TN 3 (01-89)

GN 04001.070 Do Not Reopen Correct Determinations — Operating Policy

A determination which was correct when it was made is still correct even if there is subsequently a change in the factual situation. New and material evidence (GN 04010.030) can only be used to reopen and revise incorrect determinations, i.e., determinations which were never correct, but appeared to be correct based on the evidence before the adjudicator at the time the determination was made.

EXAMPLE:Correct Determination

A woman is entitled to mother's benefits on her deceased husband's record because she has a child in her care. The entitlement notice is sent in March 1987. She is between age 60 and 65 when the child turns 16 in July 1988. Her mother's benefits terminate the month the child turns 16 as there is no automatic conversion from mother's benefits to widow's benefits. Therefore, she receives a termination notice in June 1988. A widow's application must be filed. Four months later, in October 1988, she files an application for widow's benefits. Her first month of entitlement to widow's benefits is October 1988 (since the application cannot be retroactive). We cannot reopen the initial determination dated June 1988, which terminated her benefits, and begin paying her widow's benefits effective July 1988. The determination of June 1988 to terminate her mother's benefits was correct as the child attained age 16. She was not entitled to widow's benefits for June through September 1988 because no unadjudicated application for widow's benefits has been filed. And where correct determinations have previously been made, we do not reopen such determinations. (See GN 04001.040 A. for an additional example of a correct determination.)

EXAMPLES: Correct Determination

A claimant filed for retirement benefits on 04/15/2007 and was denied for failure to establish proof of age. The claimant did not provide a birth certificate or any acceptable proof. His claim was later denied and a notice was sent on 06/15/2007.

He later comes into the office and files another retirement claim on 02/25/2008. He meets the new tolerance rules (see GN 00302.030) that were effective 02/11/2008 and asks that his prior claim denied on 06/15/2007 be reopened and revised based on this new policy established on 02/11/2008.

The prior claim denied 06/15/2007 was a correct determination based on established policy at that time. We do not reopen correct determinations simply because there is a change of facts, a different rule of law can now be applied, or a different inference can now be drawn from the evidence (see GN 04010.020.C.).

Since the new policy wasn't established until 02/11/2008, the prior determination is considered to be correct and cannot be reopened based on this change of position (see GN 04001.100).

NOTE: If this claimant later provides an acceptable document establishing his proof of age (i.e. birth certificate), we can reopen and revise the prior 06/15/2007 determination based on new and material evidence (see GN 04010.030). This new and material evidence would have to be provided within 4 years of his denial notice (06/15/2007) or before 06/15/2011.

EXAMPLE:Incorrect Determination

A claimant who is age 62 in February 1988, files for RIB on February 26, 1988. Her husband dies on February 27, 1988. SSA issues a notice of initial determination on her RIB application on February 28, 1988. She files for widow's benefits on March 1, 1988. We may reopen the initial determination dated February 28, 1988 and pay her widow's benefits (which are higher than her RIB) based on her February 26, 1988 application because she was a widow at the time that we issued our notice of determination.

EXAMPLE:Incorrect Determination

A claimant files for RIB and alleges he is age 62 in August 1988. Based on the 5 pieces of evidence which he submits, we determine that he is only age 61, and we deny him on September 1, 1988. Within 4 years, he brings in a birth certificate which shows he was age 62 in August 1988. Therefore, we can reopen and revise our determination of September 1, 1988 and entitle him to benefits effective August 1988 on the basis of new and material evidence. Even though the determination of September 1, 1988 was correct on the basis of the evidence in file at the time it was made, new and material evidence shows that the decision was actually incorrect. Had the new and material evidence been in the file when the September 1, 1988 determination was made, it would have resulted in a conclusion different from that originally reached.

EXCEPTION:When a claim is disallowed for lack of insured status and the qualifying quarter of coverage is earned after the initial determination of disallowance but assigned to a calendar quarter preceding the initial determination of disallowance, we can reopen the determination (even though it was correct when made) and pay using the application. The wording of the statute makes it clear that Congress intended the claimant to derive insured status at a point earlier than the claimant actually earned it. If after reviewing at the Earnings Record, it's not apparent whether SSA or RRB had these earnings in possession at the time of the initial determination, it should be assumed in favor of the beneficiary that SSA or RRB did have these earnings in possession at the time the initial determination was made.

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GN 04001.070 - Do Not Reopen Correct Determinations -- Operating Policy - 07/22/2008
Batch run: 01/27/2009