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Social Security Administration Provides Policy Interpretation Ruling for Reopening a Determination or Decision

Earlier this year, the Social Security Administration issued a Policy Interpretation Ruling for claimants seeking reconsideration of a decision made in the review process. The agency specifically addressed how the federal regulations for reopening a claim should be used when a decision hinges on a federal law that is later determined to be unconstitutional. The need for this Policy Interpretation came about following two Supreme Court decisions, Defense of Marriage Act in United States v. Windsor, 133 S. Ct. 2675 (2013) and Obergefell v. Hodges, 135 S. Ct. 2584 (2015). It may have an impact on Massachusetts Social Security claimants.

The two main programs of the Social Security Administration (SSA) are Title II and Title XVI. Title II benefits are ones from the Social Security Disability Insurance program, paid to individuals insured under the Social Security Act based on their payments into the system through the tax on their earnings. These payments can also be made to a particular set of disabled dependents. Title XVI benefits are better known as SSI, or Supplemental Security Income, and they are paid to disabled people who have limited income and resources. Loving FamilyMuch of the focus on whether an individual qualifies for Social Security benefits centers around whether or not she or he meets the medical criteria to be considered disabled. However, a claimant must also fall into the categories set by the SSA. The two Supreme Court cases above allow a greater amount of individuals to qualify as a disabled widow or widower, or as a dependent of a deceased insured parent.

Normally, if the claimant objects to the decision or determination of the agency, she or he can lose the right to another review if the appeal is not made within the listed time period. The decision or determination is then final. Exceptions to finality exist, and cases may be reopened under limited circumstances. The cases can be reopened for “good cause” at the agency’s initiative or by request of the party for revision. Agency regulations guide the grounds for reopening and whether or not there are deadlines to follow.

The agency acknowledged there are no regulations for situations when a claimant wants to reopen based on an “error on the face of the evidence.” A legal mistake can be considered an error on the face of the evidence, but agency regulations prevent the reopening of a previous determination or decision based on a change of administrative ruling or legal interpretation. The SSA’s long-standing reasoning for refusing to reopen decisions or determinations in this scenario is that they consider the legal interpretation was correct and reasonable when made.

This policy interpretation differentiates a decision from the Supreme Court that finds a law unconstitutional from a change of administrative ruling or legal interpretation. The SSA allows a claim to be reopened if the agency considers this to be a material change in the law that affects the claimant’s entitlement to Title II benefits, eligibility for Title XVI benefits, or the amount of either Title II or Title XVI payments. When the Supreme Court determines a law is unconstitutional, the law or policy that was applied by the SSA is no longer seen as correct or reasonable. Therefore, the SSA will allow these reconsiderations if a Title II claim is within four years of the notice of determination, and there is good cause; if the determination or decision for Title II benefits was fully or partially unfavorable; or for good cause within two years of the initial determination for Title XVI claims.

Receiving Social Security benefits can radically change the lives of a Massachusetts family. The process for a claim is often long and arduous. If you are applying for benefits or have been denied, the Massachusetts Social Security attorneys at Karsner & Meehan can help you with your claim. Call our office today at 508-822-6600.

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