TN 6 (08-07)

GN 04030.110 Reopening When Multiple Errors are Discovered – Error on the Face of the Evidence

A. Introduction

In reviewing cases, SSA technicians may discover multiple erroneous initial determinations involving several factors. Often, one of these erroneous determinations is favorable to a SSA claimant while another determination is unfavorable to the claimant. In all situations, it is important to separate all initial determinations and review the dates of the initial determination notice(s) independently to determine if reopening is possible. Decisions to reopen and revise claims should be documented electronically, if possible. These decisions should contain a detailed explanation of the actions taken and the reasons for reopening or not reopening a determination. For additional information see GN 04001.080 – Documenting the Rationale for Reopening.

B. Policy — Multiple Errors for One Claimant in a Single Determination

When multiple errors for one claimant are discovered, apply the rules of administrative finality based on the initial determination made and the date(s) of the initial determination notice. Make sure to look at each initial determination separately by analyzing the dates of the notice of the initial determination. A final determination which is unfavorable to the claimant may be reopened at anytime when it is based on error on the face of the evidence. Some determinations have a dual effect. When multiple errors are involved in one single initial determination and the result of reopening may have a dual effect, reopen these cases only when the net effect of the reopening would be favorable to the claimant (see GN 04020.080).

EXAMPLE – Multiple errors in a single initial determination

NH was entitled to retirement benefits in 01/1999. His initial award notice was dated 02/17/1999. In 02/2005, the NH brought in proof of his 1998 earnings which he stated had never been included in his annual Social Security Statement. We located his 1998 earnings in the suspense file. The NH also asked if we had included his 1959-1962 military service when we computed his benefit. In reviewing his record, we found that the military service evidence for 1959-62 was in file in 1999 but was not used to calculate his benefit. We also discovered that the NH should have been entitled to benefits one month earlier because a protective filing date was on record but had not been used.

To summarize, the following errors were discovered on the NH’s retirement claim after 4 years from the date of initial award:

  • Military service not used for 1959-1962 resulting in a lesser PIA

  • Error on earnings record for year – 1998 resulting in a lesser PIA

  • Date of entitlement error resulting in a higher MBA

After reviewing the errors in this case it is determined that the following consequences would take place if all of the errors were corrected:

  • adding the military service for the years 1959-1962 would increase the PIA by $36.00

  • correcting the 1998 earnings would increase the PIA by $5.00

  • correcting the date of entitlement would decrease the MBA by $25.00

  • An underpayment for the additional month of entitlement

  • The difference in ongoing rates through the current month

Since the single initial determination made on 02/17/1999 encompassed all of these erroneous determinations of fact (see GN 04001.030B.3.) and because the net effect of making all of these changes will result in an ongoing monthly increase of $16.00, the 02/1999 determination could be reopened and revised.

REMEMBER: When determining whether the overall net effect is favorable to the beneficiary, it is important to consider all consequences of reopening and revising the record (i.e., retroactive overpayments and underpayment accrued, entitlement to Medicare coverage, overall retroactive underpayment amount compared to the ongoing rate decrease, etc.).

NOTE: All of these errors involved an error on the face of the evidence or clerical error permitting unrestricted reopening after 4 years if favorable to the claimant.

A notice needs to be sent to the beneficiary explaining what actions we reopened and revised as well as the reasons. This notice should contain appeal rights.

C. Policy — Multiple Errors Involving Multiple Determinations for the Same Benefit Type and One Claimant

When multiple errors for one claimant are discovered in multiple, different initial determinations, apply the rules of administrative finality individually to each separate determination based on the initial determination made and the date(s) of the initial determination notice. Make sure to look at each initial determination separately by analyzing the dates of the notice of the initial determination(s).

EXAMPLE – Multiple determinations involving Disability

NH was initially entitled to Disability in 01/1995. His initial determination notice was sent 01/15/1995. The amount of his benefit was initially calculated incorrectly because of a mathematical error in the computation. His PIA was higher than it should have been (error was favorable to NH). In 02/1999, the NH began to receive Workers Compensation (WC) and his benefit was recalculated to include WC offset. We sent him his initial determination notice 02/17/1999. In 02/1999 we figured his benefit amount and the PIA correctly. In 04/2001 his claim was reviewed and the amount of his benefit was refigured incorrectly using the same exact WC information. This change was an error made in the calculation of his WC offset. We applied too much offset (error was unfavorable to NH). An initial determination notice was sent 04/24/2001. On 06/25/2006 and as part of the regular review of claims involving WC, all of this information was reviewed and an affirmative action in writing was established explaining the errors.

After reviewing the errors in this case it is determined that the following consequences would take place if the errors were corrected:

  • Monthly PIA decrease of $13.00 (not including COLAs) from 01/1995 to 01/1999

  • No change from 02/1999 to 03/2001 since benefit amount and PIA were calculated correctly

  • Monthly PIA increase of $22.00 (not including COLAs) from 04/2001 to 06/2006

The erroneous determination of 01/15/1995 cannot be reopened and revised since the error was initially favorable and we didn’t discover the error within 4 years. The only error we can reopen and revise in this case, would be the 04/24/2001 determination since we applied too much offset. Each determination should be reviewed separately based on the date of the initial determination notice to see if reopening is appropriate.

NOTE: If the first error made in 01/1995 was initially unfavorable to the NH, we could reopen and revise that determination as well even though it was made over 4 years ago since it is an error on the face of the evidence and it was unfavorable to the NH (see GN 04010.020).

D. Policy — Multiple Claims and Determinations Involving the Same Claimant

When multiple claims (Retirement, Spouse’s, Child’s, Widow(er)’s, Mother’s/Father’s, Parent’s, Disability, and LSDP) are being reviewed and multiple errors are involved, consider the initial determinations on each claim separately and apply administrative finality to each initial determination.

1. EXAMPLE – Retirement (RIB) after Disability (DIB)

The NH (BIC A) was entitled to DIB effective 09/1990 and his initial DIB award notice was sent 09/19/1990. Later he elected RIB effective 05/1992 (age 62) to avoid Workers’ Compensation (WC) offset. His initial RIB award notice was sent 05/13/1992. NH elected to be paid DIB again effective 08/1994 because the WC ended and the DIB payment was higher. That notice was sent 08/12/1994. Then in 04/1995 (age 65), the NH was converted back to RIB. The later RIB notice was sent 04/25/1995. The DIB PIA and MBA which were established in 09/1990 were too high (favorable to the claimant). The RIB PIA and MBA established in 05/1992 were too low (unfavorable to the claimant). Beginning in 08/1994 the DIB PIA and MBA are too high again (favorable to the claimant). In summary:

  • DIB PIA was too high for 09/1990 to 04/1992 and for 08/1994 to 03/1995

  • RIB PIA was too low for 05/1992 to 07/1994 and for 04/1995 and continuing

In 11/2002, these errors were discovered when reviewing the case in the PSC. Since these errors were obvious and it is absolutely clear that the determinations were incorrect, these are examples of errors on the face of the evidence (GN 04010.020). Determinations may be reopened within 4 years of the date of the initial determination if that determination was favorable to the claimant or at any time if it was unfavorable to the claimant.

Since the initial determinations of the DIB and RIB PIA/MBA are separate initial determinations, consider these initial determinations of DIB and RIB to be independent and separate determinations. Apply administrative finality separately to each claim based on the date of their initial award notice. In this case, the DIB determinations could not be reopened because correction would be unfavorable to the claimant. The RIB determination could be revised because correction would be favorable. As a result, the claimant’s RIB claim should be corrected beginning 05/1992 and an increase is due for 05/1992 to 07/1994 and from 04/1995 on.

2. EXAMPLE – Disability (DIB) After Retirement (RIB)

The NH (BIC A) was entitled to RIB effective 09/1999 (age 62) and the initial award notice was sent 09/09/1999. He later became entitled to DIB effective 05/2001. The initial DIB award notice was sent 05/05/2001. The RIB PIA and MBA which were established in 09/1999 were too high (favorable to the claimant). The DIB PIA and MBA for the period from 05/2001 to 08/2002 were too low (unfavorable to the claimant). The NH’s benefit was erroneously computed and converted back to RIB effective 09/2002 (age 65) and was too low. The later RIB notice was sent 09/11/2002. In summary:

  • RIB PIA was too high from 09/1999 to 04/2001

  • DIB PIA was too low from 05/2001 to 08/2002

  • RIB PIA was too low from 09/2002 and continuing

In 02/2005, these errors were discovered and documented with an affirmative action in writing when an AERO alert was received in the PSC.

Since the initial determinations of the RIB and DIB PIA/MBA are separate initial determinations to different benefits, these initial determinations to RIB and DIB are independent determinations. Apply administrative finality separately to each claim based on the date of their initial award notice.

In this case, the initial RIB determination made in 09/1999 could not be reopened because it was discovered after four years from the date of the initial determination and correction would be unfavorable to the claimant. The DIB determination made in 05/2001 and the subsequent RIB determination made in 09/2002 could be reopened since these errors were discovered within 4 years. The correct DIB benefit amount would be effective 05/2001 and paid until 08/2002 and the correct RIB benefit would be effective 09/2002.

E. Policy — Multiple Claimants Involved on Different Claims

When multiple claimants are involved on different claims and multiple errors are involved affecting multiple claimants, consider the initial determinations on each claim as separate and independent determinations and apply administrative finality to each determination separately.

EXAMPLE – Multiple Claimants Involved on Different Claims Involving Different Benefits

The father of two children is entitled to Retirement benefits effective 03/2001. The initial award notice was sent 03/13/2001 to both the NH and the two children. His wife is entitled to disability benefits and also receives Workers’ Compensation. She has been entitled to disability since 02/2000. Her initial disability award notice was sent 02/22/2000 to her and her two children. Both of the children have simultaneous entitlement on both records. Currently, they are being paid on the father’s record since he has a higher PIA.

In 10/2005, an AERO is received on the father’s record and it becomes apparent that his retirement benefit was figured incorrectly because his military service for 1957-1960 was not included in his initial entitlement even though it was in file at the time of the initial determination in 03/2001. He has been being underpaid since 03/2001.

In 11/2005, new worker’s compensation information is received on the wife’s disability benefit going back to the date she became entitled to disability, 02/2000. There was a change in her WC amount in every month since 02/2000, the date she became entitled to disability. She has been receiving too much Social Security disability benefits because her offset was computed incorrectly and to her favor. In summary:

  • Father’s retirement benefit was too low from 03/2001 until 10/2005

  • Mother’s disability benefit was too high from 02/2000 until 11/2005

  • Children’s benefits paid on the mother’s disability benefits were too high from 02/2000 until 02/2001 (father retirement benefit is higher than wife’s disability)

  • Children’s benefits paid on the father’s retirement were too low from 03/2001 until 10/2005

In 11/2005, these errors were discovered when reviewing the case in the PSC. Since the errors on the father’s record were obvious and it is absolutely clear that the determination was incorrect, this is an example of an error on the face of the evidence (GN 04010.020). Determinations may be reopened within 4 years of the date of the initial determination if that determination was favorable to the claimant or at any time if it was unfavorable to the claimant.

Because the mother’s Workers’ Compensation has changed, we can make a new initial determination to her benefit with each change in the amount of her Workers’ Compensation amount (see GN 04030.080B.1.).

Since the initial determinations of the Disability, Retirement and Child’s benefits are separate initial determinations to different benefits, consider each of these initial determinations to Disability, Retirement and Child’s benefits to be independent determinations. Apply administrative finality separately to each claim based on the date of their initial determination notice.

In this case, the wife’s Disability determination can be recomputed because there were changes in the WC amount (GN 04030.080B.1.).

The father’s RIB determination could be revised because correction would be favorable. As a result, the claimant’s RIB claim should be corrected beginning 03/2001 and an increase is due for the children on his record as well, effective 03/2001.

Since there was a change in the WC amount in every month, the wife’s disability benefit can be adjusted going back to the month the amount first changed as well as the children’s benefits since there were changes in the WC after the date of the initial determination of entitlement to auxiliary benefits. We can make a new initial determination and impose offset against the auxiliaries using the full amount of the WC effective with the date of the change (see GN 04030.080B.6.). Since the children are also entitled on their father’s retirement record and revising his and their records would be favorable to them, the children’s benefits on their father’s record can be reopened and revised.

F. Policy — Multiple Claimants Involved on Same Record

When more than one claimant is entitled on the same record and multiple errors are involved, consider and review the dates of the initial determination notices separately on each initial determination in deciding whether to reopen.

1. EXAMPLE — Multiple Claimants and Errors in Workers’ Compensation Offset Case

A NH (BIC HA) and his wife (BIC HB) are entitled to benefits. We processed the NH’s disability claim in 1991 and made an incorrect initial determination when we adjusted the Workers’ Compensation (WC) offset. His initial award notice was sent 02/02/1991. We underpaid his DIB (applied too much offset) for the period from 04/1990 – 12/1998. In 1994, when we entitled his wife to spouse’s benefits (05/05/1994), we incorrectly removed the WC offset on the wife’s benefit and paid the full wife’s benefit amount (an erroneous payment resulted). Both errors were discovered in 12/2002 and more than 4 years have passed.

Each determination in this case should be analyzed separately based on the notice date of their initial determination. The NH’s initial determination notice was sent 02/02/1991 and the wife’s initial determination notice was sent 05/05/1994.

Since there are errors on the face of the evidence on both of these initial determinations and we discovered them after 4 years from the notice date of their initial determinations, we can only reopen and revise the initial determination if the initial determination was originally unfavorable to the claimant (see GN 04010.020B.).

In these cases, we could reopen and revise the NH’s determination because SSA applied too much offset and he is due additional benefits. However, since the spouse’s benefits were paid to her advantage and reopening and revising her determination would be unfavorable to her, we cannot reopen and revise because it has been over 4 years from the notice date of her initial determination (see GN 04030.060C.).

2. EXAMPLE — Multiple Claimants and Multiple Errors in the Computation of Benefits

A NH (BIC A), his wife (BIC B) and children (BICS C1, C2) are entitled to benefits. We processed the NH’s claim, the wife’s claim and the children’s claims in 05/2000 and made an incorrect initial determination when we gave the NH 5 DRCs instead of 15 DRCs. The initial award notices were sent 05/22/2000. We also failed to credit his record with additional deemed Military Service wages (DMWs) for 1958-1961. We failed to give him credit for DMWs even though the proof was in file in 05/2000.

In 10/2000, his wife (BIC B) became insured and entitled on her own record. Her initial award notice was sent 10/30/2000. However, we failed to adjust the amount of her spouse’s benefit due to the entitlement on her own record. All of these errors were discovered in 12/2005, more than 4 years from the date of their initial award notices.

Since correcting the NH’s claim would be favorable to him, his spouse and his children, we can reopen and revise the initial determinations made in 05/2000 based on error on the face of the evidence.

With regard to his wife’s record and entitlement in 10/2000, since it has been over 4 years from the date of her initial determination and the result of reopening would be unfavorable, we cannot reopen and revise her initial determination made in 10/2000 (see GN 04030.060C.).

G. References

RS 00615.000 – Computation of Monthly Benefits Amounts

RS 00615.010 – Chart on Reduced Benefits

GN 00204.025 – Open Applications

DI 52101.001 – WC/PDB Policies and Procedures


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