TN 26 (01-04)

RS 00615.772 Determining the SSN Upon Which Benefits Will Be Paid

A. Policy

1. General

A simultaneously entitled child will be paid on the SSN with the higher PIA, unless one of the exceptions in RS 00615.772A.2. applies.

2. When Payment May Be Made on the Lower PIA

There are three situations when we may make payment on the lower PIA. They are:

a. Child Entitled On a Life Record and a Death record

A child is entitled on a life record and a death record, and

  • The life PIA exceeds the death PIA, but

  • 50% of the life PIA is less than 75% of the death PIA, and

  • No other beneficiary entitled on either PIA will be disadvantaged; or

b. Child Entitled On Two Death Records

A child is entitled on two death records, and

  • The child qualifies for an MSSR on the lower PIA that is higher than 75% of the higher PIA, and

  • No other beneficiary entitled on either PIA will be disadvantaged; or

c. Simultaneously Entitled Child

A simultaneously entitled child is receiving benefits on a disability record that goes into EPE (or EXR/IRP) suspension. (See DI 13010.210 for information about EPE, DI 13050.001 for more on EXR and DI 13050.066 for more about IRP.)

NOTE: Subsection RS 00615.772A.2.c. applies beginning with benefits payable for 9/94 and later if both records are disability claims. It is effective for benefits payable for 4/96 and later if one record is a disability claim and the other is either a retirement or survivor claim.

B. Procedure

1. Higher Benefit is Payable on the Lower PIA

If there are other non-simultaneously entitled auxiliaries or survivors entitled on any SSN, and either RS 00615.772A.2.a. or RS 00615.772A.2.b. applies, follow these steps to determine whether payment will be on higher or lower PIA.

Step a. - On the SSN with the higher PIA, determine each benefit amount as though the simultaneously entitled child was not entitled (without combining maximums).

Step b. - On the SSN with the higher PIA, determine each benefit amount with the simultaneously entitled child and a combined maximum.

If the rate for any beneficiary in Step a. is less than in Step b., the simultaneously entitled child must be paid on the higher PIA; stop here. If not, go to step c.

Step c. - On the SSN with the lower PIA, determine each benefit amount as though the simultaneously entitled child was not entitled (without combining maximums).

Step d. - On the SSN with the lower PIA, determine each benefit amount with all entitlements and a combined maximum considered. Pay on the higher PIA if:

  • Rate in Step d. is less than rate in Step c. for any beneficiary, or;

  • Rate in Step d. is less than rate in Step b. for the simultaneously entitled child.

2. EPE and EXR/IRP Suspension

When a simultaneously entitled child's benefits are suspended on the higher PIA because of the worker's EPE or EXR/IRP suspension, pay benefits to the child on the lower PIA for all months of suspension. If a combined family maximum (CFM) applies because of that child's entitlement, apply the CFM on the record with the lower PIA during those months per RS 00615.770B.5.

As explained in section RS 00615.772A.2.c., this change is effective for benefits payable for

  • 9/94 or later if two disability claims are involved; or

  • 4/96 or later if a disability claim and a retirement or survivor claim are involved.

NOTE: This process only applies to EPE and EXR/IRP suspension cases. It cannot be used because benefits are withheld or reduced for other reasons (such as WC/PDB offset).

All children who receive payment on the lower PIA because of this change require a notice to explain the change in their payment status. Use Miscellaneous Adjustment Notice (E3311) as shown in NL 00703.311. Fill-in #2 of that notice requires dictated language to explain the reason for the change. Use the following paragraph for that fill-in. If another notice is being prepared, add the following language to that notice and do not send the E3311.

[CHILD'S NAME] is entitled to a child's benefit on two different records. Because the benefits on one record have been suspended due to the worker's suspension, [HE OR SHE] will now receive benefits on the other record.”

C. Examples

1. Three SSNs - Two Possible Combined Family Maximums

Three children of Don and Wilma Kessler are eligible for life auxiliary benefits on both their records. Another child of Don's from a prior marriage to Agnes (now deceased) is eligible on both their records but not on Wilma's record. Therefore, this is not a triple entitlement situation. However, there are two possible combined family maximums. We can combine the maximums from SSN 1 and SSN 2 on SSN 1 or we can combine the maximums from SSN1 and SSN 3 on SSN 1. The larger of the two is the one that will be used to compute the benefits payable to the children. Because whichever combined maximum we choose will be on SSN 1 we can only have one combined maximum using only two of the maximums involved. If any child was entitled on all three records we could combine all three maximums in SSN 1. (See Example 2 for that scenario and see Example 3 for a scenario where we have three records with two combined maximums.)

The PIAs, maximums, and original rates on the three SSNs are as follows.

 

SSN 1 Don

SSN 2 Wilma

SSN 3 Agnes

PIA

$410.20

$206.70

$209.10

Maximum

$744.10

$310.10

$313.70

Original Benefit

$205.10 (50%)

$103.40 (50%)

$156.80 (75%)

The maximums are combined as follows:

1. Don and Wilma — $744.10 +$310.10 = $1,054.20

2. Don and Agnes — $744.10 +$313.70 = $1,057.80

The children of Don and Wilma Kessler are entitled on both SSN 1 and SSN 2 which results in combination 1. above. However combination 2 is higher. Since Don's child by the previous marriage is also entitled on his record, that child will share in the combined family maximum.

The higher combined family maximum is $1,057.80. The children's benefits will be computed using this combined maximum. Since Don's record has the higher PIA, the children will be paid on his record. All the children entitled on his SSN will share in the combined family maximum.

  744.10

SSN 1 maximum

+ 313.70

SSN 3 maximum

1,057.80

Total

-  410.20

Life PIA

 647.60

Remainder

divided by 4

Number of children

  161.90

Amount per child

x 4Cs

Number of children

 647.60

Total to children

+ 410.20

Life PIA

1,057.80

Total payable to family

However, there is another possibility. The fourth child, eligible on Agnes' SSN, need not file on Don's SSN. If this child is restricted to entitlement on Agnes' SSN only, the original benefit of $156.90 will be paid on the SSN. The maximums will then be combined on Don's and Wilma's SSN as follows:

744.10

SSN 1 maximum

+ 310.10

SSN 2 maximum

1,054.20

Total

- 410.20

Life PIA

644.00

Remainder

divided by 3

Number of children

214.60

Reduced to $205.10, the original benefit rate on Don's SSN

205.10

 

x 3Cs

Number of children

615.30

Total to children

+410.20

Life PIA

1,025.50

Total payable on this record

+ 156.80

Amount payable to other C

1,182.30

Total payable to family

This alternative appears to be more advantageous to the family as a whole. However, before advice is given to restrict an application to one SSN see RS 00203.060.

2. Triple Entitlement

Same facts as example 1 except Don's child by his previous marriage is entitled on all three SSNs: his father’s (Don), his deceased mother's (Agnes) and as a stepchild on Wilma's SSN, resulting in a triple entitlement situation. Therefore, the maximums of all three SSNs are combined (subject to the highest family for that month). The children's rates will be paid on Don's SSN, the record with the highest PIA. The children's rates are computed as follows:

744.10

Maximum SSN 1

+ 310.10

Maximum SSN 2

+ 313.70

Maximum SSN 3

1,367.90

Combined family maximums (the highest combined maximum in this case is more than $1,367.90 so the limit does not apply.)

- 410.20

Life PIA

957.70

Divided by 4 = $239.40 (but the original benefit amount is $205.10.)

Each child will receive $205.10.