TN 1 (07-87)

A. General

1. Survivor Entitled to Monthly Benefits

The Social Security Act governs whether an individual meets the requirements of relationship. Accordingly, a survivor who has been awarded monthly social security or railroad retirement benefits as the spouse, child, or parent of the deceased will be deemed to have this status for Medicare purposes.

2. When Relationship is in Question

When a claimant's allegation of relationship is challenged by evidence to the contrary, the DO should apply the definitions of relationship which are briefly outlined in the following sections. If documentation is necessary, follow the instructions for development in the appropriate POMS section.

3. Factors to Consider After Relationship is Determined

The DO should bear in mind that each degree of relationship—spouse, child, parent—appears twice in the priority listing in GN 02335.025 A.2. Therefore, the individual who meets the definition may be either high or low on the list. The factor (aside from his relationship to the deceased) which controls his position in the priorities in most instances is whether or not he was entitled to monthly benefits on the same earnings record as the deceased beneficiary.

The phrase “on the same earnings record” does not necessarily mean the earnings record of the beneficiary. A female beneficiary may not have had an earnings record, but have been entitled to monthly benefits on her husband's earnings record. Thus, both parties are entitled on the same earnings record and her husband will qualify in priority number 1 (GN 02335.025 A.2.) above.

B. Surviving Spouse

1. Definition

Aside from the question of entitlement to monthly benefits, a person who was living with the deceased as husband or wife in the month of her or his death will be presumed to be the spouse of the deceased in the absence of clear and strong evidence to the contrary.

A person who was living with the beneficiary will qualify as a surviving spouse in priority number 1 (GN 02335.025 A.2.), if he or she:

1. Was validly married to the beneficiary at the time of his death (GN 00305.035).

2. Would be considered to have the status of widow or widower with respect to the taking of intestate personal property by the courts of the State in which the deceased lived at the time of his death; or

3. Married the beneficiary in good faith but the marriage was invalid because of a legal impediment not known to the claimant at the time of the marriage provided the claimant was living in the same household with the beneficiary at the time of the beneficiary's death (GN 00305.170).

2. Living in the Same Household

A couple will be considered to be living together as husband and wife in the month of the beneficiary's death even though they were actually separated at the time of death if their separation was caused solely by the illness of either, or by other circumstances beyond their control. If the spouse was not living in the same household with the beneficiary at the time of his death, record on a report of contact the length of, and the reason(s) for, the separation. If the separation lasted more than 6 months, sufficient information should be obtained about the circumstances to permit a determination as to whether there was an intent to resume living together in the same household. If such intent can reasonably be found, payment may be made to the surviving spouse. For complete instructions on living in the same household see RS 00210.020.

An individual who was neither living in the same household with the decedent at the time he died, nor entitled to monthly benefits on the same earnings record will qualify as a surviving spouse in priority number 4 if he or she otherwise meets the relationship requirements.

C. Child

The principles governing parent-child relationships are found in GN 00306.000ff. The term “child” generally means:

1. A person who would have the right under applicable State law to inherit intestate personal property from the beneficiary as his natural legitimate child, or

2. A person who was legally adopted by the beneficiary, or

3. A person who is the beneficiary's stepchild.

In addition to the above, the following individual's may also qualify as “children” of a beneficiary:

4. A child of an invalid ceremonial marriage which would have been a valid marriage except for a legal impediment;

5. An illegitimate child who has inheritance rights in the deceased beneficiary's estate, or an illegitimate child who does not have such rights but, prior to the beneficiary's death:

   1. Was acknowledged in writing by the beneficiary to be his son or daughter, or

   2. Was decreed by a court to be the beneficiary's child, or

   3. The beneficiary was ordered by a court to contribute to such child's support, or

   4. The deceased beneficiary is shown to be the father of such child by other evidence and was living with or contributing to the child's support at the time of his death;

6. A child who retains inheritance rights in the beneficiary's estate even though adopted by another person during the beneficiary's lifetime;

7. An equitably adopted child.

D. Definition of Parent

A person will qualify as a parent of the deceased beneficiary if he or she:

1. Would have the status of parent with respect to the taking of intestate personal property under the law of the State in which the beneficiary lived at the time of his death, or

2. Is a stepparent of the beneficiary, or

3. Is an adoptive parent. (See GN 00306.000ff.)