SSR 00-2p: Rescinded

SSR-00-2p: Rescinded and replaced by SSR

16-2p effective March 14, 2016

EFFECTIVE/PUBLICATION DATE: 02/25/00

POLICY INTERPRETATION RULING

PURPOSE:

To explain the rules that govern the evaluation and adjudication of claims

when there is reason to believe that "similar fault" was involved in the

providing of evidence in support of the claim.

CITATIONS (AUTHORITY):

Sections 205(u) and 1631(e)(7) of the Social Security Act, as amended;

Regulations No. 4, sections 404.704, 404.708, 404.1512, 404.1520, and

404.1527; Regulations No. 16, sections 416.912, 416.920 416.924, and

416.927; and Regulations No. 22, section 422.130(b).

INTRODUCTION:

The Social Security Independence and Program Improvements Act of 1994,

Public Law 103-296, amended the Social Security Act (the Act) concerning

fraud or similar fault. These amendments to sections 205 and 1631 of the

Act provide that the Social Security Administration (SSA) shall

immediately redetermine an individual's entitlement to monthly insurance

benefits under title II or eligibility for benefits under title XVI if

there is reason to believe that fraud or similar fault was involved in the

individual's application for such benefits. This legislation further

provides that, when redetermining entitlement or eligibility, or when

making an initial determination of entitlement or eligibility, SSA "shall

disregard any evidence if there is reason to believe that fraud or similar

fault was involved in the providing of such evidence."

that fraud or similar fault was involved in the

individual's application for such benefits. This legislation further

provides that, when redetermining entitlement or eligibility, or when

making an initial determination of entitlement or eligibility, SSA "shall

disregard any evidence if there is reason to believe that fraud or similar

fault was involved in the providing of such evidence."

This Ruling sets forth the standards we (SSA and State agency

adjudicators) will apply at all levels of the administrative review

process in determining whether there is reason to believe that "similar

fault" was involved in providing evidence in connection with a claim for

benefits. It also provides guidance for the evaluation of such claims when

there is reason to believe that "similar fault" was involved. It applies

to all claims for benefits under title II and title XVI of the Act; i.e.,

claims for old-age and survivors benefits and disability benefits under

title II of the Act, and claims for Supplemental Security Income benefits

for the aged, blind, and disabled under title XVI.

This Ruling does not replace or limit other appropriate standards and

criteria for development and evaluation of claims. There may be instances

in which evidence will not be disregarded under the statutory provisions

discussed in this Ruling, but factors nevertheless may exist that justify

giving the evidence in question less credence than other evidence. For

example, in disability claims such standards frequently include those set

forth in 20 CFR 404.1527 and 416.927 for evaluating

medical opinions, and those set forth in Social Security Ruling (SSR) 96-7p , "Titles II and XVI:

Evaluation of Symptoms in Disability Claims: Assessing the Credibility of

an Individual's Statements."

INTERPRETATION:

General

ess credence than other evidence. For

example, in disability claims such standards frequently include those set

forth in 20 CFR 404.1527 and 416.927 for evaluating

medical opinions, and those set forth in Social Security Ruling (SSR) 96-7p , "Titles II and XVI:

Evaluation of Symptoms in Disability Claims: Assessing the Credibility of

an Individual's Statements."

INTERPRETATION:

General

- Sections 205(u) and 1631(e)(7) of the Act provide that evidence shall

be disregarded if there is reason to believe that fraud or similar fault

was involved in the providing of that evidence. These sections explain

that "similar fault" is involved if: "(A) an incorrect or incomplete

statement that is material to the determination is knowingly made; or (B)

information that is material to the determination is knowingly

concealed."

- Adjudicators may disregard evidence based on "similar fault" of a

claimant, a recipient of benefits, or any other person connected with the

claim. The other person need not have any direct relationship to the

claimant or recipient, or be acting on behalf of the claimant or

recipient.

- A "similar fault" finding can be made only if there is reason to

believe, based on a preponderance of the evidence, that the person

committing the fault knew that the evidence provided was false or

incomplete. A "similar fault" finding cannot be based on speculation or

suspicion.

- A "similar fault" finding is sufficient to take the administrative

actions described in this Ruling. Although a finding of "fraud" made as

part of a criminal prosecution can serve as a basis for the administrative

actions described below, such a finding is not required.

he evidence provided was false or

incomplete. A "similar fault" finding cannot be based on speculation or

suspicion.

- A "similar fault" finding is sufficient to take the administrative

actions described in this Ruling. Although a finding of "fraud" made as

part of a criminal prosecution can serve as a basis for the administrative

actions described below, such a finding is not required.

- A "similar fault" finding concerning a material fact may constitute

evidence to be considered in determining whether there is reason to

believe that "similar fault" was involved with respect to other evidence

provided by the same source, and may justify disregarding other evidence

from that source. Also, the evidence relied on to make a "similar fault"

finding in one claim may be considered in deciding whether there is

"similar fault" in another claim or in deciding whether to give less

weight to evidence in another claim.

- A "similar fault" finding does not constitute complete adjudicative

action in any claim. A person may still be found entitled to, or eligible

for, monthly benefits despite the fact that some evidence in the case

record has been disregarded based on "similar fault."

Definitions

- Similar Fault. As defined in section 205(u) and 1631(e)(7) of

the Act, "similar fault" is involved if: "(A) an incorrect or incomplete

statement that is material to the determination is knowingly made; or (B)

information that is material to the determination is knowingly concealed."

"Similar fault" differs from "fraud" in that fraud (but not similar fault)

includes an element of intent to defraud.

- Material. Used to describe a statement or information, or an

omission from a statement or information, that could influence SSA in

determining entitlement to monthly benefits under title II or eligibility

for monthly benefits under title XVI of the Act.

- Knowingly. Used to describe how a person acts in furnishing

information that he or she knows is false or incomplete.

ent to defraud.

- Material. Used to describe a statement or information, or an

omission from a statement or information, that could influence SSA in

determining entitlement to monthly benefits under title II or eligibility

for monthly benefits under title XVI of the Act.

- Knowingly. Used to describe how a person acts in furnishing

information that he or she knows is false or incomplete.

- Preponderance of evidence. A standard for deciding questions of

fact and other issues. To apply this standard, the adjudicator weighs the

evidence to decide which side of an issue is supported by the evidence

with the greater weight. Preponderance is established by that piece or

body of evidence that, when fairly considered, produces the stronger

impression and is more convincing as to its truth when weighed against the

evidence in opposition. Thus, "preponderance" does not require that a

certain number of pieces of evidence (e.g., five or six) must be present.

It is possible that just one piece of evidence may be so convincing that

it outweighs more than one piece of evidence in opposition.

Development and Evaluation

Adjudicators at all levels of the administrative review process are

responsible for taking all appropriate steps to resolve "similar fault"

issues in accordance with the standards in this Ruling. Adjudicators must

adhere to existing due process and confidentiality requirements during the

process of resolving "similar fault" issues.

In making determinations whether there is "similar fault," all

adjudicators must:

- Consider all evidence in the case record before determining

whether specific evidence may be disregarded.

- Apply the preponderance of evidence standard, as defined in

this Ruling.

- Fully document the record with the evidence that was the basis

for the finding that, based on a preponderance of the evidence, there is

reason to believe that "similar fault" was involved in providing the

evidence that is being disregarded.

ecord before determining

whether specific evidence may be disregarded.

- Apply the preponderance of evidence standard, as defined in

this Ruling.

- Fully document the record with the evidence that was the basis

for the finding that, based on a preponderance of the evidence, there is

reason to believe that "similar fault" was involved in providing the

evidence that is being disregarded.

Notice of Determination or Decision

In determinations or decisions in which a "similar fault" finding is being

made and evidence is being disregarded, the notice of determination or

decision must:

- Explain the applicable provision of the Act that allows the

adjudicator to disregard particular evidence due to a "similar fault"

finding.

- Identify the documents or other evidence that is being

disregarded.

- Provide a discussion of the evidence that supports a finding to

disregard evidence. The discussion must explain that, in accordance with

the law, the evidence identified cannot be used as evidence in the claim

because, after considering all the information in the case record, the

adjudicator has reason to believe that "similar fault" was involved in

providing the evidence and it must be disregarded. Again, a "similar

fault" finding can be made only if there is reason to believe, based on a

preponderance of the evidence, that the person knew that the evidence

provided was false or incomplete. A "similar fault" finding cannot be

based on speculation or suspicion.

adjudicator has reason to believe that "similar fault" was involved in

providing the evidence and it must be disregarded. Again, a "similar

fault" finding can be made only if there is reason to believe, based on a

preponderance of the evidence, that the person knew that the evidence

provided was false or incomplete. A "similar fault" finding cannot be

based on speculation or suspicion.

- Provide a determination or decision based on an evaluation of the

remaining evidence in accordance with other rules and procedures. A

"similar fault" finding does not constitute complete adjudicative action

in any claim. A person may still be found entitled to, or eligible for,

monthly benefits despite the fact that some evidence in the case record

has been disregarded based on "similar fault." For example, a person may

be found to be under a "disability" based on impairments that are

established by evidence that is not disregarded because of "similar

fault."

- Include standard appeal language.

EFFECTIVE DATE:

This Ruling is effective on the date of its publication in the Federal Register.

CROSS-REFERENCES:

SSR 96-7p , "Titles II and

XVI: Evaluation of Symptoms in Disability Claims: Assessing the

Credibility of an Individual's Statements," SSR 85-23 , "Title XVI:

Reopening Supplemental Security Income Determinations at Any Time for

'Similar Fault.'" Program Operations Manual System, DI 23025.001-DI

23025.095.