When multiple claimants are involved on different claims and multiple errors are involved
affecting multiple claimants, consider the initial determinations on each claim as
separate and independent determinations and apply administrative finality to each
determination separately.
EXAMPLE – Multiple Claimants Involved on Different Claims Involving Different Benefits
The father of two children is entitled to Retirement benefits effective 03/2001. The
initial award notice was sent 03/13/2001 to both the NH and the two children. His wife is entitled to disability benefits and
also receives Workers’ Compensation. She has been entitled to disability since 02/2000.
Her initial disability award notice was sent 02/22/2000 to her and her two children. Both of the children have simultaneous entitlement on
both records. Currently, they are being paid on the father’s record since he has a
higher PIA.
In 10/2005, an AERO is received on the father’s record and it becomes apparent that
his retirement benefit was figured incorrectly because his military service for 1957-1960
was not included in his initial entitlement even though it was in file at the time
of the initial determination in 03/2001. He has been being underpaid since 03/2001.
In 11/2005, new worker’s compensation information is received on the wife’s disability
benefit going back to the date she became entitled to disability, 02/2000. There was
a change in her WC amount in every month since 02/2000, the date she became entitled
to disability. She has been receiving too much Social Security disability benefits
because her offset was computed incorrectly and to her favor. In summary:
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Father’s retirement benefit was too low from 03/2001 until 10/2005
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•
Mother’s disability benefit was too high from 02/2000 until 11/2005
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•
Children’s benefits paid on the mother’s disability benefits were too high from 02/2000
until 02/2001 (father retirement benefit is higher than wife’s disability)
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•
Children’s benefits paid on the father’s retirement were too low from 03/2001 until
10/2005
In 11/2005, these errors were discovered when reviewing the case in the PSC. Since
the errors on the father’s record were obvious and it is absolutely clear that the
determination was incorrect, this is an example of an error on the face of the evidence
(GN 04010.020). Determinations may be reopened within 4 years of the date of the initial determination
if that determination was favorable to the claimant or at any time if it was unfavorable
to the claimant.
Because the mother’s Workers’ Compensation has changed, we can make a new initial
determination to her benefit with each change in the amount of her Workers’ Compensation
amount (see GN 04030.080B.1.).
Since the initial determinations of the Disability, Retirement and Child’s benefits
are separate initial determinations to different benefits, consider each of these
initial determinations to Disability, Retirement and Child’s benefits to be independent
determinations. Apply administrative finality separately to each claim based on the
date of their initial determination notice.
In this case, the wife’s Disability determination can be recomputed because there
were changes in the WC amount (GN
04030.080B.1.).
The father’s RIB determination could be revised because correction would be favorable.
As a result, the claimant’s RIB claim should be corrected beginning 03/2001 and an
increase is due for the children on his record as well, effective 03/2001.
Since there was a change in the WC amount in every month, the wife’s disability benefit
can be adjusted going back to the month the amount first changed as well as the children’s
benefits since there were changes in the WC after the date of the initial determination
of entitlement to auxiliary benefits. We can make a new initial determination and
impose offset against the auxiliaries using the full amount of the WC effective with
the date of the change (see GN 04030.080B.6.). Since the children are also entitled on their father’s retirement record and revising
his and their records would be favorable to them, the children’s benefits on their
father’s record can be reopened and revised.