TN 7 (09-98)
RS 00601.010 Equivalency and Tolerance Rules
A. Policy - Equivalency Rule For Initial Determinations
The initial determination of a benefit amount is considered correct, even if a different application of the rules provided in this chapter results in a benefit amount which is different by $.10. Consider the two possible benefit amounts equivalent and do not initiate corrective action.
NOTE: Effective 06/19/04, any action processed by an automated system will correct the rate if it is different by $.10 or more.
B. Policy - Tolerance Rule For Reopening Determinations
If an error in the computation of a benefit amount is discovered after a claim has been adjudicated, or a benefit computation has been manually-prepared or computer generated (including a benefit rate increase) and notice of the determination has been released (including a benefit check enclosure notice), do not revise the computation of the benefit amount, unless one of the following exceptions occurs:
The PIA is affected; or
The MBA of any one beneficiary would be changed by at least $1.00.
The total of monthly benefits payable would be changed by at least $2.50; or
The determination is reopened for some additional reason under the rules of administrative finality.
2. Administrative Finality
The equivalency and tolerance rules in this section are not intended to violate the rules of administrative finality. If adjustment is possible under the equivalency and tolerance rules, a separate decision must be made concerning whether reopening is possible under the rules of administrative finality. Adjustments may be made only if allowed under both administrative finality and tolerance rules. For discussions of administrative finality rules see GN 04001.000 and GN 04030.000.