In reviewing cases, SSA technicians may discover multiple erroneous initial determinations involving several factors. Often, one of these erroneous determinations is favorable to a SSA claimant while another determination is unfavorable to the claimant. In all situations, it is important to separate all initial determinations and review the dates of the initial determination notice(s) independently to determine if reopening is possible. Decisions to reopen and revise claims should be documented electronically, if possible. These decisions should contain a detailed explanation of the actions taken and the reasons for reopening or not reopening a determination. For additional information see GN 04001.080 – Documenting the Rationale for Reopening.

When multiple errors for one claimant are discovered, apply the rules of administrative finality based on the initial determination made and the date(s) of the initial determination notice. Make sure to look at each initial determination separately by analyzing the dates of the notice of the initial determination. A final determination which is unfavorable to the claimant may be reopened at anytime when it is based on error on the face of the evidence. Some determinations have a dual effect. When multiple errors are involved in one single initial determination and the result of reopening may have a dual effect, reopen these cases only when the net effect of the reopening would be favorable to the claimant (see GN 04020.080).

EXAMPLE – Multiple errors in a single initial determination

NH was entitled to retirement benefits in 01/1999. Their initial award notice was dated 02/17/1999. In 02/2005, the NH brought in proof of their 1998 earnings which they stated had never been included in their annual Social Security Statement. We located their 1998 earnings in the suspense file. The NH also asked if we had included their 1959-1962 military service when we computed their benefit. In reviewing their record, we found that the military service evidence for 1959-62 was in file in 1999 but was not used to calculate their benefit. We also discovered that the NH should have been entitled to benefits one month earlier because a protective filing date was on record but had not been used.

To summarize, the following errors were discovered on the NH’s retirement claim after 4 years from the date of initial award:

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  Military service not used for 1959-1962 resulting in a lesser PIA

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  Error on earnings record for year – 1998 resulting in a lesser PIA

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  Date of entitlement error resulting in a higher MBA

After reviewing the errors in this case it is determined that the following consequences would take place if all of the errors were corrected:

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  adding the military service for the years 1959-1962 would increase the PIA by $36.00

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  correcting the 1998 earnings would increase the PIA by $5.00

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  correcting the date of entitlement would decrease the MBA by $25.00

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  An underpayment for the additional month of entitlement

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  The difference in ongoing rates through the current month

Since the single initial determination made on 02/17/1999 encompassed all of these erroneous determinations of fact (see GN 04001.030B.3.) and because the net effect of making all of these changes will result in an ongoing monthly increase of $16.00, the 02/1999 determination could be reopened and revised.

REMEMBER: When determining whether the overall net effect is favorable to the beneficiary, it is important to consider all consequences of reopening and revising the record (i.e., retroactive overpayments and underpayment accrued, entitlement to Medicare coverage, overall retroactive underpayment amount compared to the ongoing rate decrease, etc.).

A notice needs to be sent to the beneficiary explaining what actions we reopened and revised as well as the reasons. This notice should contain appeal rights.

When multiple errors for one claimant are discovered in multiple, different initial determinations, apply the rules of administrative finality individually to each separate determination based on the initial determination made and the date(s) of the initial determination notice. Make sure to look at each initial determination separately by analyzing the dates of the notice of the initial determination(s).

EXAMPLE – Multiple determinations involving Disability

NH was initially entitled to Disability in 01/1995. Their initial determination notice was sent 01/15/1995. The amount of their benefit was initially calculated incorrectly because of a mathematical error in the computation. Their PIA was higher than it should have been (error was favorable to NH). In 02/1999, the NH began to receive Workers Compensation (WC) and their benefit was recalculated to include WC offset. We sent them their initial determination notice 02/17/1999. In 02/1999 we figured their benefit amount and the PIA correctly. In 04/2001 their claim was reviewed and the amount of their benefit was refigured incorrectly using the same exact WC information. This change was an error made in the calculation of their WC offset. We applied too much offset (error was unfavorable to NH). An initial determination notice was sent 04/24/2001. On 06/25/2006 and as part of the regular review of claims involving WC, all of this information was reviewed and an affirmative action in writing was established explaining the errors.

After reviewing the errors in this case it is determined that the following consequences would take place if the errors were corrected:

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  Monthly PIA decrease of $13.00 (not including COLAs) from 01/1995 to 01/1999

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  No change from 02/1999 to 03/2001 since benefit amount and PIA were calculated correctly

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  Monthly PIA increase of $22.00 (not including COLAs) from 04/2001 to 06/2006

The erroneous determination of 01/15/1995 cannot be reopened and revised since the error was initially favorable and we didn’t discover the error within 4 years. The only error we can reopen and revise in this case, would be the 04/24/2001 determination since we applied too much offset. Each determination should be reviewed separately based on the date of the initial determination notice to see if reopening is appropriate.

When multiple claims (Retirement, Spouse’s, Child’s, Widow(er)’s, Mother’s/Father’s, Parent’s, Disability, and LSDP) are being reviewed and multiple errors are involved, consider the initial determinations on each claim separately and apply administrative finality to each initial determination.

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

Pat, a parent of two children, is entitled to Retirement benefits effective 03/2001. The initial award notice was sent 03/13/2001 to both Pat and the two children. Pat's spouse is entitled to disability benefits and also receives Workers’ Compensation. The spouse has been entitled to disability since 02/2000. The spouse's initial disability award notice was sent 02/22/2000 to the spouse and the two children. Both of the children have simultaneous entitlement on both records. Currently, they are being paid on Pat’s record since Pat has a higher PIA.

In 10/2005, an AERO is received on Pat’s record and it becomes apparent that Pat's retirement benefit was figured incorrectly because their military service for 1957-1960 was not included in their initial entitlement even though it was in file at the time of the initial determination in 03/2001. Pat has been being underpaid since 03/2001.

In 11/2005, new worker’s compensation information is received on the spouse’s disability benefit going back to the date they became entitled to disability, 02/2000. There was a change in the spouse's WC amount in every month since 02/2000, the date they became entitled to disability. The spouse has been receiving too much Social Security disability benefits because their offset was computed incorrectly and to their favor. In summary:

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  Pat’s retirement benefit was too low from 03/2001 until 10/2005

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  Spouse’s disability benefit was too high from 02/2000 until 11/2005

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  Children’s benefits paid on the spouse’s disability benefits were too high from 02/2000 until 02/2001 (Pat's retirement benefit is higher than spouse’s disability)

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  Children’s benefits paid on Pat’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 Pat’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 spouse’s Workers’ Compensation has changed, we can make a new initial determination to the spouse's benefit with each change in the amount of the spouse's 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 spouse’s Disability determination can be recomputed because there were changes in the WC amount (GN 04030.080B.1.).

Pat’s RIB determination could be revised because correction would be favorable. As a result, Pat’s RIB claim should be corrected beginning 03/2001 and an increase is due for the children on Pat's record as well, effective 03/2001.

Since there was a change in the WC amount in every month, the spouse’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 Pat’s retirement record and revising Pat's and their records would be favorable to them, the children’s benefits on Pat’s record can be reopened and revised.

When more than one claimant is entitled on the same record and multiple errors are involved, consider and review the dates of the initial determination notices separately on each initial determination in deciding whether to reopen.

RS 00615.000 – Computation of Monthly Benefits Amounts

RS 00615.010 – Chart on Reduced Benefits

GN 00204.025 – Open Applications

DI 52101.001 – WC/PDB Policies and Procedures