TN 4 (11-88)

GN 04040.030 Relationship Between Statute of Limitations and Administrative Finality

A. Introduction

1. REVISING CLAIMS-RELATED DETERMINATIONS

Claims-related initial determinations(e.g., insured status, PIA, MBA, post-entitlement issues) are reopened and revised based on the rules of administrative finality.

2. REVISING EARNINGS

  1. Determinations relating to revision of an E/R are made:

    • Within the time limits provided by the statute of limitations for correction of earnings records (see RS 02201.001); or

    • After expiration of the time limits provided by the statute of limitation for correction of earnings records, provided an exception to the time limits permits revision of the E/R (see RS 02201.008).

  2. Where an E/R cannot be correctedbecause the time limitation under the statute of limitations has expired and no exception applies, we must use the E/R as establishedin taking any award or disallowance action.

B. Operating Policy—Relationship

1. STATUTE OF LIMITATIONS PERMITS REVISION OF E/R BUT ADMINISTRATIVE FINALITY DOES NOT PERMIT REOPENING

  1. If the E/R can be revised under the statute of limitations but the determination on the claims issue cannot be reopened under administrative finality:

    • Any increase in the PIA and benefit amount based on the revised E/R can be paid effective with the month the question was raised which resulted in the E/R being revised (i.e., rather than reopening and revising the prior determination, we make a new initial determination effective with a later date).

    • Any decrease in the benefit amount will not be made.

  2. Example:Mrs. Jones attained age 62 and filed a claim for retirement benefits in September 1984. In processing her claim, it was noted that there were no postings for 1979 in an E/R that otherwise showed consistent postings. Upon questioning, Mrs. Jones insisted that she was paid wages in that year. However, her employer was no longer in business, and Mrs. Jones was unable to furnish any evidence of wages for that year. Mrs. Jones received notice of the determination on her claim in November 1984, and that determination became final. That determination, which established the monthly benefit rate, was based in part on the earnings determination that Mrs. Jones was not paid any wages in 1979. In September 1989, Mrs. Jones discovered old records which included evidence establishing that she was paid $1500 in wages in 1979, and she presented the evidence to SSA in that month.

    The initial determination of November 1984 with respect to Mrs. Jones' application for benefits has become final and may not be reopened under the rules of administrative finality because, even though good cause can be shown to exist and new and material evidence is furnished, more than 4 years have elapsed since the notice of the initial determination and there is no indication that the claim can be reopened under the unrestricted reopening provisions. However, her E/R may be credited with wages of $1500 in 1979 since one of the exceptions to the time limitation is applicable (see RS 02201.016). Inclusion of these wages increases her PIA. While the initial claims determination may not be reopened, an amended award may be prepared to pay her the increased PIA effective with September 1989, the month she questioned the amount of her benefit by furnishing additional evidence of wages paid in 1979. If the initial claims determination could be reopened, the increased PIA could be paid retroactively to the initial month of entitlement.

2. IF STATUTE DOES NOT PERMIT REVISION OF E/R, REOPENING DOES NOT APPLY

  1. If new evidence of earnings is submitted but the E/R cannot be revised under the statute of limitations, the E/R as posted is considered to be correct, and any benefit amount based on it is considered correct.

  2. Since we cannot reopen correct determinations (GN 04001.070), we would not reopen the initial determination on the claims issue.

  3. There is no basis for changing the benefit amount prospectively.

    EXAMPLE:A RIB award was approved for Mrs. Smith on 9/19/84 based on her E/R which included wages of $5,400 for 1982. In April 1988, we learned that the wages reported for 1982 were based on domestic services performed in the employ of her son in his private home