SSA announces 1.7% Cost of Living Increase for 2015

Cost of Living Adjustment (COLA) was announced recently for 2015 benefits.  According to the SSA website:

Based on the increase in the Consumer Price Index (CPI-W) from the third quarter of 2013 through the third quarter of 2014, Social Security and Supplemental Security Income (SSI) beneficiaries will receive a 1.7 percent COLA for 2015.

Part B premium for Medicare will remain unchanged for 2015.  This link provides further details and comparisons of 2014 and 2015 Medicare costs.

Information for Wounded Warriors and Veterans Who Have a Compensation Rating of 100% Permanent & Total (P&T)

I recently read an interesting post on Social Security’s website about disability.  The disability process has an “expedited process” in certain situations, although normally it is a very narrow window of opportunity to be eligible.  Recently the Social Security Administration announced that “Some Wounded Warriors and Veterans Who Have a Compensation Rating of 100% P&T are unaware that Social Security may expedite the processing of their disability claims.”

For more information and to read the complete article go to http://goo.gl/IGqGCZ

SSDI: The truth behind media and political mischaracterizations – a commentary by NOSSCR’s Executive Director Barbara Silverstone

The Social Security Disability Insurance (SSDI) program is an integral part of the Social Security system that provides vital economic security to workers and their families. SSDI provides modest but essential coverage that American workers earn, and protects against the economic devastation that often accompanies life-changing disability. Unfortunately, recent media coverage (including recent opinion pieces in The Hill) has painted a highly inaccurate picture of this program, in an effort to encourage damaging changes that would hurt people with disabilities.

Eligibility criteria for the SSDI program are extremely strict and only people with the most significant disabilities qualify for benefits. An applicant must prove with medical evidence the inability to engage in “substantial gainful activity” (defined as earning less than $1,070 monthly in 2014), due to a physical or mental impairment expected to result in death or last for at least one year. Most applicants are denied; only about 40% are approved, a fact which belies claims that there is a “systematic bias” toward approving applicants who are not actually disabled.

People with disabilities turn to the program as a last resort, often having attempted to continue working after it is no longer healthy to do so and having spent down their savings before applying. There is no evidence that people are leaving the labor force to receive SSDI. While it is true that SSDI applications increased during the recent economic downturn, approval rates also declined. In fact, the current approval rate is the lowest it has been in 40 years.

Growth in the SSDI program has long been predicted by the Social Security Chief Actuary and is due almost entirely to two demographic factors: the aging of the baby boomers and women entering the workforce. According to the SSA, program growth has peaked and is projected to level off.

The SSDI program is complex so it is not surprising that many applicants choose to retain a representative, given the importance of the outcome. Having an experienced professional provide assistance is valuable for people with disabilities. Representatives help ensure that applicants provide SSA with all relevant medical evidence and help the agency make the right decision as early in the process as possible. SSA’s policies and procedures to regulate representatives do a good job of dealing with the very small number of representatives who violate the rules.

Notably, Congress has not uncovered any evidence of fraud in the SSDI program beyond the cases SSA itself uncovered, after several years of investigation. Nor has Congress found any evidence that people who should not be eligible are wrongly approved. Senator Coburn has been quoted on the topic and appears to mischaracterize what his 2012 investigation actually found. That investigation reviewed only 300 appeals decisions from just 3 counties, and his staff questioned the quality of about 25% of the written decisions but did not claim the decisions were wrong. In fact, the investigation did not find that a single individual was approved who should have been denied.

The Social Security Administration does a good job of identifying potential fraud in the program, despite its woefully inadequate recent funding levels and resources. SSA’s administrative budget is only about 1.4 percent of benefits paid out each year. However, Congress has provided nearly $1 billion less than requested over the past three years. SSA’s program integrity work has suffered too, receiving $421 million less than authorized over the last two years. The result? SSA has lost more than 11,000 employees since 2011 – a heavy blow to the agency’s ability to serve the American people.

If Congress is serious about protecting the integrity of this program, it should start by providing SSA with adequate funding to do so. It should enact H.R. 4090, the Social Security Fraud and Prevention Act of 2013, introduced by Representative Xavier Becerra (D-CA) earlier this year. It would provide SSA with dedicated mandatory funding for program integrity activities, strengthen fraud detection activities, and increase penalties for people convicted of exploiting the program.

The SSDI program does not need significant changes. It has provided economic security to workers who become disabled, and their families, for more than 50 years. But Congress does need to enact legislative changes to secure the future of Social Security and prevent cuts for SSDI beneficiaries in 2016. A rebalancing of the Old Age Survivors Insurance and Disability Insurance trust funds through reallocation of the payroll tax going into each of the funds, approved by Congress multiple times in the past, would account for demographic shifts and solve short-term funding gaps. This program is a key piece of our national social insurance infrastructure and it needs to be kept strong for current and future generations.

Silverstone is executive director of the National Organization of Social Security Claimants’ Representatives. Previously she served as staff attorney for NOSSCR for more than 20 years.

The article can also be accessed on The Hill’s site: http://thehill.com/blogs/congress-blog/healthcare/215601-ssdi-the-truth-behind-media-and-political-mischaracterizations

Social Security Extends Access to Benefit Verification

On Thursday, July 17, 2014 the Social Security Administration announced that local Social Security offices would continue to provide benefit verification letters until further notice. Providing services when and where the public needs them remains central to Social Security’s efforts, while continuing to encourage federal, state, and local agencies to take advantage of Social Security’s data exchange programs that can serve customers more efficiently and effectively.

“We appreciate the feedback from members of Congress, our community stakeholders and agency partners. We want to ensure that we meet the needs of our customers in a way that is convenient for them and also cost-effective and secure for all,” Acting Commissioner Carolyn W. Colvin stated. “I believe that government agencies can work closer together to assist our mutual customers.”

Over the last few years, Social Security has invested in technology that allows most government agencies and many other organizations to verify their clients’ Social Security benefits electronically without requiring them to visit a local Social Security office.

“We recognize that some members of the public may require in-person assistance and we will have a presence in local communities,” said Acting Commissioner Colvin. “We also want to ensure that the public is aware that they can access many of our services without making a trip to a local field office.”

Members of the public with Internet access can obtain benefit verification information by creating a my Social Security account at www.socialsecurity.gov/myaccount.

Verifying your clients’ Social Security benefits is easy! This YouTube webinar is designed for advocates, social service agencies, and other third parties to help promote the use of Social Security’s online service options.

“APPLY RIGHT” – To Apply for Social Security Disability – Make it Easy on Yourself!

I am an attorney. I have handled Social Security Disability cases for over 25 years. At times, I encourage potential clients to apply on their own as the case sounds solid – I do this to save them money from paying me, or another lawyer, and sometimes they call back to say “It worked! Thank-you.”

Sadly, many others call back to say “I was denied.” To prevent that, I now provide this link to this reasonably priced book: http://www.amazon.com/gp/product/B00AX3Q0KI/ref=cm_cr_rev_prod_title . The amount of information, expertise, wisdom and knowledge that has been shared by Tomasz is mind-boggling. The depth of his experience and his willingness to share it in this book provides an excellent tool.  

The color photos are excellent. There are excellent suggestions on how to answer questions that one would have dismissed as unimportant or answered from the wrong angle.

SSA has made it convenient to apply from the comfort of your home, or another’s home. You can save your work if you need more time or don’t have enough information. http://ssa.gov/pgm/disability.htm

This book is a must for anyone that applies – whether there case is rock solid or iffy – there is just no reason not to use this tool.

SGA, TWP and Other Important Numbers

Just as benefits increased in 2013, so too did the amount for SGA (substantial gainful activity).  This is perhaps the most misunderstood amount when people speak of disability.  Many believe they can make this much money and keep their disability.  The truth is that the amount is the gross wages per month, which for 2013 is $1,040 for non-blind persons and $1,740 if you are blind.  The problem comes if you are paid every two weeks – you will go over in the months you receive 3 paychecks when you had been planning on 2 checks per month to keep you under.

But wait!  TWP (trial work period) refers to amounts earned during a specific time frame.  One can both work and receive benefits, but upon successful completion of the TWP, benefits cease!  For 2013, the amount that triggers a TWP analysis is $750 … almost $300 less than SGA!  People often get these amounts confused, and this information is just the tip of the iceberg.  For further information on TWP, go to http://www.socialsecurity.gov/OACT/COLA/twp.html

Social Security Disability: Who Is Eligible?

The following article written by Thomas E. Bush is provided courtesy of JamesPublishing.com

Examples of who is disabled under social security law, and advice on dealing with SSA.

by Thomas E. Bush

Excerpted from Social Security Disability Practice


You cannot always rely on common sense to tell you who is and who is not disabled under social security law.

Examples

Lawyer

  • He is 35 years old with 10 years of trial experience.

  • He is not working, but he is looking for a job.
  • He lost his left foot in a car accident a year ago.

Because of stump complications, he is unable to use a prosthetic device to walk one block at a reasonable pace, though he uses it to walk shorter distances, e.g., around an office or around his apartment. When he goes longer distances, he rides a motorized scooter.

He is disabled. See C.F.R. Part 404, Subpart P, Appendix 1, §1.05B.

 

Bookkeeper

  • He has a college education.
  • He is a quadriplegic with only limited use of his right hand and arm and no use whatsoever of his legs and left arm.
  • He uses an arm brace to write.
  • He works a few hours per day as a bookkeeper and earns, after deductions for expenses related to his impairment, about $900 per month on average.

Because of his earnings he is not disabled. See 20 C.F.R. §§404.1520(b) and 404.1574(b)(2).

 

Construction Worker

  • He is 48 years old.
  • He has done heavy unskilled construction work since age 16.
  • He has a fourth grade education and is capable of reading only rudimentary things like inventory lists and simple instructions.
  • He has a “low normal” I.Q.
  • He is limited to sedentary work because of a heart condition.

He is not disabled unless he has some additional limitations. See 20 C.F.R. Part 404, Subpart P, Appendix 2, Rule 201.18.

 

Machine Operator

  • He is 38 years old.
  • He has done medium exertion level unskilled factory work, operating a machine since he graduated from high school.
  • A cardiovascular impairment limits him to sedentary work, and a permanent injury of the right hand limits him to such work not requiring bimanual dexterity.

He is probably disabled. See Social Security Rulings 83-10 and 96-9p.

 

Truck Driver

  • He is 61 years old.
  • He worked as a truck driver all his life except that 10 years ago during a downturn in the trucking industry, he worked for 1-1/2 years at a sedentary office job which he got with the help of his brother-in-law.
  • He is limited to sedentary work because of a pulmonary impairment.

He is not disabled because he is still capable of doing the office job. See 20 C.F.R. §§404.1520(f) and 404.1560(b).

 

Packer

  • He is 50 years old.
  • He has a high school education.
  • He has done unskilled light exertion factory work as a packer for the past 30 years.
  • He had a heart attack on January 1 and, after being off work for eight months, he recovered after an angioplasty. His cardiologist gave him a clean bill of health and was ready to send him back to work when he broke his leg in a fall unrelated to his heart condition. In a cast and unable to stand and walk as required by his job, he could not return to work until February. He was off work a total of 13 months.

He is not disabled for the time he was off work. 20 C.F.R. §404.1522(a) provides that unrelated impairments may not be combined to meet the requirement that a claimant be unable to work for 12 months.

 

Housewife

  • She is 55 years old.
  • She has an eleventh grade education.
  • She has not worked in the past 15 years. Before that she was a secretary.
  • She has a back problem diagnosed as status post laminectomy.
  • She is limited to maximum lifting of 50 lbs. with frequent lifting of 25 lbs., is capable of frequent bending, stooping, etc., and has no limitation for standing or walking.

She is disabled for the SSI program as long as she meets the income and asset limitations for that program.See 20 C.F.R. Part 404, Subpart P, Appendix 2, Rule 203.10. See also 20 C.F.R. §404.1562(b). (She is not eligible for social security disability benefits because she has not worked for so long.)

§108     SSA: A Bureaucracy

For the most part, attorneys deal with SSA’s Office of Disability Adjudication and Review (ODAR), which includes the more than 140 hearing offices scattered around the country, and, until it is transformed into the Disability Review Board under the DSI program (see §150.1), the next level of appeal, the Appeals Council, which is located in a suburb of Washington, D.C. In all, ODAR has about 8,000 employees, including about 1,150 administrative law judges and 27 administrative appeals judges. Dealing with hearing offices is generally a pleasant experience. Although dealing with the Appeals Council can be frustrating for attorneys, it is nothing compared to dealing with SSA outside of ODAR.

There is a rigidity of rule-following, whether or not application of the rule makes any sense, which characterizes the approach of low-level bureaucrats. This problem exists in all bureaucracies and is present at SSA, for the most part outside of ODAR. It is something that has been known to cause both claimants and lawyers to tear out their hair. To deal with this, you will find that it is best to be firm and persistent but never obnoxious.

For example, do not let anyone at SSA tell you that they cannot speak with you about your client’s case because they do not have proof that you are the claimant’s attorney. Pub.L. 101-239, Title X, §10307(a)(1), (3), Dec. 19, 1989, 103 Stat. 2485, effective June 1, 1991, requires SSA to keep the name of a claimant’s representative in its computer system. If SSA fails to put your name into the computer as the claimant’s representative and an SSA employee refuses to speak with you, you may fax a copy of your Appointment of Representative form to the local office. Insist that the SSA computer system be updated with your name as the claimant’s representative.

A fundamental problem in dealing with SSA outside of ODAR is, of course, the sheer size of the agency, which has more than 57,000 employees in addition to those employed by ODAR. Also, there are more than 14,000 state agency employees nation-wide involved in making determinations of disability below the ALJ hearing level. It is difficult for a lawyer first to figure out whom to contact about a claimant’s particular problem and then to determine how to contact them, whether by phone, fax, mail or, in some limited circumstances, e-mail. Once you figure it out in a particular case, be sure to keep good notes for that particular case; and also start keeping a master list of telephone and fax numbers and addresses for use in future cases. You will discover that there are knowledgeable and helpful people at all levels of SSA. You will do well to cultivate a relationship with them. Treasure their phone numbers.

The problem of SSA’s size is compounded by the complexity of its programs, the most complicated of which are the two disability programs, social security disability and SSI. When there are program changes, it is a huge task to ensure that everyone within SSA who needs to know gets the information, and often they do not. Sometimes it will be up to you to tell SSA employees about policy changes.

To take just one example of problems created by complexity, consider the Social Security Administration’s nationwide toll-free telephone number, 1-800-772-1213 (which SSA likes to write as 1-800-SSA-1213). In theory, the toll-free number is staffed by knowledgeable SSA employees capable of answering a wide variety of questions, including questions about entitlement to disability benefits. However, this is not the reality. One test showed 25 percent wrong answers to questions involving SSI, by far the most complicated of SSA’s programs. The toll-free number, if you can get past the busy signals and the recorded messages, is most useful for information about the retirement program, not for questions that a lawyer might have about disability benefit entitlement.

SSA, like all bureaucracies, attempts to routinize complex decisions; however, the more complicated the decision, the less effective this is. It does not work well at all for disability determinations below the administrative law judge hearing level because the medical-vocational issues tend to be complicated and because state agencies are not equipped to assess the actual impact of a medical impairment on a particular claimant, which often involves a credibility determination. State agency disability determinations tend to be inadequate, and many people within SSA remain almost blissfully unaware of state agency decision shortcomings. For example, studies using SSA’s own peculiar methodology repeatedly conclude that state agency determinations are correct more than 93% of the time. Such studies are unable to explain why ALJs have always found disabled more than half the claimants who come before them. These studies have led many state agency employees to believe that ALJs issue mostly wrong decisions, and there is a component within SSA (outside of the Office of Disability Adjudication & Review) that thinks so, too.

It is a mistake to view SSA as being of one mind. For example, there are those within SSA who think that disability determination would be improved by getting rid of lawyers, administrative law judges, due process hearings, and appeals. Thus, there is a component of SSA that is opposed to the very existence of the Office of Disability Adjudication and Review. This tension between different components of SSA tends to produce turf wars and, whenever restructuring of SSA is going on as it has been for the past several years, a search for hidden agendas is made to see if this or that bureaucratic change will ultimately be a benefit or detriment to the future of a particular component of SSA.


   

Thomas E. Bush has devoted his practice to social security disability issues since 1977.  He was elected to NOSSCR’s Board of Directors in 1988, and was President of NOSSCR for the 1997-98 term.  He is the author of Social Security Disability Practice, from which this article is excerpted.

Updated 07/30/12

Social Security Offices to Close to the Public a Half Hour Early Each Day and at Noon on Wednesdays

According to a recent press release from the Social Security Administration:

“Effective November 19, 2012, Social Security field offices nationwide will close to the public 30 minutes early each day.** For example, a field office that is usually open to the public Monday through Friday from 9 a.m. to 3:30 p.m. will close daily at 3:00 p.m. In addition, beginning January 2, 2013, offices will close to the public at noon every Wednesday.

While agency employees will continue to work their regular hours, this shorter public window will allow them to complete face-to-face interviews and process claims work without incurring the cost of overtime. The significantly reduced funding provided by Congress under the continuing resolution for the first six months of the fiscal year makes it impossible for the agency to provide the overtime needed to handle service to the public as it has done in the past.”

The release went on to say “Most Social Security services do not require a visit to a local office. Many services, including applying for retirement, disability or Medicare benefits, signing up for direct deposit, replacing a Medicare card, obtaining a proof of income letter or informing us of a change of address or telephone number are conveniently available at www.socialsecurity.gov  or by dialing our toll-free number, 1-800-772-1213. People who are deaf or hard of hearing may call our TTY number, 1-800-325-0778. Many of our online services also are available in Spanish at http://www.socialsecurity.gov/espanol/.”

Social Security to Add Adult Huntington’s Disease to Compassionate Allowances Program

The Social Security Administration will add symptomatic Huntington’s Disease to its Compassionate Allowances program for adults by the end of the year. The expedited disability process will identify people with significant symptoms of this devastating neurological disease. Adult Huntington’s Disease will accompany the designation of Juvenile Huntington’s Disease as a Compassionate Allowance condition, which will be effective next month.

“Woody Guthrie, the composer of ‘This Land is Your Land,’ among hundreds of other folk classics, suffered and died from Huntington’s Disease, a progressive and always fatal disease of the brain that affects nearly 30,000 people in the U.S.,” said Michael J. Astrue, Commissioner of Social Security. “Tomorrow, July 14, would be his 100th birthday and thus it is a fitting time for this announcement.”

Compassionate Allowances are a way of quickly identifying diseases and other medical conditions that invariably qualify under the statutory standard for disability. The Compassionate Allowances program fast-tracks disability decisions to ensure that Americans with the most serious disabilities receive their benefit decisions within days instead of months or years.

For more information on the Compassionate Allowances initiative, please visit www.socialsecurity.gov/compassionateallowances.