This section provides guidance to make a fault determination for waivers when we presume an overpaid individual is not at fault for their overpayment.

We make certain presumptions of not at fault for overpaid individuals. If they do not meet any of these presumptions, consider making a not at fault finding under GN 02250.005 - GN 02250.025.

1. 1. 

   Timely Reporting

   We will presume an individual is not at fault if they reported, or attempted to report, the pertinent change(s) timely. For SSI changes, we consider they reported a change in a timely manner if they report it within 10 calendar days after the month the change occurred. For guidance on presuming not at fault for timely reported work activity, refer to GN 02250.025B.1.

2. 2. 

   Continued issuance of payments after reported change

   We will presume an overpaid individual is not at fault for any payments made after they reported a change that caused or should have caused a change in benefits, refer to GN 02250.023. If this is a subsequent overpayment, refer to GN 02250.021B.2.

3. 3. 

   Incorrect change in benefit amount after reported change

   If an individual reported a change and we reduced benefits, when we should have terminated or further reduced the benefit amount, we will presume the individual is not at fault, refer to GN 02250.023.

4. 4. 

   Incorrect benefit rate or insured status

   We will presume the individual not at fault if we made an error in computing the insured status, benefit rate, or payment amount, refer to GN 02250.023.

5. 5. 

   Overpayment due to earnings (Title II only)

   If an individual has a Title II overpayment due to earnings, determine if they meet one of the criteria where we can presume the individual to be not at fault, refer to GN 02250.025.

6. 6. 

   Minor children and legally incompetent adults

   We will presume an individual is not at fault if they were overpaid as:

   • •

     a minor child and had a representative payee (payee) when they received the overpayment,

   • •

     an auxiliary child up until age 19 while they are still in high school and had a payee when they received the overpayment, or

   • •

     a legally incompetent adult.

   For the definition of legally incompetent adult, refer to GN 00501.010B.7.

   NOTE: If a child received benefits as their own payee, make the fault determination by considering all the circumstances in GN 02250.005B.2.

    

7. 7. 

   Adult individual overpaid as a minor child with a representative payee

   For information on the presumption of not at fault and when we deem recovery against equity and good conscience for an adult individual who was overpaid as a minor child with a payee, refer to GN 02250.150D.

8. 8. 

   When we find the number holder not at fault

   For Title II, if the number holder is not at fault in causing the overpayment, we will presume that any other individual receiving benefits on the same record is not at fault if they were overpaid for the same reason.

   For Title XVI, if an individual is found not at fault in causing the overpayment, we will presume their eligible spouse is not at fault if they were overpaid for the same reason.

9. 9. 

   Overpaid individual unaware that actions of another affect entitlement or eligibility to benefits

   We will presume an individual who is overpaid because of another individual's action (e.g. number holder working) is not at fault if:

   • •

     they did not know and had no reason to know that the other individual's actions caused or would cause an overpayment; and

   • •

     they were not living with the individual who caused the overpayment at the time the overpayment occurred.

   If the overpaid individual does not meet both criteria, you must develop the fault determination under GN 02250.005. We may still find the individual not at fault, even if they lived in the same household with the number holder whose actions led to the overpayment. If we do not have evidence that they knew or should have known of the number holder’s actions that led to the overpayment, we will find them not at fault. Refer to example in GN 02250.016C.1.

10. 10. 

    Misinformation from an official source

    For information on the presumption of not at fault when the overpayment was caused by misinformation from an official source, refer to GN 02250.061.

11. 11. 

    Cash surrender value of life insurance (Title XVI only)

    If an individual was overpaid because they were not aware that their life insurance had a cash surrender value or if the cash surrender value increased over the resource limit over time, we will presume they are not at fault.

12. 12. 

    Countable resources exceed limit (Title XVI only)

    For information on the presumption of not at fault when an overpayment was caused by excess resources, refer to GN 02250.090.

13. 13. 

    Medical institutionalization (Title XVI only)

    If the overpayment was caused by the individual’s admission into a medical institution, we will presume they are not at fault.

14. 14. 

    Statutory benefit continuation of payments

    For information on the presumption of not at fault when an overpayment was caused by the receipt of Statutory Benefit Continuation (SBC) and the individual appealed in good faith, refer to GN 02250.036.

15. 15. 

    Family maximum (Title II only)

    There is a maximum amount that we pay from an individual’s record, which includes the number holder, their spouse, and children. We call this the family maximum. In cases where the family maximum is involved, we will presume they are not at fault when a beneficiary is retroactively entitled on the record. We also deem recovery against equity and good conscience, refer to GN 02250.150B. For more information about family maximum, refer to RS 00615.760, GN 02201.003 and GN 02201.033

16. 16. 

    Erroneous entitlement on more than one Social Security Number (SSN) record

    An individual may be overpaid because they received benefits based on erroneous entitlement on more than one SSN record. If the individual filed for benefits and they did not withhold information regarding filing for or receiving benefits on another record, we can assume they thought they were entitled to separate payments from each record. In these circumstances, we can presume the individual is not at fault for the overpayment.

17. 17. 

    We are unable to locate documents or documentation to support an overpayment

    For information on the presumption of not at fault and deeming recovery against equity and good conscience when we are unable to locate documents or determine the cause of the overpayment, refer to GN 02250.011.

18. 18. 

    When we reopened a final determination based on a change of position

    We will presume an overpaid individual is not at fault when the overpayment resulted from a revised determination on reopening due to a change in position, refer to GN 04001.100. We also deem recovery against equity and good conscience. Refer to GN 02250.150B.

    If the reopening was due to change in position but our revised determination that unfavorably changed entitlement, eligibility, or payment amount was based on some reason other than the change in position, we will make the fault determination by considering all circumstances in GN 02250.005B.2.

19. 19. 

    Short taxable year ending in death

    We will presume an individual is not at fault when their death caused excess earnings. Effective November 11, 1988, we eliminated the short taxable year for the year of death. Prior to that time, overpayments which occurred solely because of the computation under the short taxable year were automatically considered for waiver. We will deem recovery is against equity and good conscience, refer to GN 02250.150.

20. 20. 

    Overpayments during the COVID-19 pandemic period

    We will find an overpaid individual is not at fault and deem recovery is against equity and good conscience if their overpayment occurred because we deferred processing manual adverse actions between March 17, 2020, and August 31, 2020. This waiver applies to overpayments for the period of March 2020 through September 2020, identified on or before December 31, 2020, that resulted from the pause in manual workloads. Some exceptions to this waiver process are fraud, similar fault, double check negotiation, prisoner suspensions and representative payee misuse.

    If the overpayment period has months within and outside of the pandemic period (March 2020 through September 2020), we will make more than one waiver determination. We will evaluate the fault determination for months outside the pandemic period by considering the factors in GN 02250.005B.2. If the individual is not at fault, we will determine if we can approve the waiver under one of these waiver provisions:

    • •

      Deemed to defeat the purpose, refer to GN 02250.110; or

    • •

      Against equity and good conscience, refer to GN 02250.150; or

    • •

      Defeat the purpose of the Act, refer to GN 02250.100.

    NOTE: Windfall Elimination Provision (WEP), Government Pension Offset (GPO), Bureau of Worker’s Compensation (BWC) and public disability benefit (PDB) adverse actions were held only from March 18, 2020, through June 22, 2020, when instructions were updated to resume processing these workloads. We will presume the overpaid individual is not at fault only for the months of March 2020 through June 2020 when actions were held.

Example 1: Overpaid individual unaware that actions of another affect entitlement or eligibility to benefits

Yrene returned to work but did not report their return to work timely. We stopped their disability benefits, but due to Yrene’s late reporting, both Yrene and their spouse, Chaol, were overpaid. Chaol lived in another state and had not communicated with Yrene in years. Chaol requested a waiver of the overpayment. The technician found Chaol not at fault in causing the overpayment because Chaol did not live with Yrene at the time of the overpayment and did not know or have reason to know about Yrene’s work activity. The technician found Chaol not at fault. The technician will next determine if another waiver provision applies.