I-3-9-6.Reopening at Any Time

Last Update: 9/08/05 (Transmittal I-3-36)

Citations:

A. Title II

Under the regulations cited above, the Appeals Council may reopen a determination or decision, which is otherwise final, at any time if:

  1. the determination or decision was obtained by fraud or similar fault; or

  2. another person files a claim on the same earnings record and allowance of that claim adversely affects the earlier claim; or

  3. a person previously determined to be dead and on whose earnings record entitlement is based, is later found to be alive; or

  4. the claim was denied because the claimant could not prove that the wage earner died and death is later established by reason of an unexplained absence from his or her residence for a period of 7 years; or

  5. the Railroad Retirement Board has awarded duplicate benefits on the same earnings record; or

  6. the determination or decision either:

    • denies the person on whose earnings record the claim is based gratuitous wage credits for military or naval service because another Federal agency (other than the Department of Veterans Affairs) has erroneously certified that it has awarded benefits based on the service; or

    • credits the earnings record of the person on which the claim is based with gratuitous wage credits and another Federal agency (other than the Department of Veterans Affairs) certifies that it has awarded benefits based on the period of service for which the wage credits were granted; or

  7. the claimant was denied for lack of insured status, but earnings for the appropriate period of time were later credited to the claimant's earnings record; or

  8. the determination or decision is fully or partially unfavorable, but only to correct a clerical error or an error that appears on the face of the evidence (see I-3-9-4 above); or

  9. the claimant is found entitled to monthly benefits or to a lump-sum death payment based on the earnings of a deceased person and it is later established that:

    • the claimant was convicted of a felony or an act in the nature of a felony for intentionally causing the deceased person's death; or

    • the claimant was subject to the juvenile justice system, and was found by a court of competent jurisdiction to have intentionally caused the person's death by committing an act which, if committed by an adult, would have been considered a felony or an act in the nature of a felony; or

  10. the determination or decision either:

    • denies the person on whose earnings record the claim is based deemed wages for internment during World War II because of an erroneous finding that a benefit based upon the internment has been determined by an agency of the United States to be payable under another Federal law or under a system established by that agency; or

    • awards the person on whose earnings record the claim is based deemed wages for internment during World War II and a benefit based upon the internment is determined by an agency of the United States to be payable under another Federal law or under a system established by that agency; or

  11. the determination is incorrect because:

    • the claimant was convicted of a crime that affected his or her right to receive benefits or his or her entitlement to a period of disability; or

    • the claimant's conviction of a crime that affected his or her right to receive benefits or his or her entitlement to a period of disability is overturned.

B. Title XVI

The Appeals Council may reopen a determination or decision which is otherwise final, at any time when such determination or decision was obtained by fraud or similar fault.