TN 4 (09-92)

GN 04010.020 Reopenings - Error on the Face of the Evidence

A. DEFINITION

An error on the face of the evidence exists where it is absolutely clear  that the determination or decision was incorrect. That is, based on all the evidence in the file and any evidence of record anywhere in SSA at the time the determination or decision was made, it is unmistakably certain that the determination or decision was incorrect. (For SSA /IRS Reconciliation cases, see GN 04010.020D.)

Examples of error on the face of the evidence include:

  • Relying on the wrong person's medical report or earnings record caused the adjudicator to make an incorrect determination.

  • Benefits in a cessation case were terminated as of the month disability ceased, rather than as of the close of the second month following the month the disability ceased.

  • Before a claim was finally adjudicated, the claimant submitted to a field office a medical report or additional earnings which would have resulted in a different conclusion. However, the medical report or additional earnings were not associated with the claim file until after the initial determination was made.

NOTE:  In view of the interrelationship between RRB compensation records and SSA earnings records, RRB compensation records are considered as a part of SSA earnings records for this purpose. No other records (such as VA records) are considered part of SSA records.

B. POLICY — WHEN SSA CAN REOPEN

A determination or decision in which there was an error on the face of the evidence on which it was based, may be reopened within 4 years  of the date of the notice of the initial determination if such determination was favorable  to the claimant, or at any time if it was unfavorable to the claimant (see GN 04020.080).

EXAMPLE:  Two different number holders filed for RIB on 12/10/86 electing benefits at age 62. Both submitted birth records recorded before age 5 which established the same DOB, 3/1/25. Therefore, the correct DOE would be 3/87 because the DOB is the first day of the month. However, in one case, the CR or CA incorrectly established the DOE as 2/87. In the other case, the CR or CA incorrectly established the DOE as 4/87. In both cases, it is unmistakably clear that the determinations are incorrect. The favorable (to the claimant) determination (DOE 2/87) can only be reopened within the 4-year period. The unfavorable determination (DOE 4/87) can be reopened at any time.

C. POLICY — WHEN AN ISSUE IS NOT AN ERROR ON THE FACE OF THE EVIDENCE

A determination or decision which was reasonable on the basis of the evidence in the file and on the statute, regulations, instructions, precedents, etc., existing at the time the determination or decision was made, will not be reopened merely for the following reasons:

  • There is a shift in the weight of the evidence; or

  • A different inference is now drawn from the evidence; or

  • A different rule of law would now be applied; or

  • The statute or regulations have been amended, unless the amendment specifically provides for reopening. (See GN 04001.110 for effect of statutory change.)

In such cases, there is no error on the face of the evidence on which the determination or decision was based (i.e., the “record” ) which would permit reopening.

D. POLICY — SSA/IRS RECONCILIATION CASES

1. General

In SSA/IRS Reconciliation cases only, the scope of error on the face of the evidence has been expanded to mean earnings evidence SSA should have had in its possession which is needed to reopen and increase the individual's benefits retroactively. Therefore, if an individual's SSA earnings record contains an error as a result of a disparity between IRS and SSA records, that individual is entitled to correction of his/her earnings record for those years and reopening and payment of retroactive benefits regardless of the amount of time that has elapsed since the year(s) in which the wages in question were earned.

2. Case Involves Both SSA/IRS Reconciliation and Other AERO Action

In an SSA/IRS Reconciliation case, there may be other AERO adjustments which are separate from the SSA/IRS Reconciliation action. For example, one year of earnings may increase due to a Reconciliation action and another year may increase due to another AERO operation. Apply the rules in this section to the SSA/IRS Reconciliation year(s) and apply the rules in GN 04010.030 D. to the non-SSA/IRS Reconciliation year(s). If you are unable to determine for certain, assume all years are SSA/IRS Reconciliation years.

3. Work Deductions

If work deductions are involved, follow the normal rules for imposing work deductions or for reopening and revising a previous work deduction determination.

4. Prior Adjudication

If a case was previously processed in a manner inconsistent with these guidelines, the case should be reprocessed.

5. Example

As a result of a special AERO run for SSA/IRS Reconciliation cases on August 9, 1989, a case is excepted for manual processing. Earnings for 1979 are in question, as they do not agree with the earnings for 1979 which were posted when the initial determination was processed in 1982. Since this is a Reconciliation case, the adjudicator does not have to develop to see if SSA received the additional earnings within 4 years. The adjudicator can find error on the face of the evidence and reopen and increase the benefits retroactively on the basis that SSA should have had the evidence in its possession within 4 years.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0204010020
GN 04010.020 - Reopenings - Error on the Face of the Evidence - 12/08/2005
Batch run: 01/27/2009
Rev:12/08/2005