SSR 83-26a: SECTIONS 202(b) AND (g), 204(a) AND (b), AND 216(h)(1) (42 U.S.C. 402(b) AND (g), 404(a) AND (b), AND 416(h)(1) FINALITY OF DECISION -- REOPENING FOR FRAUD OR SIMILAR FAULT -- RECOVERY OF ERRONEOUS PAYMENTS
20 CFR 404.345, 404.506, 404.507, and 404.988(c)(1)
SSR 83-26a
- When the claimant applied for wife's insurance benefits on the worker's earnings record in October 1973, she alleged that they had been ceremonially married in October 1945. Her allegation was corroborated by the worker, and she was awarded wife's insurance benefits effective September 1973. When the worker died in December 1975, the claimant's wife insurance benefits were converted to mother's insurance benefits. The Social Security Administration (SSA) later learned that the claimant and the worker had not been ceremonially married. Except for a brief stay in Tennessee, they had always resided in Kentucky. Neither Kentucky nor Tennessee recognizes common-law marriages. Held, (1) the claimant was not the worker's wife or widow under section 216(h)(1) of the Social Security Act (the Act); (2) the determinations awarding the claimant wife's and mother's insurance benefits on the worker's earnings record were based on fraudulent statements and thus, under 20 CFR 404.988(c)(1), could be reopened at any time; (3) all of the benefits paid to the claimant as the worker's wife and widow constituted an overpayment; and (4) recovery of the overpayment could not be waived because the claimant was not "without fault."
The primary issue before the Appeals Council was whether the claimant had erroneously been found entitled to wife's and mother's insurance benefits on the worker's earnings record. This depended upon whether she had legal status as his wife or widow. Another issue before the Council was whether the determination awarding her benefits could be reopened because she had established her entitlement to wife's and mother's insurance benefits by means of fraud or similar fault. Also at issue was whether the claimant had been overpaid and, if so, whether recovery of the overpayment could be waived.
When the claimant applied for wife's insurance benefits on the worker's earnings record on October 29, 1973, she alleged that they had been married by a "clergyman or authorized public official" on October 7, 1945, in Georgia. Her allegation was corroborated by the worker on his application for disability insurance benefits. Because the claimant had minor children in her care who were entitled to children's insurance benefits on the worker's earnings record, she became entitled to benefits as the worker's wife effective September 1973. When the worker died on December 10, 1975, in Kentucky, the claimant's wife's insurance benefits were converted to mother's insurance benefits.
SSA later learned that the claimant and the worker had not been ceremonially married. When confronted with this information, the claimant signed a statement on June 11, 1980, admitting that she and the worker had not been ceremonially married in Georgia or anywhere else. In fact, she further indicated that she and the worker had never been to Georgia together.
For purposes of entitlement to wife's insurance benefits and mother's insurance benefits, subsections (b) and (g) of section 202 of the Act provide that an applicant must be the wife or widow of the insured individual within the meaning of section 216 of the Act.
Section 216(h)(1)(A) provides, in pertinent part, that --
- "An applicant is the wife . . . [or] widow . . . of an insured individual if the courts of the State in which such insured individual is domiciled at the time such applicant files an application, or, if such insured individual is dead, the courts of the State in which he was domiciled at the time of death, would find that such applicant and such insured individual were validly married at the time such applicant files such application or, if such insured individual is dead, at the time he died. If such courts would not find that such applicant and such insured individual were validly married at such time, such applicant shall, nevertheless be deemed to be the wife . . . [or] widow . . . of such insured individual if such applicant would, under the laws applied by such courts in determining the devolution of intestate personal property, have the same status with respect to the taking of such property as a wife or widow of such insured individual."
If an applicant is not (and is not deemed to be) the wife or widow of the insured individual under section 216(h)(1)(A) of the Act, section 216(h)(1)(B) provides, in pertinent part, that if such applicant in good faith went through a marriage ceremony with such insured individual resulting in a purported marriage between them which, but for a legal impediment not known to the applicant at the time of such ceremony, would have been a valid marriage, such purported marriage shall be deemed to be a valid marriage if such applicant and the insured individual were living in the same household at the time she files an application or, if such insured individual is deceased, at the time of his death.
Section 404.988(c)(1) of Regulations No. 4 provides that a determination or a decision may be reopened at any time if it was obtained by fraud or similar fault.
Section 204 of the Act provides, in pertinent part, that whenever the Secretary finds that more than the correct amount of payment has been made to any person, proper adjustment or recovery shall be made. However, ". . . there shall be no adjustment of payments to, or recovery by the United States from, any person who is without fault if such adjustment or recovery would defeat the purpose of this title or would be against equity and good conscience."
Section 404.507 of Regulations No. 4 provides, in pertinent part, that --
-
"What constitutes fault . . . on the part of the overpaid individual or
on the part of any other individual from whom the Administration seeks to
recovery the overpayment depends upon whether the facts show that the
incorrect payments to the individual . . . resulted from:
- (a) An incorrect statement made by the individual which he knew or should have known to be incorrect; or
- (b) Failure to furnish information which he knew or should have known to be material; or
- (c) With respect to the overpaid individual only, acceptance of a payment which he either knew or could have been expected to know was incorrect."
The claimant's admission precluding the finding of a ceremonial marriage, the possibility of a common-law marriage was considered, as the claimant's relationship with the worker extended from 1945 through his death in 1975 and as they had eight children together. In this regard, however, it was learned that, except for a four or five-month stay in Tennessee, the claimant and the worker had always lived in Kentucky, where common-law marriages are not recognized. Although Tennessee does not recognize common-law marriages, where parties free to marry have lived together for a long time and have held themselves out to the public as husband and wife, both parties are prohibited, under Tennessee law, from denying the validity of their marriage. This provision, however, would not be recognized by courts outside Tennessee. Therefore, it was not applicable in the claimant's case because the worker was domiciled in Kentucky at the time the claimant applied for benefits as his wife and when he died. Although the claimant alleged that she and the worker traveled together in 1947 to visit her brother in Michigan, where common-law marriages were recognized prior to 1957, she did not allege that they had established residence there. Moreover, she later admitted that it was only she who had visited her brother when the brother verified only a visit by the claimant at that time.
In view of the foregoing, the Appeals Council concluded that, under Section 216(h)(1)(A) of the Act, the claimant was not the worker's wife or widow under State law. The Council also concluded that the deemed marriage provision in section 216(h)(1)(B) of the Act was not applicable in this case because the claimant and the worker had not been ceremonially married.
Although the claimant and the worker may have thought themselves married because of their having children together, the Appeals Court believed that their initial applications showed that they had colluded to obtain benefits for the claimant. In this regard, the claimant did not just indicate that she was married to the worker on her application, but indicated that she was ceremonially married to him on October 7, 1945, in Georgia. Similarly, on his application for disability insurance benefits, the worker indicated that he ceremonially married the claimant on October 7, 1945. In view of subsequent statements by the claimant that she and the worker had not been ceremonially married and had not traveled together to Georgia, it was apparent that the claimant and the worker had falsified their applications so that the claimant could become entitled to benefits. Thus, under § 404.988(c)(1) of Regulations No. 4, the initial determination that the claimant was entitled to wife's insurance benefits effective September 1973 was subject to reopening. Because the claimant was not the worker's wife or widow, she was not entitled to benefits on his earnings record. Accordingly, all benefits paid to her as the worker's wife or widow constituted an overpayment. Recovery of the overpayment could not be waived because the record showed that the claimant had intentionally given incorrect information to obtain benefits and, therefore, under § 404.507(a) was not without fault in causing or accepting the overpayment.