This section provides guidance to make a fault determination for individuals requesting a waiver of a Title II overpayment that resulted from incorrect computation of insured status or benefit rates. This section also provides guidance to make a fault determination for individuals requesting a waiver of a Title XVI overpayment that resulted from incorrect SSI payments.

An overpaid individual cannot be charged with knowledge of how we compute benefit rates or insured status. We will presume the individual is not at fault if:

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  we made an error in computing the benefit rate or insured status, unless there is evidence that the individual knew or had reason to know of the computation error or the individual’s earnings record was fraudulent, refer to GN 02250.016B.4. If the individual’s earning record was fraudulent but the individual was not involved in the fraud, we will determine whether the individual is not at fault by applying the factors in GN 02250.005.

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  the individual reported a change, but we continued issuing payments, which led the individual to believe they were entitled to receive the payments, refer to GN 02250.016B.2; or

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  the individual reported a change, and we took some action that the individual believed was a correct response to the report, refer to GN 02250.016B.3.

This section includes examples for making the not at fault determination. If any of these presumptions apply, find an overpaid individual not at fault, and then determine if the individual meets any of these waiver provisions:

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

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

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

 

Example 1: Computation error

(Not at fault): Elain, the applicant, alleged February 15, 1957, as the date of birth on their application for retirement benefits. However, due to a clerical error, the technician entered the date of birth as February 15, 1955. We subsequently notified Elain that we corrected the date of birth in our records to be February 15, 1957, causing an overpayment based on our incorrect computation of benefit based on their age. We cannot expect Elain to know how we compute benefit rates; therefore, Elain is not at fault.

 

Example 2: Reported change followed by incorrect action

(Not at fault): Nesta started receiving widows' benefits of $1,500 at age 60. Two years later, Nesta started to receive a non-covered pension from their work as a teacher and called to inform us immediately. Nesta informed us the pension amount would be $2,000 per month. When the technician input Nesta’s non-covered pension, they mistakenly input $200 instead of $2,000. Nesta received a notice in the mail stating their benefit was being reduced by $133 per month due to government pension offset (GPO). Six months later during a claims review, another technician discovered that the prior technician had previously input an incorrect pension amount. The technician then corrected the amount to $2,000. Nesta received a notice stating their monthly benefit amount should have been reduced by $1,333 due to GPO and they were now overpaid. Nesta requested a waiver. Nesta is not at fault for causing the overpayment because we took action after the report that led Nesta to believe we made a correct action.

 

Example 3: Continued benefits after change reported

(Not at fault): Cassian, a surviving divorced father, under age 60, reported their remarriage and indicated they still had a child in their care and wished to continue receiving benefits on the child's behalf. Cassian’s benefits should have been terminated but were not. When Cassian requested a waiver for the resulting overpayment, Cassian alleged that since the benefits continued after their report, Cassian thought they were still due the benefits because they had the child in their care. We will find Cassian is not at fault.

 

Example 4: Continued benefit payments after change reported

(Not at fault): Azriel reported current work during the Medical Continuing Disability Review (CDR) process, but we failed to initiate a Work CDR. The Disability Determination Services (DDS) approved the Medical CDR, benefits continued, and Azriel continued to work. We then conducted a Work CDR resulting in an overpayment. Azriel requested a waiver. Since Azriel reported their current work during the Medical CDR process and the continued issuance of checks after the report led Azriel to believe they were entitled to the checks subsequently received, we determine Azriel is not at fault.

If Azriel did not report current work during the Medical CDR, and we conduct a subsequent Work CDR resulting in an overpayment, we must consider all the circumstances surrounding the overpayment that may have prevented Azriel from understanding reporting requirements or the need to report.