SSR 73-4c: Sections 204(a) and (b); 224(a)—(42 U.S.C. 404(a) and (b); 424(a)).—Overpayment Resulting from Simultaneous Entitlement to More Than One Benefit—Determination of Fault— Recovery
Ruiz v. Secretary, U.S.D.C. D.P.R., Civ. No. 855-69 (4/13/72) (CCH U.I.R. RED. PAR. 16,666)
Beneficiary of disability insurance was receiving concurrent benefits under a workmen's compensation plan of a State, resulting in overpayment of $1,157 in benefits to him. Held, where the record showed that the beneficiary knew or should have known that both benefits could not be paid at the same time, he was not "without fault" and recovery of overpayment may not be waived.
CANCIO, Chief Judge: Plaintiff, at present 33 years of age, filed an application for disability insurance benefits on October 28, 1965 alleging inability to work since October 1, 1965 because of "ulcers and stomach problems". His claim was denied in an initial determination dated May 19, 1966 and the claimant did not seek further administrative action thereon.
Plaintiff again filed a second application for disability benefits on February 20, 1967 alleging inability to work since January 16, 1967 because of a "back injury". After denial of his claim by the Secretary of Health, Education and Welfare on initial and reconsidered determination, the claimant requested a hearing which was held before Hearing Examiner Jules L. Druss on May 9, 1968. The Hearing Examiner issued a decision dated May 25, 1968 finding that the claimant was under a disability since January 16, 1967 as alleged.
On January 6, 1969 plaintiff was notified that he had been overpaid in the amount of $1,157.90 for the months August, 1967 through December, 1968, inasmuch as he had received workmen's compensation benefits during this time. Plaintiff requested a hearing, and a hearing was held before the Hearing Examiner on June 23, 1969 in Arecibo, Puerto Rico.
The record indicates that the State Insurance Fund of the Commonwealth of Puerto Rico granted plaintiff periodic workmen's compensation payments from August, 1966 until November 30, 1967, in a weekly amount of $35.00. A lump-sum payment of $3,937.50 representing a settlement at $35.00 per week for 112½ weeks beginning November 30, 1967, was also paid to plaintiff.
It is well settled that entitlement to social security benefits is a matter of Federal law, i.e, benefits provided by a federally created program, and entitlement is established subject to all conditions set out by the Act under which benefits are to be paid. Flemming v. Nestor, 363 U.S. 603 (1960), reh. denied 364 U.S. 854 (1962); Gruenwald v. Gardner, 390 F.2d 591 (2 Cir., 1968), cert. denied Gruenwald v. Cohen, 393 U.S. 982 (1968); Price v. Folsom, 168 F. Supp. 392 (D.N.J. 1958), aff'd 280 F.2d 956 (3 Cir. 1960), cert. denied 365 U.S. 817 (1961); Coy v. Folsom, 228 F.2d 276 (3 Cir. 1955); Ewing v. Risher, 176 F.2d 641 (10 Cir. 1949).
Section 224 of the Social Security Act provides inter alia that a claimant's social security disability insurance benefit must be reduced in accordance with the formula set out therein, if the claimant receives periodic workmen's compensation payments or a lump-sum payment as a substitution for periodic payments. The record is clear with respect to the compensation payments the plaintiff actually received.
Plaintiff, as a recipient of an overpayment of social security benefits, is required under the Act to repay these benefits in accordance with section 204(a) of the Act, except where he is without fault in causing the overpayment and waiver of recovery is indicated—that is recovery would defeat the purpose of Title II of the Act or be against equity and good conscience. Section 204(a) and (b) of the Act, 20 CFR 404.506; Stravakis v. Gardner, 408 F.2d 207 (D.C. Cir. 1969); Morris v. Celebrezze, 238 F. Supp. 717 (E.D.N.Y. 1965). The law places upon plaintiff the burden of proving that such repayment would defeat the purpose of Title II or violate equity and good conscience and should therefore be waived. Sturdevant v. Celebrezze, 239 F. Supp. 745 (E.D. Pa. 1965); Price v. Folsom, 168 F.Supp. 392 (D.N.J. 1958), aff'd 280 F.2d 956, cert. denied 395 U.S. 817.
Plaintiff clearly is "without fault" within the meaning of the regulations of the Secretary of Health, Education, and Welfare, 20 CFR 404.507. It is obvious that plaintiff upon filing his application for disability benefits was specifically asked questions about his receipt of workmen's compensation benefits. In questions numbered seven and eight on his application of February 20, 1967, plaintiff specifically replied that he had filed for benefits under a workmen's compensation law and that a decision of record including a report from the State Insurance Fund of Puerto Rico as well as plaintiff's testimony at the hearing shows that he knew or should have know that both compensation benefits could not be paid to him at the same time.
This Court considers that in view of the whole record on this action, the conclusions of the hearing examiner are reasonable, and therefore will not be disturbed by this Court. Vineyard v. Gardner, 376 F.2d 1012 (8 Cir. 1967); Bailey v. Gardner, 368 F.2d 841 (6 Cir. 1966); Calli v. Celebrezze, 339 F.2d 924 (9 Cir. 1964).
It is therefore ordered that this action be and it is hereby dismissed.