Fighting the Social Security Administration

If you were awarded benefits, why would you need to fight SSA?

If you were awarded benefits, why would you need to fight SSA?

After completing a two year journey through SSA’s disability determination process you have been awarded Social Security Disability benefits. You made contact with the SSA payment center which set you up to receive your back benefits in installments and your monthly benefits going forward. At some point in time you were told by SSA to continue to provide updates about work, medical updates, and any time at all you have any other income. You were also told that at some time SSA may want to review your case to ensure that you are still disabled. At the time, you were excited about finally generating a source of income which you did not have in the prior two plus years.

Three years go by. You received a number of letters from the Administration which describe staying on disability, reminders of what the requirements are, and what you need to report. These letters are only occasional. One letter you received mentioned something about overpayment, but you remembered having an interview with an SSA worker who determined the dollar amount of your benefits. You have received payments in that amount every month for years now and you never did go back to work or won the lottery, so clearly, you were not overpaid.

Your benefits are monthly and you have adjusted to live within your means. You also try to save the benefit checks where you can so once in a while you can go out to eat, see a movie, or buy gifts at the holidays. It is not easy, especially since you need to keep up with your treatment, but since you are single and without child-related costs  you have managed to save and maintain about $1,800 in your bank account for emergencies.

Two Christmases ago, right after you were awarded benefits, your grandmother Millie sent you a $250 check to help get you back on your feet. That was especially nice of her since she usually only sends a sappy card with a $20 bill in it. You deposited that $250 check at the time and forgot about it.

On the three year and one month anniversary of the award of your benefits, you receive a thick packet from SSA. Inside is a letter asking you to report any income you may have received, a function report for you to complete, a release so that SSA can collect medical records, and a statement showing the payment schedule for your benefits with the cost of living adjustments for the next two years, among other documents. You complete these documents and return them to SSA.

Thirty days go by. Your benefits are not deposited into your account as usual. You try calling SSA and the first time you wait on hold until the Administration’s phone system hangs up on you. You call again and get a front desk person who tells you that they are not sure why your benefits have stopped, but that you can talk to a case worker. You call the case worker several times and leave several messages. At the sixty day mark, you receive a letter stating that you have been overpaid, that you owe SSA $26,000, and that you have no defenses because you knew or should have known that you needed to report earnings and did not do so.

You frantically call and call SSA, the case worker, and anyone that would answer the phone. Eventually, the case worker calls you back. They inform you that SSA performed a continuing disability review on your file, and determined that three years ago in December, your bank account showed an amount of $2,050 for two weeks because of unearned income of $250. The case worker further tells you that to remain eligible for your benefits, you can never have a back account balance above $2,000, that you did, and because of that SSA retroactively determined that you were ineligible for benefits. You were also determined to be ineligible because you had unearned income you failed to report. Because of that retroactive determination, you owe SSA all of the money they paid you from that December to present. The case worker further tells you not to waste everyone’s time trying to appeal SSA’s decision because you will lose any appeal you file automatically.

Is there anything to be done? Can SSA really tell someone they owe $26,000 because of some Christmas money that you received three years ago? Don’t SSA’s case workers have the final word on how your disability benefits get paid? Aren’t they right when they tell you that you will lose any appeal?

Look for the answers in our next post!

If you were awarded benefits and you are currently going through a similar experience to the one above please contact us today!

If you are interested in learning more about Social Security Disability please contact us for a free consultation!

Why Is It So Easy For People To Get Disability? Part 1

Did Ronald Regan make it so easy to get on disability?

Did Ronald Regan make it so easy to get on disability?

According to Forbes.com, it is very easy to get on Social Security Disability. Not only that, but according to Forbes, there is a 200 billion dollar “disability industrial complex” that has arisen because so many Americans are “gaming the system.” This had led to questions about the solvency on the Social Security trust which funds the Disability Insurance program known as SSDI. Despite the disability trust fund being solvent through at least 2027, politicians maintain that, in addition to the ease with which individuals can get on disability, it is similarly easy for them to commit fraud or other abuses of the system. They maintain that if this “tremendous fraud, waste, and abuse” is eliminated and if it becomes even more difficult to get on disability, the Social Security system would become solvent for all time. These two very common assertions raise the question, why is it so easy to get on disability and game the system?

Of course, to get to the bottom of this, you need to know exactly what you’re talking about, otherwise pundits that purport to know what they are talking about could mislead readers. Forbes contends that the $200 billion in disability payments made each year are paid to people who otherwise might be receiving a form of welfare, and that these people are not motivated to work since a substantial portion of their income is replaced by disability payments. This is one of the ways that Forbes characterized Social Security Disability:

The Social Security Administration pays out benefits in relation to how much money you made when you were working, with some means-testing considerations thrown in. The overall effect is to replace the majority of your income if you’re poor, and a smaller fraction of your income if you were well-paid in your previous jobs.

This is a vague and somewhat disingenuous description that only seems to incorporate the SSDI program. For instance, Forbes’s description seems to imply that just anyone can be awarded benefits. While it is true that the vast majority of people working are in OASDI covered employment (employment that allows you to gain quarters of coverage used toward SSDI eligibility), they are not guaranteed eligibility and the vast, vast, vast majority of OASDI workers would become a technical denial. For example, there are approximately 163 million workers in OASDI covered employment for 2015, but only 2.4 million applications covering 1.47% of all OASDI covered workers (1.7% if we use the greatest number of SSDI applications from the last 15 years, 2.9 million in 2010).

However, you cannot reach the $200 billion mark if you do not also include the approximately $54 billion in SSI payments made each year which, because of math, is clearly what Forbes did. SSI is not funded by the same trust which funds SSDI. It also is primarily means tested and, with very few exceptions, any benefits paid or accrued will be offset by any form of income, earned or unearned, that a claimant may receive. So, in essence, in talking about the program’s solvency, Forbes was already inaccurate by about 25% of their reported figure as any SSDI funding issues would necessarily exclude SSI. This means that the “disability industrial complex” is actually only about $150 billion, 25% less than Forbes’s quoted amount.

The funding figures are relevant in that the amount of benefits an applicant is allegedly guaranteed to receive are too high, and, according to Forbes, that is drawing otherwise able-bodied workers to the program. This is also directly related to the process of obtaining disability benefits as disability applicants must not have any substantial income for twelve months at least in order to qualify.

Funding also becomes relevant because critics like to point out that disability claimants are actively choosing to be paid not to work, since the benefits are so great. But, if claimants are really accepting benefits in order to stay out of work, they are also choosing a lifetime of living around or below to the poverty line that will never improve without them going back to work. Anyone claiming SSI only will have to learn to live on a maximum $773 per month with a state supplemental payment that will be about $50-100. Beyond that, while the maximum benefit an SSDI claimant can receive is $2,663 per month, and the average benefit for SSDI is $1,146 while the average SSI benefit is $510 per month. So, while some people may believe that a person could be set for life collecting disability benefits, if they are an average disability claimant, they would likely be living off of $13,752 per year. The federal poverty line is $11,880 per year or $990 per month which means the average SSI only claimant would be drastically below the poverty line, while the average SSDI claimant would be slightly above the poverty line. In either case, claimants may very well have to rely on programs such as SNAP and TANF, two of the programs that make up welfare as we know it, in order to make ends meet.

Forbes’s contention that disability is the new welfare also comes from the spike in disability applications that comes with higher levels of unemployment. According to Forbes, instead of going to find a job during times of high unemployment, individuals will apply for disability benefits at a greater rate. This is something that can be discerned from SSA’s own data. In 2009, after the beginning of the financial crisis, there was an increase in applications from 2.3 million applications to 2.8 million applications.

There are various ways to look at this. First, this is common sense. During times of high unemployment, there are typically no jobs for people to find regardless of their desire to find them. So, since there are fewer jobs, people necessarily look for alternate means of support. However, the inverse to this is also true, i.e. during times of low unemployment there are fewer applicants. In fact, as the unemployment rate has dropped since 2009, so have the number of applicants down to 2.4 million in 2015. Moreover, levels of high unemployment could also have the effect of making people qualified that might otherwise not be since claimants must be out of work for 12 months. Lastly, Forbes also neglected to mention that technical denials, denials based on an claimant’s lack of basic qualifications, also go up during times of high unemployment while medical denials tend to stay flat. So, while the number of individuals applying may go up precipitously when unemployment is high, actual benefit approvals only tend to increase minimally. This, in and of itself, should show Forbes and other SSA critics that disability is not, in fact, being used to replace “welfare” because you have to be awarded benefits because you can collect them.

Stay tuned later this week when we roll out part II of our answer to the question, “why is it so easy to get disability?”

If you would like to talk to an attorney about disability or have questions about your pending application contact us today via email or call us at 1-866-262-8595!

 

A Brief Guide to Public Benefits: Medicare, Medicaid, and Social Security Disability Insurance

Many people do not understand the difference between Medicare and Medicaid and fewer still don’t understand the relationship between these programs and Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). This is not surprising given the similarities and complexity of these programs. Simply put, both Medicare and Medicaid help cover costs for qualified individuals’ medical expenses.

Medicaid is administered by individual states. The District of Columbia, Guam, Puerto Rico, United States Virgin Islands, American Samoa, and Commonwealth of the Northern Mariana Islands also have Medicaid programs, bringing the total to 56 separate Medicaid Programs. These programs are funded by a combination of state/territory taxes and federal taxes. Because each of these programs is independent, the requirements to qualify for Medicaid varies from state to state. Generally speaking, to qualify for Medicaid you must have limited income and limited financial resources. Additional requirements may include, being 65 years of age or older, being disabled, or being younger than 19 years of age. Medicaid can cover doctor visits, hospital stays, prenatal and maternity care, mental health care, and medications, as well as vision and dental care for children.

In Massachusetts, the Medicaid program is called MassHealth. For individuals under the age of 65, there are three Medicaid programs available through MassHealth:  1) Standard; 2) CommonHealth; and 3) Long-Term Care. See Table 1 for the general requirements for these programs. It is important to note that this table only includes the general requirements.

Table 1:  General Standards for MassHealth for Individuals 21-64 Years of Age.

  Standard CommonHealth Long Term Care
Disability Requirement ·       Legally Blind, Determined by Massachustts Commission for the Blind

·       Disabled, Determined by Social Security Administration

·       Disabled, Determined by MassHealth Disability Determination Unit

·       Legally Blind, Determined by Massachustts Commission for the Blind

·       Disabled, Determined by Social Security Administration

·       Disabled, Determined by MassHealth Disability Determination Unit

·       Be eligible for MassHealth Standard as a disabled person or pregnant; AND

·       Determined to require long-term care by MassHealth

Assets Requirement ·       Assets are NOT considered ·       Assets are NOT considered ·       Less than $2,000 in countable assets
Income Requirement ·       Less than or equal to 133% of the Federal Poverty Line ·       Less than or equal to 133% of the Federal Poverty Line; OR

·       Have income above 133% of the Federal Poverty Line, and pay a one-time detuctible

·       Is currently working 40 hours a week or more; OR

·       Is currently working and has worked at least 240 hours over the 6 months preceding the application

·       Less than or equal to 100% of the Federal Poverty Line.

Medicare is administered by the federal government and funded by federal taxes. It is available to individuals 65 years of age and older, individuals under 65 years of age with certain disabilities, and individuals with end-stage renal disease (ESRD). It is a large program with four main components, parts A through D. Part A, Hospital Insurance covers inpatient stays at hospitals, skilled nursing facilities, hospice care, and home health care. This is typically available for free provided you or your spouse paid Medicare taxes while working. Part B, covers doctor care, outpatient care, home health care, durable medical equipment, and some preventative care. This is typically available for a set premium. Part C, covers all the benefits in Parts A and B, and may cover the benefits of Part D and additional benefits, for additional fees. Part C is run by Medicare-Approved, private insurance companies.  Part D helps cover prescription drug costs and is also run by Medicare-Approved, private insurance companies.

It is possible to qualify for both Medicare and Medicaid.  Individuals who qualify for both programs are called “duel eligibles.” Between the two programs, most medical expenses are probably covered.

SSDI and SSI are distinct and separate programs from Medicaid and Medicare, but qualifying for one of the former may allow you to qualify for one of the latter sooner. Often individuals who apply for SSDI and SSI either already receive Medicaid or begin to receive Medicaid after they are awarded benefits. Individuals who receive SSI are automatically eligible for MassHealth. Individuals under 65 years of age who are awarded SSDI are eligible for Medicare Part A, at no cost, 24 months from the date when they were entitled to receive SSDI benefits. Individuals may begin receiving SSDI benefits as early as one year before their application date. There is always a 5-month waiting period from the onset date of a disability to the date that an individual in entitled to receive SSDI. Also, individuals are only entitled to SSDI benefits for a maximum of 12 months prior to the application date. Therefore, the earliest individuals can qualify for Medicare via SSDI is 24 months after their application date. That is assuming they were found to be disabled at least 17 months prior to their application date. Since Medicare is often an important benefit to disabled individuals, it is important to file SSDI claims earlier rather than later.

Once individuals qualify for Medicare Part A at no cost, they will be eligible for Parts B, C, and/or D. These will typically require a monthly premium for coverage; however, some states have programs which will help low-income individuals pay these costs.

Medicaid and Medicare can help you obtain vital medical care at little or no cost. All of these programs are much too complex to cover comprehensively in a blog post. There are numerous exceptions and caveats to the rules and requirements covered in this blog. If you are considering applying for SSDI or SSI, it is important to discuss the details of your particular case with an experienced attorney or a representative from the Social Security Administration so that you understand when and how you will qualify for these programs. The important thing to remember is that each day you delay in applying for SSDI and/or SSI, not only are you potentially losing cash benefits, you are also increasing the time you will have to wait to qualify for Medicaid and/or Medicare.

A few links with more information about these programs:

https://www.medicare.gov/Pubs/pdf/11306.pdf

http://www.mass.gov/eohhs/consumer/insurance/masshealth-coverage-types/masshealth-commonhealth.html#Income standards

http://www.mass.gov/eohhs/docs/masshealth/membappforms/aca-1-english-mb.pdf

http://www.benefits.gov/benefits/benefit-details/1282

http://www.mass.gov/eohhs/docs/masshealth/regulations/member-eligibility/130-cmr-520-000.pdf

https://www.ssa.gov/pubs/EN-05-10043.pdf

The Stigma of Public Assistance

Disability Stigma

The question of whether to apply for Social Security Disability Insurance or Supplemental Security Income is a tough one for many people with a number of personal, social, political, religious, etc. elements to be considered. In reading about social assistance programs you encounter people who believe that everyone living with some form of  social assistance is very excited and happy to be doing so, others that note that there is still a stigma and that there are those out there trying to enhance it, and, generally, the middle ground.

It turns out, unsurprisingly, that many of the people harboring extreme opinions about social assistance programs are the least informed about them. Very often, these people are ignorant of programs like work incentives for people collecting disability or even the general eligibility requirements for people to even qualify for, let alone collect benefits. Unfortunately, these less than educated opinions have very much worked their ways into the national political discourse and really colored the way people choose to pursue benefits to which they may be entitled.

The reality of the situation is that most people collecting benefits do not want to be on any form of public assistance, but need to be. Think of this objectively: in order to qualify for SSDI you must be out of work for twelve months or more, have a severe condition or conditions, not be able to physically or mentally (or both) maintain any work in your old field or a new one, and not have any substantial income. Earnings over $1,130, or $13,560 for the year, are considered “substantial” for 2016. You can have severe conditions and still not be approved. Not being able to find a job is not the same as being unable to maintain one and will not be considered the same way, if at all.

So, with an objective look at the eligibility requirements, we see that a person’s situation would already have to be pretty dire in order for them to qualify for SSDI, let alone actually collect it. Who has ever lived a full adult life without any real income, let alone with no earnings for multiple years? And this is even considering that SSDI is a type of insurance that anyone who has been gainfully employed has paid for themselves through their contributions to payroll taxes. A person would probably not be shamed for collecting on a renter’s policy for thefts from an apartment or billing healthcare costs to their health insurance, so why is it that they should be ashamed for attempting to collect SSDI?

The simple answer is that they should not. However, this is the way such benefits are often regarded in the United States.

But this is also a good reason to have a representative for your SSDI claim. Attorneys and direct-pay advocates have a number of responsibilities that should help anyone thinking of applying with the stigma aspect of the application. Most importantly, representatives are responsible for only representing individuals with legitimate claims for benefits. Doing otherwise may substantially prejudice an individual’s rights down the line which ultimately is a form of malpractice. Representatives can actually also help make the system more efficient by presenting completed files to the agency, making sure claimants stick to claim-related appointments, and concisely stating an individual’s case to the Agency, thereby eliminating administrative waste. And those are only a few of the advantages of having a representative for your SSDI  (or SSI!) claim.

If you are thinking about applying for benefits, or if you have received a denial and contemplating what to do next, use our contact form or give us a call at 1-866-262-8595.