TN 4 (06-05)

SI 04070.080 RSDI/SSI Rules of Administrative Finality and Erroneous Death Determinations

A. Policy - Reopening Concurrent SSI/RSDI Claims

1. Administrative Finality Period for RSDI Determinations/Decisions

Although SSI determinations and decisions cannot be reopened after 2 years have elapsed (except in cases of fraud or similar fault), RSDI (Title II) claims can be reopened for up to 4 years if there is good cause.

2. Effect of 4-Year Rule on Reopening SSI Determinations/Decisions

Under the 4-year rule on reopening RSDI determinations/decisions:

  • Often the amount of the Title II benefit will affect the payment amount of SSI. If a revised Title II determination was made before the administrative finality period for SSI purposes, it can only be applied to SSI determinations made within the 1-year or 2-year period.

  • The change may be used to reopen both actual and deemed determinations within the applicable administrative finality period.

  • Determinations or decisions made before the applicable SSI administrative finality period cannot be reopened and revised, even if they are incorrect as a result of the revision to the Title II benefit.

3. When RSDI Revisions Will Affect SSI Payments

The question of revisions will arise when issues in common to both programs come up (e.g., age, disability) and when there is a change in the benefit amount.

B. Policy – Erroneous Death Determination

Termination of SSI payments due to death is an actual (i.e., not “deemed”) initial determination that does not require a notice. Therefore, upon discovery of an erroneous death determination, the determination can be reopened and revised during the 2-year period after the date of the initial determination (i.e., the date the death termination data were input to the SSI system) under the rules of administrative finality. Proof that the claimant/recipient is still alive is always new and material evidence. (See GN 02602.055 — If an Individual Deceased on SSA Records is Alive)

If more than 2 years have passed since the erroneous death termination action, see the example in SI 04070.010A.2. and GN 03101.010 – Time Limit for Filing Appeal and GN 03101.020 – Good Cause for Extending Time Limit, about filing a request for reconsideration based on establishment of good cause for late filing. This should be granted because there was no notice of termination due to death. (SSA's Goldberg/Kelly procedures provide written advance notice before termination of a living recipient's eligibility.)

C. Policy – Cessation of Title XVI Disability and Blindness

The medical improvement review standards must be considered before reopening and revising certain types of disability or blindness determinations.

See DI 27505.000 – Rules for Reopening and DI 28010.001 – Medical Improvement and Related Issues-General.

D. References

DI 12026.000 – Reconsideration-Medical Cessations and Favorable Initial and Reconsidered Determinations Revised Due to Medical Reasons-Title II and Title XVI

DI 12045.040 – Death of Claimant-Reconsideration Level - DI 12045.050 – Death of Claimant-Appeals Council (AC) Level

DI 13005.001 – Field Office Role In Medical Issue Cases

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SI 04070.080 - RSDI/SSI Rules of Administrative Finality and Erroneous Death Determinations - 06/14/2005
Batch run: 04/25/2016