Retirement Claim Denials Because of Lack of Insured Status

Thursday, January 28, 2016
Management Challenge: 
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Audit Report
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Insured status is the earnings requirement an individual must meet to establish entitlement to retirement benefits. The claimant must be fully insured, have attained age 62, and have applied for benefits. Before denying a retirement claim for lack of insured status, SSA employees must complete all development for lag earnings and resolve all earnings discrepancies and coverage issues.

SSA employees should not deny a claim for lack of insured status if the individual will be insured within 4 months of the month of adjudication and evidence of earnings for the qualifying quarter is available.

Under the "deemed filing" provision, individuals who file an application for reduced retirement or spousal benefits must also file for the other benefit if they are eligible for both benefits in their first month of entitlement.

Our objective was to determine whether SSA properly denied retirement applications for lack of insured status.