Social Security Disability

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1 Social Security Disability What CPAs Need To Know Theresa Busher, Public Affairs Specialist x

2 Disability Review 2

3 Social Security Disability Programs Supplemental Security Income SSI or Title 16 Needs-based, for adults and children Arrives 1 st of the month Social Security Disability: SSD, SSDI, Regular Disability, Title 2, RSDI Includes Disabled Adult Child Benefits (draw from a parent s record) Checks arrive on a Wed or 3 rd of the month 3

4 Social Security s Definition of Disability-Age 18+ A physical and/or mental condition preventing substantial work for at least 12 months or expected to result in death Substantial work (SGA=substantial gainful Activity) is $1040 or more gross wages per month in $1740/month SGA if blind Different decision from other types of disability (employer, VA, Workers Comp) 4

5 SSI Essentials Benefits paid to application date (no retro) Max benefit in 2013 = $710/month For children: Parental income counts until age 18, as long as parent/child in the same home Non parental income (ie-grandparents) doesn t count Benefits paid through representative payee 5

6 SSI Eligibility- Income Earned income = wages or self-employment Unearned income = SSD, VA, unemployment, child support Free food/shelter can count as a form of income VA stipends to caregiver spouse are NOT counted as family income 6

7 SSI Eligibility- Resources Individual limit = $2000, couple = $3000 For children, we look at total parental resources, including Cash, bank accounts Investments (stocks, bonds, IRAs) Life insurance cash surrender value only We can exclude a car and home of residence 7

8 SSI is also based on Living Arrangements SSI benefit amounts may vary depending on where a child or adult lives In someone else s home (including with parents, if over age 18) In group care or supported living Institutions ie) you cannot receive SSI for any complete month of residence at the Domiciliary, Medical Center, or Nursing Home. 8

9 Social Security Disability (SSD) Based on work, not need Must have worked recently to qualify May be retroactive up to one year Qualifies you for Medicare after 24 months Rare for children under age 18 9

10 How Much Work Do You Need Based on credits For SSD? 1 credit=$1160 in 2013, up to 4 credits per year. So $4640 or above = 4 credits. Amount of credits needed depends on age Under 24: 6 credits in 3 years before disabled Age 24 31: sliding scale Over 31: 20 credits in 10 years before disabled 10

11 Your Dependents May Get Benefits If You Receive SSD Dependents = children under 18 or 19 if in high school Normally unmarried, and Benefits usually stop at high school graduation. No distinction between dependents with or without impairments until age 18 **Parent must be on Social Security OR be deceased for kids to draw** 11

12 What Do Dependents Receive? If parent is on SSD or retirement: eligible for up to 50% of worker s monthly benefit If parent is deceased: eligible for up to 75% of worker s monthly benefit amount In both cases, amount all children on worker s record have a Family Maximum 12

13 Another Form of SSD: Disabled Adult Child Benefits (DAC) Must be at least 18 with a disabling condition that occurred BEFORE age 22 Same definition of disability (ie-not performing work) Normally unmarried, and Must have parent who is drawing Social Security disability/retirement or is deceased 13

14 Disabled Adult Child Benefits Are Part of SSD Not need-based Same disability process as SSI/SSD If under age 18, earliest child can file for DAC is 6 months prior to 18 Otherwise, child files when Parent passes away Or parent goes on Social Security Disability or Retirement 14

15 The Application Process 15

16 Filing a Disability Claim : Age Call Social Security at to schedule an SSI appointment (in office or ph.) 2. Complete Social Security Disability Report online BEFORE appointment at 3. Complete SSD application online BEFORE at 4. Print confirmation letter for your records 16

17 If Age 18+: All Adults Screened for SSI & SSD Claimant may receive a denial notice If not enough credits (uninsured) for SSD If income/resources too high for SSI Any help you can give the vets in supporting them through the process is great! 17

18 The Disability Determination Division (DDD) 18

19 Disability Determination Process Ohio claims are sent to the Disability Determination Division (aka DDD or BDD) in Columbus Most cases decided within 120 days of initial claim contact We will send any evidence provided by claimant with electronic file to Columbus. No evidence needed to start the process, but lack of records may = consultative exam. 19

20 5 Steps of Sequential Evaluation Engaging in Substantial Gainful Activity (SGA) commonly known as work? Does the person have a severe impairment? Does the impairment meet or equal the listings? Does this prevent past work? Does this prevent other work? 20

21 What information are we looking for? Dates of treatment Diagnosis and capability statement Recent physical and mental exams Progress Notes and/or Nurses Notes IP and ER stays Any available test results Description of functional limitations due to symptoms 21

22 Fast Track Unit began August 2005 Specialized unit designed to expedite claims Specific to Ohio Has since processed over 11,800 claims Goal: Complete medical decision in 20 days Average processing time currently 10.1 days SSA field office claims representative identifies potential claims and Fast Track supervisor selects these priority claims 22

23 Compassionate Allowance CAL National SSA Program began 10/08 No time goal but expediencies still apply claims processed; 20.7 day average Can be flagged CAL at any claim level Claims can be added to CAL by adjudicative staff Currently, a list of rare diseases, cancers and other life threatening conditions are included in CAL program. See more at 23

24 Fast Track/CAL Examples Acute Leukemia Down s Syndrome Chronic dialysis ALS (Lou Gehrig s Disease) Low birth weight infants Comatose x 30+ days Quadriplegia/Paraplegia Metastatic or terminal cancers Recent transplant (heart, lung, liver, kidney) 24

25 Military Casualty/Wounded Warrior Individuals serving on active duty on or after October 1 st, Note: Veteran does not have to have deployed. Any allegation is eligible (does not have to be service-connected) National program; no time limit for adjudication but are priority claims Fax reports or other records directly to Fast Track ( or ) 25

26 If Claim is Denied Denial letter is sent via old-fashioned mail 60 days to appeal each level: Reconsideration (back to Columbus) Administrative Law Judge Hearing Appeals Council Review (Falls Church, VA) US District Court File appeal at 26

27 If Approved 27

28 If Claim is Approved: SSI Benefits are paid back to the first full month AFTER the month of filing No dependent benefits payable Income/Resources verified for parents/child Living Arrangements verified Does SSI recipient pay rent or give money towards household expenses? 28

29 SSI is also based on Living Arrangements The following questions will be asked: Does the adult pay any rent? Is the rent amount of a reasonable, current value? Is the adult in a separate household? Max. amount you can receive with SSI may be around $450/month if you are in a subsidized living situation. 29

30 Re-determinations Continue with SSI Updates on Income/ Assets Holding Out Spouse : considered married, even if not legal spouses Work or other income must be reported Resources can t top $2000 Living Arrangements Still in your own household or living with others? Do you pay for a fair share of expenses? Can change over time Normally completed every 6-12 months 30 30

31 If Claim is Approved: SSD Benefits paid 5 months after disability onset (usually month when work stopped) Average benefit = aprox. $1100 per month No ongoing issues of resources, other income, living situation as with SSI Dependent benefits may be paid to children Medicare will kick in after 24 months 31

32 Can you get both SSI and SSDI? Yes, depending on the amount of SSDI If you are eligible, you must apply for and accept SSDI benefits SSI supplements up to $730 ($710 + $20) For 2013, $730 total ($710 + $20) in combined SSI/SSD SSI pays on the 1 st of the month, SSDI on the 3 rd or on Wednesdays (2 nd, 3 rd or 4 th Wed of month) 32 32

33 Direct Deposit A Must New beneficiaries must give direct deposit info or. 1. Get a Direct Express Card 2. Establish an ETA Account with a local bank (low cost account for federal benefit monies) 33

34 Continuing Medical Reviews Regular medical reviews are conducted based on likelihood of impairment improving Ex: possible improvement = 3 to 5 years Reviews currently are sent via snail mail, then completed with Ohio DDS in Columbus Claimant must complete! All children getting SSI are medically reviewed at age 18. Work/fraud referrals can also trigger. 34

35 Work Issues 35 35

36 Work Incentives: SSI Basics Key to remember: all months of work affect the monthly SSI payment! $20 general exclusion (if no other income) Wages: $65 plus 1/2 of remaining wages are excluded per month Can earn up to $1505/month and still receive some SSI if wages are only type of income Under 1619(a) and 1619(b) Medicaid provisions, full Medicaid normally continues with SSI and 36 work 36

37 Work Incentives: SSDI Or DAC Basics Trial work period Trial work month if earnings over $750/month 9 month period, can be non-consecutive Can receive wages and full benefits After 9 month period, we are looking at the ability to continue performing Substantial Gainful Activity (SGA) SGA 2013= $1040/month non-blind or 37 $1740/month if blind 37

38 More Work Incentives: SSDI/DAC Extended Period of Eligibility After a 9 month trial work period Can go on and off of benefits each month Lasts for 3 years Continuation of Medicare 7 ½ years as of October 2000 States can increase that option So you could work forever under SGA and keep all SSD/DAC benefits 38 38

39 More Work Incentives: SSDI/DAC Employment Subsidy Beneficiary is receiving support from employer that results in more pay than the actual value of services being performed by employee Subsidy=provided and verified through employer Special Conditions Similar to Subsidy, but provided by employer or someone other than employer (ie-job coach, BVR, etc) 39 39

40 Work Incentives: SSDI and SSI Impairment Related Work Expenses Worker-paid expenses needed to maintain a job Must relate directly to disabling condition Disabled worker must be paying out of pocket, not reimbursed by another source Examples: Seeing Eye Dog or aid animal Some RX drugs Adaptive equipment Personal Attendant 40 40

41 Work Incentives: SSDI and SSI Expedited Reinstatement of Benefits can restart benefits after work cessation Up to 6 months of temporary benefits Must be the same disabling condition Recovery during Vocational Rehab=no medical cessation 41 41

42 Social Security Resources Local offices open 9am to 3pm, except Wednesdays, 9am to Noon from 7am to 7pm 42 42

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