What Does Social Security Mean by "Similar Fault" to Fraud?

It's not uncommon for the Social Security Administration (SSA) to find that a disability applicant or recipient has given false or inaccurate information for the purpose of getting Social Security benefits. When that happens, the agency must re-determine whether the person is actually entitled to benefits, and will do so while disregarding any evidence that was inaccurate or misleading.

The Social Security Administration (SSA) uses two names to describe this type of wrongdoing: "fraud" and a "similar fault" to fraud.

Fraud is when a claimant gives false information related to a disability claim. To be convicted of fraud, the SSA must prove that the person intended to defraud the government. (For more information on what constitutes fraud, see our article on disability fraud.)

Similar fault differs from fraud because the person does not need to have intended to defraud the SSA.

How Does the SSA Define "Similar Fault"?

The SSA defines similar fault (SF) as when a claimant (applicant) either:

• provides an incorrect or incomplete statement that is important, and material, to determining the claimant's eligibility for disability, and the claimant does this knowingly, OR
• conceals information important to the determination of eligibility, and the claimant does this knowingly.

In addition, any other person (like a doctor or interpreter) involved in the claim can commit a similar fault to fraud as well.

The SSA describes similar fault in more detail in its policy ruling SSR 22-2p.

What Is Important Material Information?

The SSA calls information that's important to determining whether someone is eligible for benefits "material"—information that could help the SSA decide a claimant's eligibility for either SSDI (Social Security Disability Insurance) or SSI (Supplemental Security Income).

What Does "Knowingly" Mean?

To knowingly provide false or inaccurate information means to do so with the awareness that the information is false, inaccurate, or incomplete. The SSA must have reason to believe the person knew that the evidence provided was false or incomplete.

How Does the SSA Prove That Someone Committed a Fault Similar to Fraud?

To find that a similar fault occurred, Social Security needs more than "mere suspicion, speculation, or a hunch." But the SSA no longer needs to show that similar fault occurred by a "preponderance of evidence." In May 2022, Social Security changed that standard so that the agency now only needs "reason to believe" that a similar fault occurred. Reason to believe means that the agency has reasonable grounds to suspect that similar fault was involved in the application or in providing evidence.

Examples Where Social Security Found Similar Fault

Here are some examples where a claimant or another person related to the claimant committed similar fault.

• The claimant filed for disability based on severe carpal tunnel syndrome in both hands. She originally visited a hand specialist who advised her that she was not a candidate for surgery, and that likely the nerve damage could not be corrected. The claimant provided these medical records and the doctor's opinion to the SSA in support of her claim. However, shortly after applying for disability, the claimant went to a new doctor for a second opinion. The second doctor conducted additional nerve testing and concluded that, in fact, she was an excellent candidate for surgery and could likely make a near complete recovery. Because this opinion and the new medical evidence did not support her case, the claimant failed to disclose it to the SSA.
• The claimant filed for disability due to a back problem. Because the claimant did not speak English, he brought his own interpreter with him to assist with his application. When the Social Security field officer asked the claimant to describe his pain, the claimant stated (in his own language) that it was a shooting and burning sensation that went from his right hip down his leg. However, the interpreter intentionally magnified the claimant's symptoms when she translated the claimant's response to the field officer's question. Specifically, the interpreter stated that the claimant had significant pain in both legs and required help in his daily life with cooking, cleaning, and personal care.

What Happens if the SSA Decides Similar Fault Occurred?

If the SSA determines that a fault similar to fraud occurred in a disability claim, the SSA can:

• ignore any evidence it determines was based on the similar fault
• decide to do nothing, because the similar fault didn't affect the outcome of the claim
• modify, deny, or discontinue benefits if eligibility for the benefits was decided using evidence based on SF
• require claimants to repay any benefits they were not legally entitled to, or
• conduct a continuing disability review (for claimants who are already receiving benefits), to see if a claimant is disabled.

If the SSA decides your claim contained evidence based on similar fault, the agency will send you a decision letter that contains:

• an explanation of federal laws on similar fault
• a description of the evidence it disregarded
• why it believed the evidence was wrong, inaccurate, misleading, or incomplete, and
• information on how to appeal the SSA's decision.

If the SSA accuses you of committing fraud or a similar fault, consider contacting a disability lawyer immediately.

_{Updated May 20, 2022}