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Fraud and Similar Fault in Social Security Disability Cases

SSR 16-1p sets forth the manner in which Social Security will redetermine a disability claim if they have reason to believe there has been fraud or similar fault in providing or withholding material evidence. Fraud connotes an intent to defraud; similar fault involves knowingly providing incomplete or inaccurate information, and is similar in nature to fraud but without the same degree of specific intent.

In making the disability redetermination, Social Security will disregard the inaccurate evidence. Depending on the circumstances, this may result in a termination of benefits or even an overpayment situation.

The redetermination is made under a preponderance of the evidence standard, which is a legal standard for that degree of proof which makes the existence of a fact more likely than not.

SSR 16-2p sets forth the circumstances and manner in which similar fault is determined in initial adjudication or re-determination of a disability application.

Disability applications must provide complete and accurate information regarding the applicant’s disability.

As I understand this ruling, if incomplete or inaccurate information is provided, Social Security will determine whether or not the person is eligible or remains eligible for benefits based on a complete and accurate record. They will disregard any inaccurate evidence. They may determine whether there has been an over payment if a termination decision is made.

Again, the legal standard for making the determination is preponderance of evidence, as explained above.

This material should not be construed as legal advice for any particular fact situation, but is intended for general informational purposes only. For advice specific to any individual situation, an experienced attorney should be contacted.

Melvin Cook:
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