TN 71 (11-08)

A. Definition

An open application is one for which all classes of benefits covered by the scope of the application (as defined in GN 00204.020) have not been adjudicated. For example, effective with the 2/78 or later versions, the SSA-8-F4 (Application for Lump Sum Death Payment) (LSDP) is limited to benefits on the deceased NH's record. Since retirement and disability benefits on the claimant's own SSN are not within the scope of the LSDP application, there is no open application and no need to adjudicate these benefits.

Class of benefits under title II refers to retirement, spouse’s (including divorced spouse), child’s, widow(er)’s, mother’s/father’s, parent’s, and disability benefits as well as the LSDP.

B. Policy

1. General

1. Adjudication of a claim for one class of benefits is not an adjudication of another class of benefits on that earnings record (E/R), nor is it an adjudication of benefits on another E/R. See GN 00204.026 for situations where open applications should not be pursued.

2. Applications filed before 7/30/65 cannot be open applications, unless the claimant met the entitlement requirements within 3 months of the filing date.

3. As noted in GN 00204.020 and SI 00601.035B., a Title XVI application is an application for Title II benefits (not a lead; not a protective filing but an application) and may be open for any class of Title II benefits. (See GN 00204.027 for additional instructions.)

4. An open application is valid only for classes of benefits or conditions of entitlement in the law when the earlier application was actually filed (e.g., an application filed in 1966 cannot be open for disabled widow’s benefits (DWB) which did not exist until 1968). See the chart in GN 00204.025C. to determine what classes of benefits existed at the time of the application.

5. The month of entitlement (MOET) for an open application filed before the first month of eligibility is the first month all eligibility requirements are met.

6. If SSI is not involved, the claimant may elect to receive the full amount of retroactivity available. If SSI is involved and eligibility will continue regardless of the choice, the claimant must elect the full available retroactivity per SI 00510.005B. See GN 00204.030 for the rules on retroactivity; see SI 00601.035 when an SSI claimant does not elect full retroactivity.

7. If an earlier application is open and the claimant was eligible for a class of benefits based on that application and a new application is filed covering the same class of benefits, the claimant may elect either the month of:

   • the open application (including any month(s) in the retroactive period of the open application) if eligibility existed in that month, or

   • first eligibility based on the open application (if later), or

   • the current application (or any earlier month in the current application’s retroactive life) provided SSI is not involved. If SSI is involved, the claimant must elect the earliest month that benefits are payable. (See SI 00510.005B for the SSI policy on filing for other benefits).

2. Blanket adjudication paragraphs

a. General

Both Title II and XVI have blanket paragraphs that are included in award, and denial/disallowance notices to advise claimants that they are not entitled to any other benefits. These paragraphs adjudicate all benefits covered by the scope of the application and, therefore, constitute an initial determination (with full appeal rights) that the claimant is not entitled to such benefits. The determination is subject to reopening under the rules of administrative finality.

b. Title II Claims

Beginning 02/01/79, award, disallowance, and denial notice include a blanket adjudication paragraph, which adjudicates all classes of benefits within the scope of the application. Therefore, assume claims adjudicated before 2/79 are open for other classes of Title II benefits absent evidence to the contrary (e.g., the record shows the claimant had previously received a notice containing a blanket paragraph) or if one of the exceptions in GN 00204.026 applies. Assume any Title II applications adjudicated after 01/79 are not open. (See GN 00204.025B.4. to determine if reopening is applicable under the rules of administrative finality).

For manual notices, add the appropriate paragraph per NL 00601.160.

NOTE: Whenever a prior application will allow the claimant earlier eligibility to a class of benefits than that afforded on a current application, always be alert to the possibility of an open application.

c. Title XVI claims

The blanket paragraph included in Title XVI notices adjudicates all classes of Title II benefits. No blanket paragraph existed prior to October 1986. From October 1986 through May 1994, a blanket paragraph was added to the notice by entering CLST in the first position of the SSR CG field. Beginning June 1994, the CL field on the SSA-450SI replaced the CLST entry. For cases processed through MSSICS, a “No” response to the potential entitlement question on the BSSA screen generates the blanket paragraph. Both processes post an entry of “Y” in the C/O field on the SSI Display (SSID). However, because of coding problems with the “Y” indicator on the SSR, the “Y” indicator was found to be unreliable in 2002 as proof that Title II was properly adjudicated.

On November 17, 2007, four additional MSSICS screens were released to document the development of Title II entitlement. For initial claims events that are opened on or after November 17, 2007, the information from the new screens, BSRD, BSSW, BSCF, and/or BSCM, will be used to build a reliable closeout indicator to the SSR. Open initial claims events prior to November 17, 2007 will still have a BSSA screen and the information on that screen will be used to build the closeout indicator on the SSR.

See GN 00204.027 for the policy and procedures in place for adjudicating a Title II claim, which resulted from a Title XVI filing. Denial notices issued by the DDS also include the blanket adjudicative paragraph unless the FO advises the DDS (per DI 11055.130B) that a Title II claim is pending. For manual notices, add paragraph number 1598 (NL 00804.245).

d. Scope of blanket paragraph

The blanket paragraphs apply not only to the application being adjudicated, but also to any application filed earlier by the claimant. Thus, if the claimant files an application and the record shows the claimant had previously received a notice containing a blanket paragraph, there is no need to consider the possibility that a prior application is open. However, all benefits covered by the scope of the current application must still be adjudicated since it is a new application.

3. Termination notices

Various notices have been used in terminations of mother's/father's and young spouse's benefits when the youngest child attained age 18 and effective 9/81 the age was lowered from age 18 to age 16. Procedures required these notices to contain language informing the recipient to contact SSA upon attainment of age 62, or at 60 if a widow(er), or at age 50 if disabled and a widow(er). This language serves as a denial of aged widow(er), disabled widow(er) and retirement benefits.

The rationale used here is that, at the time of termination, the claimant is informed to contact SSA at retirement age, or if disabled, at age 50. This notice means that he/she does not meet the factors of entitlement for these benefits at this time.

The termination notice serves as a disallowance/denial of another type of benefit, thus effectively adjudicating the prior application and requiring a new application to establish entitlement. In adjudicating current claims, it should be assumed, absent evidence to the contrary, that procedures were properly followed. (See GN 00204.025B.4. to determine if reopening is applicable under the rules of administrative finality.)

4. Open applications and administrative finality

The rules in GN 00204.025 through GN 00204.027 provide guidelines for determining if a prior application has been adjudicated. If an individual’s application remains open for one or more classes of benefits, we have not made a new initial determination as to whether the individual qualified or is eligible for those benefits. therefore, the administrative finality and reopening rules do not apply because a final determination has not been made on the individual’s entitlement to other benefits or classes of benefits covered by that application. (The individual’s claim has not been adjudicated for the class of benefits and a new notice of initial determination has not been issued.) The rules of administrative finality apply only to an individual’s initial determination per GN 04001.030 Relationship Between Initial Determination and Administrative Finality. Likewise, if the claimant restricted the scope of his or her application, no determination was made with respect to other benefits or classes of benefits covered by that application. Therefore, if the scope was restricted, administrative finality and reopening rules may not be used later to establish eligibility to any benefits excluded from the scope of the application. However, if a blanket paragraph was erroneously added to a notice (i.e., it is subsequently determined that entitlement existed during the life of the application), consider whether the determination may be reopened under the rules of administrative finality per GN 04001.001 through GN 04001.140 or SI 04070.001 through SI 04070.080.

C. Procedure — benefit summary chart

As noted in GN 00204.025B.1.d., an application is only valid for classes of benefits or conditions of entitlement that existed at the time the application was filed. Use the following summary list to determine if entitlement for a particular class of benefits could have existed at the time of the application. If the application date is later than the date shown in the “Effective” column, entitlement could have existed. Conversely, if the application date is earlier than the date shown in the “Effective” column, entitlement could not have existed so there would not be an open application for that class of benefits.

NOTE: An expedited reinstatement (EXR) application is not a class of benefits or a condition of entitlement, thus it is not included in the Benefit Summary Chart.

D. Procedure — development

Adjudicators must be alert to those cases where an earlier MOET could be established if an application had been previously filed.

• Examine the current application, prior claims records/files (including SSI records).

• Retrieve the prior folder if necessary per existing procedures.

• Determine whether there is an open application.

• Document the current file indicating whether an open application exists. If so, include the date of the prior filing and state the filing date that is being used.

• Documentation of the use of an open application for Title II reduced benefits is not required when a Title XVI application is open and the Title II benefit is lower than the Title XVI payment at any point of possible Title II entitlement. (Documentation, however, should be made that the Title II benefit is lower than the Title XVI payment.)

E. References

• See NL 00601.160 for instructions pertaining to the Title II blanket paragraph.

• See NL 00804.245 for the blanket paragraph included in SSI notices