Effective Dates: 12/16/2025 - Present Previous | Next

TN 86 (12-25)

DI 11010.350 Corrective Actions on Erroneous Awards and Improper Payments in Disability Claims

Citations: 20 CFR §§ 404.988; 416.1488; 404.1596; 416.1336; 404.992; 416.1492

A. Effect of an erroneous award notice or payment

Field offices (FO) effectuate certain types of disability determinations and decisions which, if done in error, may lead to overpayments or improper payments.  These types of determinations and decisions include:

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    administrative law judge (ALJ) decisions under Title XVI (see SI 00603.040C),

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    Disability Determination Services (DDS) determinations (see sections in DI 11010.000), and

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    FO administrative determinations (e.g., res judicata, collateral estoppel) (see DI 11011.001).

The receipt of an award notice or payment, even when issued in error, can establish a substantive right upon which the claimant may rely. Therefore, the Social Security Administration (SSA) must provide due process before taking an adverse action affecting payments. This means SSA must provide notice, an opportunity to respond, and access to related evidence before payments terminate.

REMINDER: While there are various checks in the claims effectuation process to provide measures of quality control, the quality of the process largely depends on how well the processing technicians perform their work. Fulfilling all required adjudicative responsibilities, including sufficient review of the claim to identify record discrepancies material to eligibility and areas where further development remains necessary to establish entitlement, is essential for properly effectuating payments and avoiding technical errors as described in this section. For more information on adjudicative responsibility and performance quality, see GN 01010.008.

NOTE: 

Instructions in this section relate to correcting erroneous awards in disability claims. For instructions on reversing incorrect technical denials upon reopening or reconsideration in disability claims, see DI 81010.110 and DI 12005.010F.

B. Identifying payments awarded in error

When conducting quality assurance functions and other reviews, or related SSA business processes (e.g., computer matching runs through an interface with state records), the FO may discover erroneous awards and improper payments. Erroneously effectuated award situations may include cases where an adjudicating component mistakenly:

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    establishes entitlement in a disability claim when the medical determination on the claim is a denial,

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    processes a closed period award as an ongoing entitlement,

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    adopts a prior allowance to issue payments in a new disability claim that does not meet the administrative collateral estoppel criteria, or

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    effectuates a disability claim allowance when the nonmedical eligibility criteria were never met in the period of disability.

If an erroneous award notice and payments were released, determine the appropriate corrective action and provide due process before terminating payments. If the claimant received an erroneous award notice, but not a payment, then put the claim into suspended payment status to prevent payments from starting in the due process period.

After identifying the necessary corrective action, do not delay in providing the required due process. After due process, expeditiously complete corrective actions where appropriate.

NOTE: 

If reopening is permitted, the FO has authority to reopen a disability determination and deny the claim when substantial gainful activity (SGA) or other nonmedical issues arise. The FO may also decide on initial determination and reconsideration issues concerning monthly payments without revising the disability finding in a claim. For ALJ decisions under Title XVI, the payment determination after the decision is an initial determination which the FO may correct. For ALJ decisions under Title II, the processing center (PC) may correct an erroneous effectuation of the decision, following instructions in DI 42010.045. For more information on the authority to reopen disability claims and revise determinations on nonmedical issues, see DI 27501.005B.3.d and GN 04001.020.

C. Resolving the error when a disability claim denial or closed period award was processed as an ongoing entitlement

Generally, when the DDS inputs a determination and the case closure transmits correctly, the decisional data propagates onto the FO's adjudicative screens (e.g., Disability Allowance/Denial screen, Disability Page). However, in certain cases with systems limitations and other electronic process exclusions, the data does not automatically transmit from the DDS case processing systems. Processing such cases involves manual completion of adjudicative screens and, in rare instances, some possibility of user error.

For examples of when the DDS inputs case movement information but cannot transmit decisional data, see DI 32001.015B.2. For lists of adjudicative screens and standards, see GN 01010.001.

1. Incorrect determination or decision is found and conditions for reopening are met

In general, SSA can reopen an incorrect determination or decision:

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    Within 1 year of the date of the notice of initial determination for any reason under Title II or Title XVI. (See DI 27505.001A.1.)

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    Within 2 years of the date of the notice of initial determination for good cause under Title XVI. (See DI 27505.001A.2 and SI 04070.010F.5.)

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    Within 4 years of the date of the notice of initial determination for good cause under Title II. (See DI 27505.001A.3 and GN 04010.001.)

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    At any time for reasons described in DI 27505.001A.4, including fraud or similar fault (FSF), or to correct certain Title II case processing errors as described in GN 04010.010D.

a. Due process when an allowance sampled for quality review is effectuated, but the review resulted in a denial

When the Office of Quality Review (OQR) selects a DDS medical allowance for review and that review results in a denial, but the FO effectuated the original allowance in error, return the case to the DDS with a report of contact or equivalent message stating “reopening due to inadvertent effectuation in OQR sampled case.”

The DDS will reopen the medical allowance determination and, when necessary, issue due process and revised determination notices following instructions in DI 27525.015.

b. Due process when a denial or closed period of disability is erroneously effectuated for ongoing payment

When a denial determination or decision was erroneously processed as an allowance and payments were issued, or when only a closed period of disability was established but ongoing payments were issued in error, take the following actions before terminating the payments:

Due process table

Process steps

Additional Title II instructions

Additional Title XVI instructions

1. Document the rationale for reopening on a special determination form or report of contact in the claim file.

Store all documentation using applicable retention systems (e.g., Evidence Portal (EP)).

For more information on documenting the reopening, see GN 04001.080.

For information on the required notice before terminating payments, see GN 03001.005 and GN 03001.015.

For more information on documenting the reopening, see SI 04070.015.

For information on the required notice before terminating payments, see SI 02301.300B.1.

2. Send due process (advance) notice.

Where appropriate, the notice must explain that the claimant was found not disabled for the period under consideration, but we mistakenly issued an award notice or payment following the unfavorable disability determination or decision notice.

Upon releasing the advance notice, set a 15-day tickle or diary date for possible rebuttal. (If all claim segments are inactive, establish a modernized development worksheet (MDW) to control follow-up issues.)

Prior to an adverse action, the claimant will have at least 10 calendar days (plus 5 days for mailing) to respond to the advance notice and may present rebuttal evidence. If, after receipt of new evidence, the case contains inconsistent information which raises doubt as to the validity of the rationale for reopening and revising the award, but the issue requires further development, then complete development to resolve the issue.

If the claimant does not respond within the number of days provided on the advance notice, assume the information in the advance notice is correct and proceed with the adverse action (following instructions in DI 11010.350C.1.d in this section).

An adverse action to revise an allowance to a denial is generally excluded from automated Goldberg/Kelly (GK) processing and may require manual GK procedures (see SI 02301.307).

When the Supplemental Security Income (SSI) record is in payment status, the SSA-L8155 (Notice of Planned Action) must be mailed at least 15 days prior to the end of the month or handed at least 10 days before the first day of the adverse action month.

3. Issue revised determination, as applicable.

Following due process, issue a final notice for all events that result in an adverse action. The notice must provide sufficient information for the claimant to make an informed appeal decision:

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    action taken,

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    basis for the action,

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    effect of the action, and

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    appeal rights.

Revised determinations under Title II generally require a manual notice prepared on an SSA-L951 (Social Security Notice Letterhead) or another standard form letter in applicable notice systems (e.g., the Document Processing System (DPS)). For more information on notices of revision, see GN 04001.090.

If a systems limitation prevents automatic adjustments, complete manual inputs following instructions in DI 11010.350C.1.d in this section. After the record updates, review the SSI display (SSID) to verify due process data (DPD) field entries are correct and reflect the appropriate GK processing (see SI 02301.301).

When an initial determination is reopened and revised, issue a notice of the revised determination, following instructions in SI 04070.050.

NOTE: 

Exhibits or model letters can serve as guides for preparing notices in situations that do not occur in sufficient volume to warrant fully automated form notices and will require entry of case specific information or modification of standard paragraphs to fit a unique circumstance.

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    For a general exhibit letter of advance notice when Social Security benefits will be reduced, see NL 00703.123.

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    For examples of manual SSI notices, see NL 00804.700.

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    For other exhibit letters and dictated notice language, see sections in NL 00703.000 and NL 00804.000.

c. Claimant submits new and material medical evidence

If, for the period under consideration, the nonmedical requirements for eligibility remain met and the new (i.e., non-duplicate) medical evidence indicates more severe impairment(s) or additional impairment(s) not previously alleged:

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    Enter the evidence in the disability claim file.

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    Add a copy of the due process notice to the file with a report of contact or equivalent message stating “request for reopening of medical denial - trailer material received mm/dd/yyyy in FO following due process notice.”

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    Call or email the DDS to explain the situation and request expeditious processing of the case as a medical reactivation.

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    If reactivation is permitted, reactivate the medically denied claim following instructions in DI 81010.143, then return the case to the DDS.

The DDS will issue a revised determination or other disposition notice (such as a ‘No Change in Basis or End Result’ letter as described in NL 00705.256) and return the case following instructions in DI 27530.010.

NOTE: 

If an unfavorable decision on the claim was made at the ALJ or Appeals Council (AC) level, do not reactivate the claim. Enter the medical evidence in the file and continue any development necessary on issues not decided by the ALJ, including terminating improper payments, where appropriate. If there is a reasonable possibility that the additional evidence may serve as a basis to reopen and revise the disability decision, notify the hearing office or AC via phone or email.

d. Payment adjustments following due process

Once no further development is necessary to resolve due process issues, complete actions to update the record:

Correction table

Adverse action situation

System inputs

Related references

Title XVI erroneous award: action required to manually stop SSI disability payments (when a systems limitation prevents automatic adjustments after GK processing).

Use SSI data inputs (e.g., 450SI-PR9) or claim path screens (e.g., Payment Status page) to transmit the appropriate denial or nonpayment status code(s) to the SSI record.

If no existing status code completely conforms to the situation, use the most appropriate code available, then enter a special message on the record explaining the specific basis for the nonpayment or termination event and the reason for the code selection.

For SSI disability denial codes, see the table in DI 26510.045B. For a summary of SSI nonpayment and termination events by payment status code, see SI 02301.215.

Title II erroneous award: action required to end Social Security disability entitlement.

Use the Post-Entitlement Online System (POS) to input S9 (miscellaneous suspension) on the benefits record.

Send a high priority (2560HP) MDW request for the PC to update the S9 to T9 (undefined termination) or to establish another applicable termination event.

For instructions on MDW functions and other modes of requesting PC assistance, see GN 01070.228. For a priority list of Title II suspension and termination codes, see GN 02602.025.

Title II beneficiary remains entitled, but the entitlement month or benefit rate was miscalculated: action required to correct miscomputed disability benefit amounts or months of entitlement.

Use electronic form 101 (EF101) to prepare an amended award.

After routing the amended award to the PC for effectuation, send the PC a manager-to-manager request with an explanation of the situation and recommendation of priority processing.

For an overview of EF101 procedures and other manual processing methods, see GN 01010.200. For benefit computations, see sections in RS 00615.000.

NOTE: 

These payment terminations are not medical cessations. The technical error correction is not subject to the medical improvement review standard (MIRS) and statutory benefit continuation (SBC) provisions. However, GK payment continuation provisions will apply to the reopening actions that result in reduction or stoppage of SSI payments. Under GK provisions, the individual has 60 days to request reconsideration and payment continuation after receiving the due process notice, but only 10 days to request unreduced payments without interruption. For more information on SBC, see DI 12027.001. For more information on GK payment continuation, see SI 02301.310.

Reminder: In general, the disability determination, the payment eligibility determination, and the overpayment assessment are each separate initial determinations with applicable appeal rights. Distinguish separate determinations, where possible, in the notice(s). When an adverse action results in an overpayment, the initial notice of overpayment must include the required information listed in GN 02201.009B for Title II and SI 02201.025B for Title XVI. Typically, following an adverse action, the PC is responsible for notification of Title II overpayments and the FO is responsible for notification of Title XVI overpayments.

2. Incorrect determination or decision is found and time limit for reopening has expired

If the erroneously effectuated claim is precluded from reopening, initiate a continuing disability review (CDR) and send the case to the DDS. The DDS will follow the MIRS process for the CDR and evaluate whether a Group I error exception applies.

For disability claim reopening rules, see DI 27505.001. For FO procedures to identify and initiate medical CDRs, see DI 13005.001. For an overview of error exceptions in the MIRS evaluation process, see DI 28020.001 and DI 28020.350.

D. Reopening a disability claim for nonmedical reasons

1. Revising a disability claim allowance to a technical denial when nonmedical eligibility criteria were not met

Nonmedical eligibility criteria for payments include:

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    Insured status requirements for disability insurance benefits (DIB). (See RS 00301.120.)

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    Marriage duration and prescribed period requirements for disabled widow(er) benefits (DWB). (See DI 10110.001.)

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    Relationship and dependency requirements for childhood disability benefits (CDB). (See GN 00306.002.)

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    Parental control and responsibility requirements for disabled/minor child-in-care benefits. (See DI 23505.001 and RS 01310.001D.)

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    Income and resource limits and residency requirements for SSI. (See SI 00501.001.)

When the claimant/recipient did not meet the applicable nonmedical eligibility criteria for the period of disability covered by the application, and the conditions for reopening are met, follow applicable instructions in GN 01010.480 to document the reopening issue. Revise the erroneous allowance following due process and payment adjustment instructions in DI 11010.350C.1 in this section.

2. Nonmedical eligibility criteria were met in a new disability claim, but collateral estoppel was misapplied

a. Conditions for reopening are met and a disability determination is needed

If collateral estoppel was misapplied to allow a new disability claim (i.e., the case did not meet the administrative collateral estoppel criteria listed in DI 11011.001 when the prior determination or decision was adopted), but a favorable determination remains possible based on the applicable POD (as described in DI 25501.220), send the claim to the DDS for an initial disability determination. Take the following actions prior to case transfer:

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    Issue a manual notice to notify the claimant that SSA improperly awarded payments in the new disability claim and that we must now review the case to see whether the determination was correct or should be changed. The notice must also include a request, with appropriate closeout language, for any additional information or forms that the claimant needs to submit. (For forms used in disability claims, see DI 11005.016. For closeout procedures, see DI 11018.005.)

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    After obtaining required forms, establish or reactivate the applicable claim in the Electronic Disability Collect System (EDCS). (If the case is excluded from electronic processing, establish the claim folder following instructions in DI 81010.030E.)

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    Add a report of contact to the file with the remarks “reopening due to misapplied collateral estoppel award issued mm/dd/yyyy [date of the erroneous award notice]” as well as a brief outline of the case facts and a request for the DDS to extend due process when issuing a revised determination.

REMINDER: Document the request for any prior paper folder(s) following instructions in DI 11005.085B. Before deciding to request new medical evidence, the DDS must consider development already undertaken and relevant evidence in the prior claim(s), as explained in DI 22505.006B.

If the new disability determination will be less than fully favorable, the DDS releases the appropriate Title II due process predetermination notice (described in DI 27525.001B.1) or Title XVI due process GK notice (described in DI 27540.015B). After completing full development, the DDS documents the case with any applicable revised instructions for the FO and issues the determination notice, following procedures in DI 27530.010.

When payment adjustments are necessary after due process, follow instructions in DI 11010.350C.1.d in this section.

NOTE: 

Not all FO processing errors will result in a determination that is materially incorrect. In general, do not reopen determinations that were correct when made. Even when an employee does not follow some policy guidelines when making the determination, the end result may still be treated as a correct determination when supported by the totality of the available information and evidence in the case. For example, if the FO did not record the remarks “clearly not SGA” on a report of contact covering work activity in a collateral estoppel case but other evidence in the file verifies the claimant’s earnings after disability onset were all wages below the trial work period (TWP) amount threshold, then the collateral estoppel determination would not need to be reopened on the basis of SGA.

b. MIRS and SBC Exclusions

An unfavorable disability determination by the DDS on a misapplied collateral estoppel claim is a nonmedical reopening not subject to MIRS. For more information on when MIRS does not apply, see DI 28005.001F.

GK processing will apply only to SSI payments. The claimant will not be eligible for SBC of Social Security benefits when appealing the DDS initial determination on the reopened claim. If the claimant is entitled to regular payments in the prior claim from which the favorable determination or decision had been adopted, payments on that prior claim will continue.

NOTE: 

Do not initiate a medical CDR unless the time limit for reopening the misapplied collateral estoppel claim has expired or medical evidence raises an issue as to whether disability continues on any other claim. For events that may raise a CDR, see DI 13001.005. For more information on CDR processing in erroneous award situations, see DI 11010.350C.2 in this section.

3. Claimant engaging in SGA had returned to work before the disability determination date and less than 12 months after the established onset date (EOD)

a. Title II case processing

Follow instructions in DI 13010.105B.1 to reopen the disability determination to a denial when:

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    conditions for reopening are met (see GN 04001.010),

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    SGA precludes the claimant from meeting the disability duration requirement, and

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    no earlier EOD is possible due to the period of SGA.

b. Title XVI case processing

Follow instructions in DI 13010.110C for when to reopen the allowance and revise to a denial. Document the reopening in a report of contact and prepare the revised determination (N33 SGA denial) via EDCS reactivation/FO-determination or a paper form SSA-831 (Disability Determination and Transmittal).

For EDCS instructions on using the FO denial function in SGA determinations, see DI 81010.140C. For updating payment status, see DI 11010.350C.1.d in this section.

E. Remedying improper payments to non-claimants

1. Attorney or non-attorney representative fee paid in erroneous award situation

Complete a report of contact in the Registration, Appointment, and Services for Representatives (RASR) system to document the claim effectuation error and amount of the erroneous fee payment. For instructions on when to pursue recovery of excess fees paid to authorized representatives or entities, see GN 03920.052.

2. Payment erroneously sent to an incorrect account or individual

Improper payments include misdirected erroneous payments and incorrect direct deposits due to keying mistakes or other errors. An incorrect direct deposit payment is an electronic fund transfer (EFT) to an incorrect bank account when the account owner:

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    spends the funds and the occurrence is deemed a legally defined overpayment (LDO) based on LDO criteria in GN 02201.001, or

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    is not entitled to payments and has neither a claim record nor connection to the claimant's record.

Upon discovering the nonreceipt issue in an erroneous award case:

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    For Title XVI cases, input an F-stop. Enter a special message on the SSI record to document the reason for the stop-payment.

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    For Title II cases, send a priority MDW to the PC to evaluate for possible stop-payment and recovery action. The MDW must include remarks explaining the situation (for example, “erroneously effectuated DIB award and misdirected check; F-stop required on payment issued mm/dd/yyyy”).

For F-stop instructions, see GN 02408.020. For identifying erroneous award cases and suspending payments when the claimant received the erroneous award notice, but did not receive a payment, see instructions in DI 11010.350B in this section.

NOTE: 

If the payment is not returned through automated processes, the PC may complete stop-payment actions using Title II post-entitlement data inputs or may establish a non-entitled debtor (NED) record using the Debt Management System (DMS). For more information on recovery of misrouted payments, see sections in GN 02408.000.

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DI 11010.350 - Corrective Actions on Erroneous Awards and Improper Payments in Disability Claims - 12/16/2025
Batch run: 12/16/2025
Rev:12/16/2025