TN 4 (09-90)

A. Policy Principle - General

An adverse claim is one which, if sustained,would nullify the entitlement for the same month(s) of an earlier claimant to whom an award has been made. (See GN 01010.100 - GN 01010.140) If the entitlement of the prior claimant is defeated by the new claim for even one month, the claims are adverse. The determination which is to be reopened is the one which gave rise to the entitlement of the earlier claimant, regardless of how long ago it might have been made. Where the entitlement of the prior claimant ended before the first month of entitlement of the subsequent beneficiary, the claims are not adverse within the rules of administrative finality.

B. Policy Principle - Claimant Awarded on Wrong E/R

Where an award was approved to a claimant on the wrong E/R, a claim by the correct SSN holder is not an adverse claim. When this happens, see if the first claimant's award on the incorrect E/R can be reopened under the rules of administrative finality (see GN 04001.010). If it cannot be reopened, transfer the award to his/her correct SSN. Payment should be continued on his/her correct SSN using the rates established on the incorrect E/R. If the first claimant's correct E/R gives a higher benefit than the incorrect E/R,consider doing a recalculation on the correct E/R (see GN 04030.050E.). If an error on the face of the evidence caused payments to the first claimant to be made on the wrong E/R, the recalculation will be effective with his/her first MOE. (Since error on the face of the evidence applies to individuals, not to E/R's, we can determine the MOE to a recalculation on the correct E/R based on whether there was an error on the face on the incorrect E/R, i.e.,the same individual is involved on both E/R's). Otherwise, it will be effective the month we discovered the error.

C. Policy Principle - Adverse Adjustment

The rules of administrative finality do not apply to cases where the entitlement of a new beneficiary necessitates a downward adjustment in the benefit rates of beneficiaries already on the rolls. This is because such cases do not involve the reopening of a prior determination or decision; what is involved rather, is a new initial determination effective with the first month of entitlement of the new beneficiary. However, for the notice requirements before such reduction may be effectuated see GN 03001.005.