GN 03316.115 Disclosure Without Consent Concerning Adverse Claims/Adverse Actions
NOTE: These instructions discussed in GN 03316.115A.1. and GN 03316.115A.2. do not apply to hearing cases. The administrative law judge should decide what is proper to disclose to parties who are or may be adversely affected. When there is a disclosure question in a field office (FO) or regional office (RO) in a hearing case, consult the Office of Disability Adjudication and Review, regional office.
1. Adverse Claim Situations - When to Disclose
An adverse claim is an award of benefits to a subsequent claimant or the reinstatement/resumption of benefits to a prior beneficiary that results in the nonentitlement or termination of an earlier beneficiary.
You may disclose a copy of the relevant evidence to the adversely affected beneficiary.
EXAMPLE: X is entitled, but another woman (Y) submits evidence of an earlier marriage to the NH which appears to be still valid. You may show X the evidence establishing Y's earlier marriage to the NH, so X may try to refute it. You may also disclose to Y information relevant to the issue of who is the true widow.
2. Adverse Action – When to Disclose
An adverse action is a determination resulting in either nonentitlement, termination of entitlement or a benefit reduction to an earlier (i.e., a currently-entitled or previously-entitled) beneficiary because of a subsequent award to a late-filing claimant on the same SSN.
You may disclose to any adversely affected beneficiary any information that is relevant to the determination which is adverse to that beneficiary.
CAUTION: Do not disclose the new names of adopted children. (See GN 01010.330A.4.)
EXAMPLE: SSA sends a an adverse adjustment notice. The wife questions her low benefit rate as a spouse, and the FO explains that the family maximum is a factor because of several children entitled in another household. The wife asks to see what evidence SSA has that her husband is the father of the children, and requests the names and address of the children or their payee.
Because the wife’s benefits is adversely affected by the addition of the other beneficiaries, you may give her information establishing paternity (including the names of the children and of the children's mother, which would be on their birth certificates), since this is relevant to her own benefit rate. However, she is not entitled to the address of the children, nor the name or address of their payee.
3. Conflicting Claims Pending/Simultaneously – When to Disclose
You may disclose information at SSA's initiative to the extent necessary to resolve discrepancies between the claimants’ allegations.
NOTE: You may disclose this information in order to resolve questions that SSA needs in order to make a determination, as well as in response to a request from a claimant.
EXAMPLE: The benefits for E and one or more Cs in her care are reduced because of the entitlement of another child of the NH and an unwed mother. You may show E the evidence on which paternity was based.
Also, see GN 01010.310, GN 01010.325, GN 01010.330, and GN 01010.335.
B. List of Systems of Records From Which Disclosure May Be Made In Adverse Actions
Disclosure may be made from the following systems of records in adverse claims situations:
60-0089 - Claims Folders System,
60-0090 - Master Beneficiary Record, and
60-0320 - Electronic Disability (eDib) Claims File.
See GN 03316.001D.