If a new claim for benefits is filed on the same earnings record as an earlier claim,
when we adjudicate the new claim we are not bound by the findings of fact that were made in a determination or decision on the earlier claim.
However, res judicata, as defined in GN 04040.010, may be applicable.
EXCEPTION - Insured Status
A finding in connection with an earlier claim that a person has insured status can only be revised for a later claim if the first initial determination
can be reopened based on GN 04001.010.
Although a finding of insured status may not be reopened in a subsequent claim if
none of the conditions discussed in GN 04001.010 applies, SSA may revise the amount of the PIA with respect to the subsequent claim
based on the earnings (if any) which are still posted to the earnings record. (This
means if no earnings are posted, the PIA is zero.)
Mr. Wilson filed for RIB on 03/10/98. A E/R showed he had 40 quarters of coverage.
He was awarded RIB of $675.70 on 06/5/98. This rate was increased through subsequent
conversions/COLAs to $755.20 effective December 2002. He died on 03/12/03 and his
widow filed for benefits and questioned the correctness of his benefit amount. A certified
E/R was obtained which showed that Mr. Wilson had only 39 QCs. Because of the lapse
of more than 4 years, SSA cannot revise the finding of insured status, but survivors'
benefits should be computed based on the correct earnings record. In claims processed
with initial eligibility before 12/81, the benefit would be determined based on the
guaranteed minimum PIA (see RS 00605.070). For claims processed with initial eligibility after 12/81, the benefit would be
determined based on the actual earnings with no guaranteed minimum (see RS 00605.100).
However, if Mr. Wilson had acquired an additional QC after the lifetime of his application,
thus giving him an insured status, the amount of the PIA should be computed as if
the widow's application were the first application filed after considering the DIB
Guarantee PIA provision (see RS 00605.035).
The computation of the PIA will depend on the facts in a particular case (see
NOTE: Refer to GN 04030.070B.4. for information regarding the effect of a DIB guarantee PIA on a subsequent claim.
a. Example - Prior Entitlement Terminated; New Claim Later Filed By Same Claimant
A woman was paid benefits as a young wife from 12/95 until 12/2001. Her benefits terminated
when her youngest child reached age 16 in 12/2001. When she later files as an aged
spouse in 12/2006 we discover that she should never have been entitled as the wife
of the NH since she does not meet the relationship requirements. Since none of the
rules for reopening apply, the determination on her earlier claim for wife's benefits
cannot be revised. However, even though we previously made a determination which found
that she was entitled to benefits as the wife of the NH, we are not bound by the erroneous
finding of fact made in that determination when we adjudicate her later claim in 12/2006.
We can deny her aged spouse's claim.
b. Example - Auxiliaries Erroneously Entitled; New Claimant Files
B2 and C1 were awarded benefits in 03/2002. C1 was entitled as a stepchild based on
the determination that B2 was married to the NH. A current claim is filed by B2 for
a different stepchild, C2 in 06/2006. In the course of developing this claim, it is
shown that B2 was never married to the NH. The prior determination of benefits made
in 03/2002 for B2 and C1 cannot be reopened, i.e., it was more than 4 years ago and
none of the special situations in GN 04020.001 exist. SSA will continue to pay benefits to them. However, the current claim by C2,
filed in 06/2006, as a stepchild will be denied because the only way C2 can be entitled
is as a stepchild. Since B2 was not married to the NH, C2’s claim must be denied.
SSA cannot take benefits away from B2 and C1 because the rules of administrative finality
preclude it. When B2's benefits are terminated due to C1 attaining age 16, if B2 again
files for wife's or widow's benefits on this record, her claim will be denied unless
she later marries the NH.
c. Example - Incorrect Computation; New Auxiliary Files
When the NH is entitled in 01/2002 we compute his PIA and benefit amount incorrectly.
More than 4 years later a child files for benefits in 02/2007. The adjudicator notices
the error. The child should be paid based on the correct PIA rather than on the incorrect
rate protected by the rules of administrative finality for the NH. For additional
information and examples, see RS 00615.754. See GN 04030.070B.4 about the effect of a DIB Guarantee PIA on a subsequent claim.
NOTE: When there is one or more claimants on a record being paid based on an incorrect
PIA that is protected by the rules of administrative finality and other claimants
are being paid based on the correct PIA, change the MBR PIA to the lower correct PIA
effective with the date of entitlement of the new claimant. In addition, prepare a
special message to show the PIAs that were used to compute the benefits for the protected
claimants and post the Administrative Finality code to the MBR.
EXCEPTION – WEP PIA: This policy does NOT apply to the imposition of a WEP PIA because it applies strictly to computation factors
and a decision to impose WEP is not a computation factor (RS 00605.405). Therefore, it is a separate determination made independently of the PIA computation
and should be treated differently when a child later files for benefits. Consequently,
when a new auxiliary files for benefits, the child’s benefit should be based on the
PIA being used to pay the NH unless an appeal is taken to correct the error. For additional
information regarding WEP and administrative finality see GN 04030.100 – Reopening When Windfall Elimination Provision (WEP) is Involved.