On 06/21/2003, a CR completed an RZ and during the interview the CR determined that
the claimant was in the incorrect living arrangement. As a result of the interview,
it was determined that the claimant’s living arrangement changed from LA: D to LA:
A in 07/2001. The CR made the changes and the initial underpayment determination notice
was sent 06/28/2003.
On 05/28/2005, another CR realized that this initial determination that changed the
living arrangement was not correct. The living arrangement should have remained the
same (LA: D). The CR determined that there was an error on the face of this evidence.
The problem now is whether this 06/28/2003 determination can be reopened and revised.
Since an underpayment or overpayment determination is an initial determination, any
period covered by the initial determination is also subject to be reopened and revised.
So, since an initial determination was made on 06/28/2003 that resulted in an underpayment and covered the period going back to 07/2001, and
we later discovered the error on 05/28/2005 which is within the 2 year period from
06/28/2003, we can reopen and revise this case. Since the initial underpayment determination
affects months going back to 07/2001, we can revise these months going back to 07/2001.
If the CR had discovered this error after the two year period on 09/28/2005, then
the CR can not reopen the initial underpayment determination made on 06/28/2003. However if any LA deemed determinations were incorrect, the CR could make a “revised
determination” on this record going back to 10/01/2003. The CR can not go back to
07/2001 if the error was discovered outside of the 2 year time frame from the date
of the initial underpayment determination. The CR would have to make a “revised determination”
on 09/28/2005 and the furthest the CR could go back to correct this error would be
2 years to 10/01/2003.
For more information on deemed determinations, see SI 04070.005A.4., SI 04070.010A.3., and SI 04070.030A. – SI 04070.030C.