TN 13 (07-09)
RS 01404.256 Processing "Ensign" Claims
Take the following action in all claims for Title II retirement and disability benefits for which insured status is an issue and the claimant states that he/she worked under another SSN:
As part of the normal review of SSA queries, verify whether the claimant previously applied for retirement or disability benefits and was denied because of the provisions of the "Ensign Amendment."
Check the master beneficiary record (MBR) for “Ensign Case” in the Special message field and/or obtain a Processing Center Action Control System(PCACS) query to determine if the Listing Code “424 or 425” is present (see RS 01404.256B.5. in this section). If either is present, then take one of the following actions:
If the MBR has an “Ensign Amendment” special message or the PCACS listing code 424 or 425 exists and the appeal period has expired for the prior claim, then explain to the claimant that his/her claim was previously denied and SSA must determine whether the individual was convicted of using an incorrect Social Security number (see RS 01404.254D., When to refer "Ensign Amendment" cases to the servicing RO).
If the NH's current request is within the appeal period of the prior claim, then determine whether the claimant wishes to file an appeal. If so, assist the NH in filing the appeal request. Follow normal appeal procedures found in GN 03101.010. The FO that adjudicated the claim is responsible for processing the reconsideration. See GN 03102.175.
If the NH was previously denied benefits due to a lack of insured status and is currently appealing the prior denial and presents documentation to add earnings from work performed under a SSN other than the SSN that belongs to him or her, the “Ensign Amendment” provisions must be considered.
If this is the initial claim for retirement and/or disability benefits, then take the application and follow the procedures in RS 01404.256B., in this section..
If the claimant is 64 years and 9 months or older, and it appears that the "Ensign Amendment" applies, take the RIB claim first. If the RIB claim is denied due to lack of insured status as the result of a finding of a conviction pursuant to the “Ensign Amendment,” take the Medicare only claim after processing the RIB denial.
B. Procedure – Processing a Claim when the “Ensign Amendment" May Apply
Take the following steps in processing claims when the “Ensign Amendment” provisions may apply:
Follow the guidelines provided in RS 01404.254D., and determine if the claimant was convicted in a Federal court of falsely using the other SSN(s).
Obtain a complete explanation as to the dates, employers, circumstances, etc. provided by the claimant.
Document the claimant’s statement on the Remarks (RMKS) screen.
Document the conviction special determination on the Report of Contact (RPOC) Screen in MCS
If evidence of a conviction is found (See RS 01404.254D.):
Prepare a special determination and document the determination of “Conviction of Violation” on the RPOC screen; and
Enter Unit Code; “ENSIGN” on the DWO1 screen in MCS; and
Enter the listing code 425 on the DECI screen in MCS); and
Suppress the MCS notice and prepare a manual disallowance notice per RS 01404.260; and
Enter disallowance code of 026 for retirement claims or assure that the system has generated an 090 denial for disability claims; and
Add “Ensign Case/Conviction” in the Special Message Field on the MBR; and
Do not take action to correct the NH’s earnings record if a conviction is confirmed.
If necessary, take the appropriate action to develop and correct the earnings record of the individual whose SSN was wrongfully used by the NH e.g. place the incorrect earnings in suspense. (For resolving scrambled earnings situations see RM 03870.045 - RM 03870.060)
If evidence of a conviction is not found:
Document the circumstances as to why and when the claimant used the other SSN(s) on the RPOC screen; and
Prepare a special determination that there was no finding of a conviction; and
Follow normal procedures to develop and correct the earnings record and process the claim.
If the claimant submits evidence of earnings or work under the erroneous SSN(s):
Accept any evidence/documentation (W-2s, employer statement, etc.) the claimant may have of the work under the erroneous SSN; and
Enter the information in the appropriate application (RPOC, DW01, NDRED, eDIB, EVID, etc.)
If the individual was convicted of using the other SSN, do not take action to correct his or her earnings record (See RS 01404.252A.8.).