I-3-9-60.Reopening at Any Time

A. Title II Cases

As set forth in 20 CFR 404.988(c), the Appeals Council (AC) may reopen a determination or decision that is otherwise final at any time in the following circumstances:

• The determination or decision was obtained by fraud or similar fault (see Hearings, Appeals and Litigation Law (HALLEX) manual I-3-10-7);

• Another person files a claim on the same earnings record and allowance of that claim adversely affects the earlier claim;

• A person previously determined to be dead and on whose earnings record entitlement is based, is later found to be alive;

• The claim was denied because the claimant could not prove that the wage earner died and death is later established by a presumption of death under 20 CFR 404.721(b) or by location or identification of his or her body;

• The Railroad Retirement Board has awarded duplicate benefits on the same earnings record;

• The determination or decision 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;

• The determination or decision 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 same period of service for which the wage credits were granted;

• 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 under the conditions described in 20 CFR 404.988(c)(7);

• The determination or decision is fully or partially unfavorable to a party, but only to correct a clerical error or an error that appears on the face of the evidence that was considered when the determination or decision was made;

• A 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;

• A 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, if the claimant was subject to the juvenile justice system, the claimant 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;

• The determination or decision 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;

• The determination or decision 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;

• The determination or decision 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 determination or decision is incorrect because 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 Cases

As set forth in 20 CFR 416.1488(c), the AC may reopen a determination or decision that is otherwise final, at any time when such determination or decision was obtained by fraud or similar fault. See HALLEX I-3-10-7.