20 CFR 404.1112

SSR 66-16c

SILVERMAN v. CELEBREZZE, U.S.D.C., S.D. N.Y., 63 CIV. 975 (8/3/65)

Where a worker died while an occupant of a nursing home; and where the evidence established that the worker's convalescence in the nursing home was not the prime reason for the divided marital abode, but rather a willing severance of the marital abode due to a generally inharmonious relationship, held, the surviving widow as not "living in the same household" with the worker at the time of his death; and, therefore, the lump-sum death payment cannot be awarded to her on the basis of relationship.

CANNELIA, J., District Judge:

* * * * * * *

The plaintiff * * * instituted this action in accordance with the provisions of 42 U.S.C.A. § 405(g). She seeks reversal of that part of the administrative decision below disallowing her claim for the lump sum benefit applied for as widow of a deceased wage earner under 42 U.S.C.A. § 402(i). Plaintiff had filed the § 402(i) application following the death of her husband on October 10, 1660.[1] On December 13, 1960, plaintiff was awarded the lump sum death benefit in the amount of $201.00.[2]

Subsequently, * * * the deceased wage earner's son by a previous marriage, filed a similar application for the lump sum death benefit asserting a right as a person equitably entitled under the statute. Following the receipt of the application with supporting evidence, the Social Security Administration altered its original decision. It determined that [the son] was entitled to the payment and on September 6, 1961, awarded him the amount of $160.29.

Having been notified of the decision to award the sum to her stepson and deduct the prior payment made to her form future benefits which she would receive, the plaintiff, on August 22, 1961 requested a hearing before the Social Security Administration. * * *

The hearing examiner found that the plaintiff was not a widow of the wage earner living in the same household with him at the time of his death within the meaning of § 402(i). In addition, he held that she was not a person equitably entitled to the benefits, either in her individual or representative capacity as administratrix of her late husband's estate. The examiner held that [the son] was barred from the award since he had paid part of the funeral expenses while under a contractual obligation to do so. 20 C.F.R. § 404.340(b)(2).

On review by the Appeals Council of the Social Security Administration, the hearing examiner's decision as to both parties was reversed in part. As far as the plaintiff was concerned, the Appeals Council affirmed that part of the decision holding that she was not a widow entitled to an award under § 402(i), i.e., she was not living in the same household with the decedent at the time of his death. They held, however, that a payment of $75.00, made toward the funeral expenses by a fraternal order, was a payment made by the estate. The plaintiff, in her capacity as administratrix of the estate, was thus awarded $75.00. The Council also held that 20 C.F.R. § 404.340(b)(2) was not intended to foreclose recovery by someone in [the son's] position and decided he too was entitled to an award. The maximum benefit of $201.00 was thus divided between the plaintiff, as administratrix, and her stepson. The decision of the Appeals Council constituted a final decision of the Secretary subject to review in this court pursuant to 42 U.S.C.A. § 405(g)

The findings of fact made by the Secretary are conclusive, if supported by substantial evidence, and are binding on this court's review of the administrative decision. 42 U.S.C.A. § 405(g); Shapiro v. Ribicoff, 316 F.2d 262, 264 (2d Cir. 1964); * * *. The plaintiff has challenged two ultimate conclusions on the ground that they are not supported by substantial evidence. The Secretary concluded that the plaintiff's claim as a widow was not proper under § 402(i) and in addition held that the plaintiff was not equitably entitled to payment beyond the $75.00 awarded. This court must therefore screen the record to determine if the conclusions reached, in light of the statutory language, are supported by substantial evidence. The quest must of necessity begin with discovery of the applicable rules of law.

Initially the discussion must concern the plaintiff's claim as widow, for if the Secretary's conclusion cannot be upheld, the question of whether anyone is "equitably entitled" to the benefits would become moot. See 42 U.S.C.A. § 402(i). Prior to the adoption of the Social Security Amendments of 1958, Section 402(i) provided that a widow was entitled to the lump sum death payment if she was ". . . living with the deceased at the time of death." To implement and clarify this section, § 416(h)(3) set forth the definition to be applied to determine if the widow was "living with" her spouse at time of death. It presented an alternate, three-fold approach. A widow was "living with" her spouse if they were both members of the same household, or if she was receiving support from him or if he had been ordered by a court to contribute to her support. * * *.

The 1958 amendment repealed § 416(h)(3) (see Pub.L. 85-840, § 305(b); 1958 U.S. Cong. & Ad. News at pg. 1214) and later the corresponding regulation, 20 C.F.R. § 1111, was deleted. 27 F.R. 10679 (November 2, 1962). In addition, § 402(i) was amended by the insertion of the words, "in the same household" after "living" in line six of the section. The question which must obviously be answered is whether the amendments to the statute worked any substantive change in the law. In this context, the legislative history is quite enlightening. The summary of provisions of the 1958 bill (1958 U.S. Cong. & Ad. News at pg. 4224) states that "[A] lump sum would be paid to the widow of a deceased worker only if she was living in the same household with him or has paid his burial expenses" (Emphasis supplied). An explanation of then applicable law and the changes which would be made by the amendment can be found further on in Senate Report at 1958 U.S. Cong. & Ad. News at pg. 4238, where the following statement is made:

* * * The committee-approved bill, like the House bill, would change the requirement to one that the spouse must have been living in the same household with the worker. Since the purpose of the lump-sum death payment is to help with the expenses incidental to the death of the worker, it is appropriate for the payment to be made only to the spouse who is actually living in the same household with the worker since it can be assumed that she will take responsibility for those expenses. * * * The spouse who is not living in the same household with the worker may receive the lump-sum death payment if she actually did pay the worker's burial expenses. (Emphasis supplied).

Congress obviously intended a change in the standard to be applied on application of a widow for the lump sum death payment. The precise inquiry must be thus directed to whether the plaintiff was "living in the same household" with her husband at the time of his death. 20 C.F.R. § 404.1112(a) contains the regulation defining the concept of "living in the same household." It provides that:

A husband and wife were "living in the same household" if they customarily lived together as husband and wife in the same place of abode. The temporary absence of one spouse from such place of abode does not preclude a finding that they were "living in the same household."[3]

The evidence adduced before the Secretary is clearly substantial to support the conclusion that the plaintiff and her husband had not "customarily lived together as husband and wife in the same place of abode", viewed as of the time of death. The record abounds with reference to the various dwellings in which the plaintiff and the decedent resided, for the most part separated from each other, prior to the summer of 1960. It is undisputed that the husband died in a nursing home and had been living apart from the plaintiff for a period of time before his demise. The plaintiff places reliance on 20 C.F.R. § 404.1112(b)(2) and argues that the confinement of the decedent in the nursing home was a temporary absence within the meaning of the regulations. But reliance is valid only if the separation of the couple was necessitated by decent's illness, not if the evidence relative to this point indicates a general inharmonious relationship manifested by a willing severance of the marital abode. The evidence before the administrative agency, viewed in light of the substantial evidence test, is perfectly adequate to support a conclusion that the decedent's convalescence in the nursing home was not the prime reason for the divided marital abode. It is clear, in addition, that the Secretary chose to disregard the plaintiff's claim that when the decedent recovered, he would return to the marital abode, a conclusion the Secretary was entitled to make. * * *. Insofar as this first point is concerned, there is substantial evidence in the record to support the conclusion that the plaintiff was not a widow "living in the same household" at the time of the decedent's death.

The court now reaches the plaintiff's alternate contention that even if she is held not to occupy the status of an entitled widow, she is equitably entitled to the benefit within the meaning of § 402(i). The initial point to reference must concern the payor of the expenses and the plaintiff's capacity in bringing the § 405(g) action. Considering the latter, plaintiff has brought suit in this court in her individual capacity and cannot be heard to assert claims she could allege as administratrix of the estate. In addition, the expenses were paid by [the son] out of the proceeds of the bank account awarded to him by the stipulation made in the Surrogate's Court. The account appears clearly to have been a Totten Trust, the proceeds of which vested in [the son] upon the death of his father. See Matter of Totten, 179 N.Y. (1904). The expenses were thus not paid out of estate funds and the plaintiff is not entitled to the lump sum benefit even could she claim as administratrix.

Plaintiff's motion for summary judgment is denied. The defendant's motion for judgment on the pleadings, treated as one for summary judgement, is granted.

[1] The application was filed on November 11, 1960.

[2] The maximum amount of the benefit is determined by taking an amount equal to three times the decedent's primary insurance amount or $255 whichever is smaller. 42 U.S.C.A. § 402(i).

[3] 20 C.F.R. § 404.1112(b) delineates the events constituting temporary absence and (c) notes the effect of any other absence on fulfillment of the statutory condition.

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