TN 3 (01-89)
GN 04001.040 Role of Notice in Reopening
A. Policy Principle
1. Notice is Required
The regulations require that when we make an initial determination, the claimant must be sent a notice with the appropriate appeal paragraph (GN 03101.050).
2. Reopen Final Determination or Decision
We reopen only final determinations or decisions.
A determination or decision is final as of the date of the notice of the determination or decision unless:
it is timely appealed; or
good cause for late filing of an appeal is found; or
in the case of a hearing decision, the AC takes jurisdiction on its own motion within 60 days of the notice of the hearing decision; or
the AC denies a request for review (does not issue a decision), in which case the ALJ decision is the final decision as of the date of the notice that the AC denied review; or
it is reopened and revised.
If a change occurs within the appeal period, it does not alter the fact that the initial determination is final and can only be revised if it is appealed or reopened (or the AC initiates own motion review).
EXAMPLE: A claimant who is age 62 in February 1988 files for RIB on February 26, 1988. SSA issues a notice of initial determination on her RIB application on February 27, 1988. Her husband dies on February 28, 1988. She files for widow's benefits (which are higher than her RIB) on March 1, 1988. We may not reopen the final determination dated February 27, 1988 because it was a correct determination; i.e., she was not a widow at the time that we issued our notice of determination. We would pay her based on the application filed March 1, 1988.
(GN 04001.070 explains that we do not reopen correct determinations.)
B. Operating Policy — Use of Notice to Count Time for Reopening
1. Beginning Date
The time for reopening all of the following is counted from the date of the notice of the initial determination:
Revised initial determination
Revised Reconsideration determination
Revised ALJ decision
Revised AC decision
Sometimes initial determination notices sent to the last known address in file are returned to SSA by the post office as undeliverable. This does not affect the counting of the time limit for reopening. It would, however, affect the time period for requesting appeal (GN 03101.010 and GN 03101.050).
2. Conversion Operations and Cost of Living Adjustments (COLAs)
In conversion operations the notice of the initial determination is the first check issued in the increased amount (which may be accompanied by a printed notice). The period for reopening is counted from the mailing date of the check or, for people with direct deposit, from the date checks were issued for the conversion (GN 04030.060).
3. Ending Date
The applicable period for reopening ends on the first or fourth anniversary of the date, as appropriate. This is true even when that determination has been reconsidered or revised or a decision in the case has been rendered by an ALJ or the AC. When the period for reopening expires on a weekend, legal holiday, or any other day all or part of which is a non-workday by Federal statute or Executive Order, the period is extended to the next full workday.
EXAMPLE: Initial Determination Notice— March 15, 1985; Reconsideration Determination Notice—October 15, 1985. Beginning March 16, 1986, we cannot reopen either of these determinations based on the 1-year rule. Beginning March 16, 1989, we cannot reopen either of these determinations based on the 4 year rule. Even though the reconsideration determination was made within 4 years, the notice of the initial determination was more than 4 years ago. The 5 days mailing time which is allowed when a person files an appeal request (GN 03101.010) is not added to the 1 or 4 year period.
EXAMPLE: Initial Determination Notice— April 10, 1988; Reconsideration Determination Notice—November 21, 1988; Revised Initial Determination Notice—March 10, 1991; Revised Initial Determination Notice—February 2, 1992 (The initial determination was reopened and revised a second time.) Effective April 11, 1989, we cannot reopen any of the determinations based on the 1-year rule. Effective April 11, 1992, we could no longer reopen and revise any of the above determinations based on the 4-year rule because the notice of the initial determination was more than 4 years ago.
C. Operating Policy — Defective Notices
The rules of administrative finality apply to initial determinations where a defective notice was sent (e.g., the appeal paragraph was omitted) the same as to initial determinations where a correct notice was sent. The time limits for reopening in both situations are counted from the date of the notice (GN 03101.050).
If we send a totally incorrect notice (e.g., we send an allowance notice and it should have been a denial), this would not meet the requirements of the regulations for a notice. When we discover the error and send the correct notice, we would count the time for reopening from the date of the correct notice. If there is some correct and some incorrect information on the notice, it would have to be decided on a case by case basis as to whether we told the claimant enough correct information to say we had made an initial determination.
D. Operating Policy — Open Applications and Blanket Denial
If the blanket denial paragraph is inadvertently omitted from the notice it does not mean the notice is defective. It means the application is adjudicated and “closed” only with respect to the specific class of benefits identified in the title of the application form. Administrative finality would apply to the initial determination that was made on the specific class of benefits identified in the title of the application form. The application is not adjudicated and is still “open” with respect to the remaining classes of benefits within the scope of the application. Therefore, administrative finality would not apply to the remaining classes of benefits (see GN 00204.025 for open applications and blanket denial paragraph).
NOTE: If the file is not clear as to whether an appeal or blanket denial paragraph has been added to the notice, a presumption should be made that the paragraph(s) has been added.
E. Effect of Partial Adjudication on Revision — Policy Principle
A partial adjudication involving an earnings investigation is not considered a “final decision” for purposes of correcting an E/R under section 205(c)(5)(A) of the Act (GN 01010.100). This means that if the investigation results in a correction of the E/R, the E/R which might otherwise be barred to correction by the statute of limitations can be corrected by applying the exception in section 205(c)(5)(A).
In other partial adjudication cases (i.e., cases which do not involve an earnings investigation) the partial adjudication is considered a “final decision” under section 205(c)(5)(A).
2. Claimant Notification
The claimant must be notified in order to meet the requirements of a “final decision” in section 205(c)(5)(A). In cases other than earnings investigations, the notice of the partial adjudication will be the “final decision” notice. In earnings investigation cases, the “final decision” notice will be either:
The revised determination notice; or
A special notice advising the claimant that the investigation has not resulted in a change to the E/R, the PIA and benefit amount.
The notice should also contain the reconsideration paragraph and advise the claimant that the notice is the final decision on his/her application for purposes of correcting his/her E/R under section 205(c)(5)(A) of the Social Security Act.