RS 01404.110: Pre-lag Development and Documentation Requirements for Resolving Earnings Record Inaccuracies
Effective Dates: 08/17/2016 - Present TN 14 (08-11) RS 01404.110 Pre-lag Development and Documentation Requirements A. Policy on resolving earnings records inaccuracies SSA employees are responsible for resolving earnings record inaccuracies. We are always required to resolve potential earnings record inaccuracies for any situation provided in RS 01404.110C. In addition, unless required in RS 01404.110C, when a claimant agrees with their Social Security Statement or the earnings posted to their social security earnings record, we are required to resolve earnings alerts (EARQ) only in the following situations: * it is clear the claimant is incapable and will require a representative payee; or * a multiple FICA or possible duplicate earnings alert exists and using the alerted earnings could result in an incorrect increase. B. When not to develop potential earnings record inaccuracies Do not develop potential earnings record inaccuracies in the following situations: * In Lump Sum Death Payment (LSDP)-only claims where no possible future entitlement exists. * Subsequent claims when development was completed in a prior LSDP-only or other claim.
- * Survivor claims if no combination of pre-lag or lag earnings establishes insured status.
* The additional alleged earnings (including lag earnings) do not affect entitlement, the primary insurance amount (PIA), or deductions. * The additional alleged earnings are less than the amount needed for a quarter of coverage (QC) and no additional earnings are posted to the earnings record or alleged for the same quarter or year which would result in obtaining the amount needed for a QC unless it would affect the PIA as indicated above. For more information on increment amounts, see RS 00301.250. * If the earnings record shows maximum earnings posted as duplicate items (i.e., the maximum is posted twice) unless a workers’ compensation/public disability benefit (WC/PDB) Average Current Earnings (ACE) determination is needed. * The time limitation has expired and no exception exists. See exceptions to the statute of limitation in RS 02201.008. * The Summary Earnings Query (SEQY) or Detailed Earnings Query (DEQY) show the MEF has been corrected. * Unposted lag earnings in pre-claim situations, unless it is apparent from the number holder’s (NH's) explanation that the earnings will not be reported or posted for the preceding lag year. For more information on limits on earnings records development, see RM 03870.006.
- * Medicare-only claims and the 30th QC are not necessary for entitlement to premium HI.
C. When to develop potential earnings inaccuracies 1. Develop for potential earnings record inaccuracies in the following claims situations:
- * Insured status is involved.
* Allegations of missing or inaccurate earnings. * Claimant does not agree with the Social Security Statement * The NH or surviving claimant is incapable and requires a representative payee. For more information on incapability and representative payees, see GN 00502.001 - GN 00502.075. * It appears from the NH’s explanation that lag earnings will not be posted. (RM 03870.006) * On an auxiliary or survivor's own earnings record when the applicant is eligible to apply on his or her own Social Security number (SSN). * On life claim disallowances if possible future entitlement to benefits exists (per RS 02201.010 and GN 01010.440). Develop the earnings record issue after disallowing the claim. * On lump sum death payment (LSDP)-only claims when a survivor is potentially entitled to future monthly benefits on the deceased NH's earnings record. * A WC/PDB ACE determination is necessary. Develop even when maximum earnings are posted on the earnings record as duplicate items. * On all scrambled earnings situations. (per RM 03870.045 - RM 03870.090). * On DIB claims when the PIA computation includes one or two years of zero earnings that are not fully explained by the claimant's response to the childcare dropout year questions (RS 00605.235, GN 00204.055O, and MSOM MCS 005.027). * On Medicare-only claims when entitlement to Medicare is an issue. 2. Develop allegation of earnings record inaccuracy in the following pre-claim situations
- * Posted earnings are missing or inaccurate.
- * Posted lag earnings are inaccurate.
* It appears from the NH’s explanation that lag earnings will not be posted (see RM 03870.006). D. Earnings queries to use to develop potential earnings errors Use the following earnings queries when developing potential earnings record errors in all initial claims (in-office, Teleclaim, or Internet): * The EARQ is used to identify potential inaccuracies on the earnings record for years after 1977 (SM 00355.001 – SM 00355.080, RS 01404.003A). The EARQ alerts replace the MCS EC earnings alerts messages on the Yearly Earnings Data (DEIE) and Remarks (DRMKS) screens for processing all claims (interview, Internet or Teleclaim). The EARQ displays alerts by year, alert type and EIN. There can be multiple alerts for the same SSN for different EINs. The EARQ displays each individual alert on a separate screen. * Use the DEQY for years after 1977 and SEQY for years 1937 to present ( see SM 00344.001 – SM 00344.035). The SEQY displays annual earnings from the MEF for the years 1937 on (SM 00345.900 – SM 00345.915). Determine whether resolution of the EARQ is required per RS 01404.110B and RS 01404.110C. If resolution of the earnings issue or EARQ alert is required, request a DEQY for the EARQ alert year(s) and the years before and after the alerted year(s) to discuss and review the questionable earnings record posting. E. Procedure for general documentation of earnings records in claims cases General documentation guidelines for claims cases are below. For examples of documentation of guidelines for each of the EARQ alert situations, see RS 01404.120 and RS 01404.140.
- 1. No correction required for EARQ alerts
If an EARQ alert requires resolution, and review of the earnings record with the claimant/representative results in no corrective action, then: * Obtain a statement from the claimant/representative identifying the years in question and an explanation. See RS 01404.110E.5 for manner of documentation. EXAMPLE: My earnings record is correct for 2007. I did not work in 2007 due to the birth of my child in 12/06. I did not work for 18 months from 12/06 through 05/08. * If the claimant cannot explain the work history, document the file per RS 01404.110E.5, indicating that the claimant was informed of the possible erroneous posting and could not give an explanation. * If the claimant questions the earnings record but no development is necessary per RS 01404.110B: * Explain to the claimant why no corrective action is necessary; and * Document the file to indicate why no action was taken per RS 01404.110E.5. EXAMPLE: The EARQ alerted for 1986 wages, but development is not necessary per RS 01404.110B (the time limitation for correction has expired).
- 2. No correction for uninsured spouse
Do not document if, in an auxiliary claim, the spouse is uninsured and has no posted earnings from 1978 on.
- 3. Partial awards
Prepare partial awards (GN 01010.110) if immediate payment is due and the earnings record inconsistency cannot be resolved. Develop the unresolved/questionable earnings issue post-adjudicatively. 4. Claimant unsure or unwilling to agree to the accuracy of their earnings record When the claimant/representative is either unsure of the NH’s , work history or is unwilling to agree to the accuracy of the earnings record, document the file per RS 01404.110E.5 EXAMPLE: Mr. Jones is unsure of his work history and is unwilling to agree to the accuracy of his Social Security earnings record concerning the alerted earnings for 1979 and 1992.
- 5. Manner of documentation
- Document the file as follows:
- a. Paper claims
- Use the Remarks portion of the application.
- b. Earnings computation (EC) claims
Use the Report of Contact – RPOC screen (MSOM MCS 008.007), or the Worksheet Remarks – (DW03) screen as appropriate (MSOM MCS 008.006).
- c. Teleclaims
Follow RS 01404.110E.5.a. or RS 01404.110E.5.b., as appropriate.
- d. Internet and Modernized Claims System (MCS) claims
Use the MCS Report of Contact – (RPOC) screen (MSOM MCS 008.007), or the Worksheet Remarks – (DW03) screen as appropriate (MSOM MCS 008.006). e. In the modified posted earnings (EMOD) item correction (ICOR) System Enter any remarks necessary concerning the NH’s work history on the Worksheet Remarks (ERMK) screen (MSOM EM 017.005). Enter information pertinent to the basis of the decision on the Earnings Rationale (EART) screen (MSOM EM 026.003).
- f. Post-adjudicative statement
If no correction is being made or a statement is being requested by the PC as the result of a post-adjudicative review and it was determined that the NH did not previously explain or insufficiently explained an earnings record inconsistency, complete a “Statement of Claimant or Other Person,” SSA-795. The PC should advise the FO how to forward the information; whether to FAX the SSA—795 using the 3601 or fax to NDRED, etc. NOTE: It is not necessary to obtain the claimant’s signature, simply document the claimant’s statement as indicated.
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