim for the 15-day protest period before initiating the adverse adjustment action (30 days for foreign claims); and

  3. Notify the FO explaining why the claim is delayed and for quality feedback purposes.

3. Protest cases

  1. If you receive a protest within the 15-day period or before the decision is effectuated (i.e., before you send the formal initial determination adjustment notice), complete any necessary development and examine the material submitted with the protest to determine if the adverse adjustment is still proper.

    • If the adverse adjustment is correct, process the new claim. If you can reach the adversely affected beneficiary by telephone, advice him or her that you considered the material submitted but the new claimant's entitlement is correct.

    • If you cannot reach the adversely affected claimant by telephone, include the following language on the adjustment notice:

      We received the material you submitted and we considered it. However, we have determined that the new claimant's entitlement is correct. Therefore, we reduced your monthly benefit amount beginning (Month/YYYY) because we started to pay another person on this record.”

    • Document the claims file (e.g., report of contact (RPOC) in Modernized Claims System (MCS), special message (SP MSG) in the Master Beneficiary Record (MBR), etc.) to show that the adversely affected claimant was advised that his or her protest was reviewed but it did not affect the initial determination.

    • If you already effectuated the adverse adjustment action, see the first bullet in GN 01010.335A.3.d. regarding the notice and telephone contact.

    • If you warrant reopening of the initial determination, see the second bullet in GN 01010.335A.3.d.

  2. If by error or otherwise, an SSA-561-U2 (request of reconsideration) or other specific request for reconsideration is filed before you send the notice of the actual initial determination, see GN 03101.050. If the claimant files a SSA-561-U2 within the 15-day period, consider it a protest and continue benefits at the current rate until the review of the protest is completed.

  3. If the new claimant is an adopted child and the adversely affected beneficiaries demand the adoptive name, submit the case to the Office of Retirement and Disability Policy (ORDP), Office of Income Security Programs (OISP), Relationship and Claims Evidence Team (RCET) in Central Office (CO).

  4. If the claimant files a protest within the 15-day period but is not associated until after you effectuate the actual initial determination and the adjustment notice sent, review the case to see whether reopening the award to the new beneficiary is warranted.

  • If after the proper review, you do not warrant reopening of the claim, document the claims file as shown in GN 01010.335A.3.a. Do not send a separate notice since to answer the protest since we consider to have answered it at the initial determination notice. However, if you can reach the claimant by telephone, advise him or her that you considered the protest in the determination. Document the file accordingly as per GN 01010.335A.3.a.

  • If after reviewing the claim, you warrant reopening of the claim, restore the benefits of the adversely affected beneficiary to the previous rates and subsequently refer the claim to a Senior Claims Processing Specialist (SCPS) for possible reopening of the award decision for the new beneficiary. Continue benefits to the new beneficiary at the restored rate until the SCPS determines the proper action.

NOTE: Any subsequent revision will be a revised initial deter