SSR 77-14c: SECTION 205(a) (42 U.S.C. 405(a)) -- APPLICATIONS -- EFFECTIVE FILING REQUIREMENT FOR ENTITLEMENT TO BENEFITS

20 CFR 404.601 and 404.613

SSR 77-14c

Goff v. Weinberger, (1975-1976 transfer Binder) 1A U.I.R. 14,470 (D. Conn.

1975), aff'd 538 F.2d 309 (2d Cir. 1976), cert. denied 45 U.S.

L.W. 3302 (Oct. 18, 1976)

CLARIE, Chief Judge:

This action was brought pursuant to § 205(g) of the Social Security Act,

as amended, 42 U.S.C. § 405(g), requesting judicial review of a final

decision of the Secretary of Health, Education and Welfare. The Appeals

Council reversed the Administrative Law Judge's decision, which had

allowed dependents' insurance benefits to the plaintiff and her children

retroactive to March 31, 1959. The case comes before the Court on

cross-motions for summary judgment pursuant to Rule 56, Fed. R. Civ. P. No

remaining factual issues exist to be resolved and the case can now be

decided as a matter of law. The legal issue presented is whether or not

the record contains substantial evidence to support the Secretary's denial

action of survivor's insurance benefits for any month prior to January,

1970; and whether or not any valid application was filed with the Social

Security Administration prior to January, 1971. The Court finds that the

Secretary's findings are supported by substantial evidence and his

decision is therefore affirmed.

Facts

At the time of Clayton E. Wooley's death, he was married to the

plaintiff, Nellie T. Goff. He died on March 31, 1959 from injuries

suffered during the course of his employment by the State of Connecticut

and was covered at the time by Workmen's Compensation. At that time the

couple had three living children, a stepchild, Jane (Woolley) Turgeon,

born June 1, 1949, married during May 1969; James Woolley, born February

3, 1953, and Patricia Woolley, born October 19, 1955.

. Goff. He died on March 31, 1959 from injuries

suffered during the course of his employment by the State of Connecticut

and was covered at the time by Workmen's Compensation. At that time the

couple had three living children, a stepchild, Jane (Woolley) Turgeon,

born June 1, 1949, married during May 1969; James Woolley, born February

3, 1953, and Patricia Woolley, born October 19, 1955.

The plaintiff concedes that no written application for Social Security

benefits was formally filed in writing in behalf of the children until

January 28, 1971. The defendant awarded payments for one year

retroactively back to January, 1970, to the two minor children, James and

Patricia, both of whom were under 18 years of age.

The plaintiff thereafter married her present husband, Joseph P. Goff, in

1962. She complains that she and the children should have been qualified

to receive benefits commencing on March 31, 1959. Immediately after the

death of her husband on March 31, 1959, she applied under Connecticut

State Law § 5-144, for Workmen's Compensation and received an award for

herself and said children. For that purpose she was represented by

retained counsel and consulted him on the question of whether or not she

and the children were entitled to receive Social Security Benefits. The

attorney stated in an attached affidavit, that he had telephoned the New

Britain Social Security Office sometime during July, 1959, to inquire as

to the family's eligibility and was informed by a Social Security

employee, that since she and the children were already receiving benefits

under the State Workmen's Compensation Act, they did not qualify for

Social Security insurance benefits.

attorney stated in an attached affidavit, that he had telephoned the New

Britain Social Security Office sometime during July, 1959, to inquire as

to the family's eligibility and was informed by a Social Security

employee, that since she and the children were already receiving benefits

under the State Workmen's Compensation Act, they did not qualify for

Social Security insurance benefits.

She now claims that since she was dissuaded from filing in 1959, through

the alleged false advice given by an employee of the agency to her

attorney, the latter's oral inquiry should be considered tantamount to a

written statement of intent to file an application for benefits, as

required by § 404.613 of Regulation No. 4. In fact, the Administrative Law

Judge here made his finding that the oral telephone inquiry made by the

plaintiff's attorney, of which no record could be found, constituted a

lawful statement of intent, within the meaning of the Social Security

regulations and justified a finding that the claim of the mother and

children was valid and effective on March 31, 1959.

Discussion of Law

Title 42 U.S.C. § 405(a) vests in the Secretary the right to make and

promulgate procedural regulations to administer the

Act. [1] Under these regulations,

20 C.F.R. § 404.601(d) provides:

20 C.F.R. § 404.601(e) provides:

In furtherance of the foregoing policy, § 404.613 of these regulations

provides, that if an individual files a written statement with the Social

Security Administration, which indicates an intention to claim benefits

and such statement bears his signature, the filing of such statement shall

be considered to be the filing of an application for such benefits. Thus

the administrative purpose of the Act and its supporting regulations were

specifically designed to assure, that only a written expression of intent

to claim Social Security benefits should be accepted and considered as a

valid application under the law

tatement bears his signature, the filing of such statement shall

be considered to be the filing of an application for such benefits. Thus

the administrative purpose of the Act and its supporting regulations were

specifically designed to assure, that only a written expression of intent

to claim Social Security benefits should be accepted and considered as a

valid application under the law. This case is clearly distinguishable from

the case of Tuck v. Finch , 430 F.2d 1075 (4th Cir. 1970), cited by

the plaintiff, and the plaintiff concedes that no written record exists in

the Social Security office to confirm that an application, written or

oral, was ever filed.

The Social Security Act, supplemented by its regulations, was intended to

eliminate or at least reduce to a minimum the possibility of fraud,

confusion, and laxity in its administration. The vastness of the program

makes it essential to adhere to the written application procedure, if

there is to be an orderly and controllable system of management for

approving claims and paying out insurance benefits.

The plaintiff claims that the defendant is estopped from denying relief,

because the agency's own employee dissuaded her from filing a written

application. Furthermore, she claims that since the Administrative Law

Judge, its own agency employee, found in her favor, the Government has

thereby waived any procedural non-compliance by her in failing to file the

required written application.

The Government cannot be estopped in this manner from insisting upon the

performance of statutory conditions precedent, by the unauthorized acts of

a local Social Security office employee.

Also see, McIndoe v. United States , 194 F.2d 602, 603 (9th

Cir. 1952); and Taylor v. Flemming , 186 F.Supp. 280, 284 (W.D.

Arkansas 1960).

by her in failing to file the

required written application.

The Government cannot be estopped in this manner from insisting upon the

performance of statutory conditions precedent, by the unauthorized acts of

a local Social Security office employee.

Also see, McIndoe v. United States , 194 F.2d 602, 603 (9th

Cir. 1952); and Taylor v. Flemming , 186 F.Supp. 280, 284 (W.D.

Arkansas 1960).

While the Administrative Law Judge found that the telephone inquiry made

by the plaintiff's attorney constituted a statement of intent on the part

of the plaintiff to file for benefits within the meaning of § 404.613,

that conclusion was in fact an interpretation of a rule of law applied to

the factual circumstances as the judge found them. To press beyond and

claim that his ruling, as an employee of the agency, constituted an actual

waiver of the defendant's position, so as to estop it from denying

benefits, would destroy the quasi-judicial character of the Administrative

Law Judge. It would also unduly curb the Secretary's clear statutory right

to an effective review of final rulings, pursuant to 42 U.S.C. § 405(b).

This statute provides in part:

Such a construction would also unduly limit the right to a full judicial

review under 42 U.S.C. § 405(g); a result never contemplated by the

Congress.

The factual situation found to exist here does not conform to the

essential requirements of the Social Security Regulations, 20 C.F.R. §§

404.602 and 404.613. Failure of the plaintiff to file a timely application

under the rules is not simply a non- essential procedural requirement, it

is a substantial and basic requirement of the regulations.

result never contemplated by the

Congress.

The factual situation found to exist here does not conform to the

essential requirements of the Social Security Regulations, 20 C.F.R. §§

404.602 and 404.613. Failure of the plaintiff to file a timely application

under the rules is not simply a non- essential procedural requirement, it

is a substantial and basic requirement of the regulations.

The defendant Secretary is charged with the duty to weigh the evidence,

to resolve material complaints in the testimony and to determine the cases

accordingly. Moss v. Gardner , 411 F.2d 1195 (4th Cir. 1969); Staples v. Gardner , 357 F.2d 922 (5th Cir. 1966); Stumbo v.

Gardner , 365 F.2d 275 (6th Cir. 1966); Rhinehart v. Finch , 438

F.2d 920 (9th Cir. 1971). The findings of the Secretary are conclusive, if

supported by substantial evidence and a proper application of the law.

The Court adopts the findings and decisions of the Appeals Council (Tr.

4-10) as affirmed by the Secretary of Health, Education, and Welfare. The

Court finds that the Secretary's determinations were supported by

substantial evidence, as required under § 205(g) of the Social Security

Act, 42 U.S.C. § 405(g). Newman v. Celebrezze , 310 F.2d 780 (2d

Cir. 1962); Dondero v. Celebrezze , 312 F.2d 677 (2d Cir. 1963).

The defendant's motion for summary judgment is granted.

SO ORDERED.

[1] 42 U.S.C. § 405(a) provides:

" Rules and regulations . The Secretary shall have full power and

authority to make rules and regulations and to establish procedures, not

inconsistent with the provisions of this title, which are necessary or

appropriate to carry out such provisions, and shall adopt reasonable and

proper rules and regulations to regulate and provide for the nature and

extent of the proofs and evidence and the method of taking and furnishing

the same in order to establish the right to benefits hereunder."