Filing a request for a Reconsideration

Some states (including New York) have no Reconsideration phase. In these states, you must file a Request for Hearing before an Administrative Law Judge.)

If you are denied benefits at the initial level, you should appeal as soon as possible (within 60 days of the date on the denial notice). In most states, you do this by sending a letter to SSA telling them that you disagree with the decision or filling out a Request for Reconsideration (SSA-561)and mailing it to SSA.

The Reconsideration is a waste of time. In more than 90-percent of the cases SSA upholds the original decision. If you live in a state that requires the reconsideration phase, file the appeal and don’t submit any additional medical evidence. That will result in a quick denial which will allow you to request a hearing before an Administrative Law Judge.

Supplemental Security Income (SSI) Explained

SSISupplemental Security Income, commonly known as SSI, is a needs-based program that provides a monthly check to persons who are blind, over age-65, or have a disability haven’t worked enough in the recent years to qualify for SSDI (Social Security Disability Insurance). Continue reading

SSA Claims Representative tells a claimant that she cannot refuse to apply for federal welfare

Accept Or Refuse Directions On A SignpostSSA Claims Representatives are required to take Supplemental Secutity Income (SSI) claims from all applicants for Social Security Disability benefits unless the applicant (aka claimant) states that they don’t want to apply for the federal welfare program

This past April one of my clients applied for Social Security Disability benefits and was interviewed by a Claims Representative at the Albany, NY District Office. Prior to her interview I advised the client not to apply for SSI because her husband’s income made her ineligible. I instructed her to tell the Claims Representative that interviewed her that she did not want to file a claim for SSI, and that she wanted to apply for SSDI only.

The client’s husband was present at the interview. He told me that his wife repeatedly told the Claims Representative that she did not want to apply for SSI and, per my instructions, that she wanted to apply for SSDI benefits only.

The Claims Representative refused to take “no” for an answer. Instead he badgered the client into filing an SSI claim* by implying that it was a legal requirement of the disability application process, and that I knew that. Both statements are patently untrue.

There is no legitimate reason to take an SSI claim from an individual who is clearly ineligible for benefits – and there is no excuse for taking an SSI claim from an individual who clearly states that they do not want to apply for the federal welfare program. That is unconscionable, and I suspect that this is routine behavior for the Claims Rep that interviewed my client.

The SSA employee’s misconduct has been reported to his superiors, however it remains to be seen if he will be held accountable for his actions.

* The SSI claim was immediately denied

Applying for Social Security Disability benefits (SSDI)

What is SSDI?

SSDI stands for Social Security Disability Insurance. SSDI is an insurance program for disabled people who have worked “on the books” and paid FICA taxes for a certain number of calendar quarters. SSDI pays a variable monthly benefit amount, which depends on your work history. Payments begin after a 5-month waiting period from the time of disability. SSDI is administered by the Social Security Administration (SSA).

How long does it take to start?

It is to your advantage to file for benefits as soon as you become disabled. However, you must be disabled for five full months before you become entitled to SSDI. You will receive your first benefit payment for the sixth month of your disability. You do not receive SSDI benefits for the waiting period.

These are terms you need to know:

Date of Onset

Your “date of onset” is considered the first day you are unable to work because of your disability. The date of onset may or may not be the same as the date you were diagnosed. Applicants usually use the day they last worked as the date of onset.

Note: If you had periodic absences from work caused by your disabling condition be sure to mention that on your application because that can affect your date of onset.  For example, if you stopped work in January 2013, returned to work in March 2013, and then stopped work again in July 2013, your “date of onset” would be January 2013 because the time you spent on the job from March through June 2013 would be considered “an unsuccessful work attempt.”

Month of Entitlement

Your “month of entitlement” to SSDI will be that month which is five full months following your last day of work (your sixth month of disability). For example: If you last worked on January 5, 2005, your month of entitlement to SSDI will be July 2005.

Past Due Benefits

If your disability began (and you were unable to work) more than six months before you applied for SSDI, you may be eligible for “past due benefits.” Applications for SSDI can be retroactive up to 12 months from the date of application.

What happens if I don’t apply right away?

Sometimes people apply for benefits many months after they stop working. This does not change the eligibility date, but it may effect when your first benefit payment will arrive. For example, if you become disabled and unable to work on January 1, your date of onset is January 1. If you apply for SSDI benefits in January, your month of entitlement to SSDI and your first benefit payment will be for June. The check for June will arrive in July.

A person who is disabled on January 1, but waits to apply until June or July (or even later) is already eligible to receive SSDI benefits (because he/she has been disabled for 5 full months). However, since the application has to be evaluated, processed and approved (which normally takes at least 90 days), the first check may not be received until September or later. This person, though, will be able to receive a separate check covering the time from the month of entitlement (June) to the date of the first check (September). That is called the “past due benefit.”

Remember: The month of entitlement is the month following 5 full months after your date of onset (last day you worked).

How are SSDI benefits calculated?

SSDI benefits amounts are determined by a formula which takes into account your age and earnings record. This formula allows for yearly increases in the level of individual benefits in order to reflect adjustments in the cost of living. The amount of your benefits will be based upon your average earnings for all of the years you’ve been working, not just your most recent salary.

There is no minimum SSDI benefit amount. Your monthly benefit will be based on your earnings record. If you receive only a small SSDI benefit, however, and you don’t have a large amount of savings or other assets/resources, you may be eligible for some Supplemental Security Income (SSI) benefits in addition to your SSDI benefit.

SSDI beneficiaries may receive additional unearned income and have unlimited assets/resources. Unearned income you may receive includes private disability payments from an insurance policy or short-term and long-term disability coverage from your employer.

How do I file an application?

You can call your local Social Security Office for an appointment to file a claim. WARNING: do not walk into a local office and expect to file a claim. You may wait an hour or more to speak with an SSA Representative, who will tell you that you must make an appointment.

Social Security also has a toll-free telephone number — 1-800-772-1213 — that you can call to begin your claim.

Tell the SSA (Tele-Claim) representative that would like to apply for Social Security Disability Benefits.

The Tele-Claim representative will ask you some basic questions (name, address, date of birth) as well as some questions about your disability.

What happens next?

The Tele-Claim representative will refer your claim for SSDI benefits to your local Social Security District Office. A Claims Representative will call you back at a later date (usually within two weeks) to complete the applications over the telephone. Be sure to get the name and telephone number of the Claims Representative with whom you speak and the date and time of any calls. You should also ask for the address of your local Social Security District Office for your records.

Note: When you are contacted by your local Social Security Office ask them to provide you with a “Benefit Estimate,” that’s the amount of money you will be paid per month if your claim is approved.

What will I be asked?

In addition to basic demographic information, the Social Security Claims Representative will ask you questions about your disability. The most important question is about the date you last worked because of your disability. It is best to use the earliest date possible. SSA can often establish an earlier date of disability onset if you were in and out of work because of illness.

Required application documents.

Social Security will tell you which documents you will need to submit with your claim.

* birth certificate, passport, baptismal certificate or school records, etc.
* social security card
* W-2 for last year or income tax return (1040) or Schedule SE, if you are self-employed
* your last pay stub for all jobs for the current year.

WARNING! SSA has a policy of taking unnecessary claims for Supplemental Security Income (SSI), which is Federal Welfare. When a Federal Welfare claim is taken in conjuction with an SSDI claim, it can delay the payment of your past due benefits for six months or more…Read More

DO NOT answer any questions about your income, savings, etc. until you ask the Claims Representative  the purpose of the questions. If you’re told it’s for a Supplemental Security Income (SSI) claim, do not answer any questions until the Claims Representative (aka CR) gives you a clear explanation of how income and resources affect the payment of Supplemental Security Income.

If the CR tells you that you must file a claim to find out — ask to speak to a supervisor.

What happens next?

Social Security will mail the completed application to you for review, corrections and signing. Be sure you check the forms for accuracy before signing. You should initial next to any changes you may make on the applications they send you.

Included with the applications is a Disability Report The Disability Report will ask for the names, addresses and telephone numbers of all doctors, hospitals and clinics that have medical information on your disability.

 

Where do I send my applications?

Once you have gathered the requested documentation and you have completed and reviewed your applications, make photocopies of everything to keep for your records.

A return envelope with the address of our local Social Security District Office will be included with the applications sent to you. Enclose the original application and the original documenting proof that is requested.

When Social Security receives the application, they will photocopy the original documents and mail them back to you. If more information is needed, they will write you.

What is the medical determination?

SSDI claims are reviewed for a medical determination of disability by the New York State office of Disability Determination Services (DDS). The determination is based on medical information from your doctors, hospitals or clinics which you have been to for treatment.

The Office of Disability Determination Services (DDS) will request the medical records from your doctors, hospitals or clinics.

WARNING! They will also send you a questionnaire regarding your daily activities, how you spend your day, do you cook, do you drive, etc. Answers to these questions can  and will be used against you, so be sure your answers focus on the effects your disabling condition have on your ability to engage in your day to day daily activities.

Note: You can also choose to ignore the questionnaire. DDS determinations are based upon your medical reports.

How long does the processing of my claim take?

It may take three to six months for a decision to be made on your SSDI claim. Once the medical determination of your disability has been made, Social Security will notify you in writing as to whether or not your claim has been approved. SSDI will also inform you of your month of entitlement to SSDI benefits, the amount of your monthly benefit, and when you will receive your first benefit payment.

Remember: Given the time it takes to process a claim, it is best to apply for SSDI as soon as you have stopped working because of a disability.

How will I be paid?

SSDI benefit payments are based on your date of birth. If you were born during the first week of the month, you will be paid on the first Wednesday of each month and so on.

What if my claim is denied?

Don’t panic! It’s just the nature of the system. The majority of initial claims for Social Security Disability Benefits are denied. Fight back! Send a letter to your local Social Security Office stating that you disagree with their decision and want to file an appeal — and be sure to request a copy (CDR) of your disability claim, so you can review it.

How long does an appeal take?

Here, in the Capital region of upstate New York, it can take an average of 15-months for a hearing before an Administrative Law Judge to be scheduled — and 6 to 8-weeks to receive a decision. However, it is often possible to expedite a disability claim by requesting a decision based upon the written evidence in file — commonly know as an OTR (on the record).  In order to obtain a successful OTR decision, there must be enough medical evidence in file to prove that the claimant is disabled without the need for further information.

See How to appeal a denied disability claim for more information.

Just Say No to SSI

The Social Security Administration’s Supplemental Security Income (SSI) program is a federally funded assistance program provided for individuals who are aged, disabled, or blind and have limited income — it’s federal welfare.

The Social Security Administration has a policy of requiring their claims representatives to take Supplemental Security Income (SSI) claims from all applicants for Social Security Disability Insurance benefits (SSDI) — whether they were eligible or not.

SSA Claims Representatives(CRs) do not provide the applicant with the information necessary to make an informed decision regarding the decision to apply for SSI.  CRs will often tell applicants that it is a requirement of the disability applications process — that’s a lie. There is no SSA regulation requiring an applicant to apply for SSI when they apply for Social Security Disability benefits.

There is no legitimate reason for taking a federal welfare claim from an individual who is clearly ineligible. They are denied immediately, and the only purpose of these bogus claims to reduce — on paper — the average processing time for initial disability claims. A bonafide SSDI claim takes about 100 days to process.

When an SSI claim is taken in conjunction with an SSDI claim, it results in a hold being placed on the release of any past due SSDI benefits until the local Social Security office tells the SSA payment center if any SSI payments were made. The purpose of the hold is to prevent claimants from being paid by both programs for the same time period.

And that’s where the system grinds to a halt. As a direct result of overloading the system with unnecessary claims the payment centers cannot process the release of past due benefits in a timely manner.

A 2011 report by the Social Security Administration Office of the Inspector General concluded that the average length of time that SSA withheld past due benefits was over 3.5 years, and often went unpaid for as long as 10 years after they were due. Read the full report here

SSA officials are aware of the delays brought on by their indefensible bogus claims policy; they don’t care, and disabled beneficiaries suffer for it.

DO NOT SIGN an application for Supplemental Security Income (SSI) until the Claims Representative explains to you how your income and resources would affect the claim.

If the Claims Rep tells you they can’t do that unless you file the claim, ask them to “put that in writing.”

For a detailed discssion of SSA’s scam read FUBAR: SSA’s dysfunctional disability claims process

FUBAR: SSA’s Dysfunctional Disability Claims Process

The Social Security Administration–SSA should be the first line of defense for American workers who become “involuntarily retired” because of illness or injury; but there is nothing “social” or “secure” in the way the administration functions today.

About 43 million people visited SSA Field Offices for assistance in 2007. Since that time SSA Field Offices continue to receive more and more customers. This year SSA Field Offices are expected to see more than a million more customers than last year; and officials estimate they’ll receive 3.3 million new disability claims over the next year.

SSA administers two program for disabled individuals. Title II is Social Security Disability Insurance (SSDI), which is funded by a worker’s contribution to
FICA
, and Supplemental Security Income (SSI)) which is a Federal Welfare program administered by the Social Security Administration.

Social Security disability backlogs are at an all-time high, with the average wait time lasting 499 days and in some regions upwards of 700 days. At the same time, the Social Security Administration (SSA) staffing levels are at their lowest levels since 1972. According to SSA’s Budget Appendix for FY 2009, SSA’s civilian full-time staff employment for Fiscal Year 2009 will essentially remain unchanged, leaving it at this low level.(1)

All this translates into unreasonable delays in Social Security disability claims processing, with thousands of people with disabilities facing tremendous economic hardship including bankruptcy, homelessness, and in some cases suicide.

Despite this the Social Security Administration(SSA) has an unwritten policy of requiring over-worked Claims Representative to take Supplemental Security Income (SSI) claims from all applicants for Social Security Disability (SSD) benefits, even if they are clearly ineligible for the Federal Welfare benefit.

This policy violates the claimant’s privacy by including questions regarding the individual’s personal information in the application process for Social Security Disability benefits, without informing the claimant why the information is needed. Claims Representatives are required to glean information about the claimant’s family income, bank accounts, life insurance policies, property, investments, etc. in order to get enough information to process and deny an SSI claim for excess income or resources.

SSA does this to artificially inflate their claims processing times. For example, an SSI disability claim that is denied in one day because of excess income still gets counted as a bona fide disability claim when SSA computes its overall processing time.

Some SSA personnel have created bogus claims in order to improve processing time statistics. According to Witold Skwierczynski, the President of the National Council of SSA Field Operations Locals, in June 2009, the Manager of the Independence, Missouri Social Security Office became concerned when he realized that his office would not meet his quota of SSI claims for the month, so he checked the agency’s computer system to find out who had filed for Social Security Disability, but not SSI. He then manufactured 38 bogus SSI claims by answering questions on the applications without contacting the applicants.(2) The manager was not held accountable for his criminal actions.

SSA’s policy of requiring Claims Reps to take bogus SSI claims is a waste of their time, a waste of tax-payer dollars – and it often delays the payment of past-due SSDI benefits due to claimants who are awarded benefits.

The majority of SSD awards are processed at SSA Program Service Centers – PCs. Once an SSI claim is taken, an SSI Windfall Offset indicator is input to the computer record to prevent a claimant from being paid both SSDI and SSI benefits for the same time period. Once the “indicator” is input to the claimant’s record the local office cannot remove it — the Program Service Center must do it — and that is the problem.

The staff at SSA PCs have little or no knowledge of the Supplemental Security Income program, so they must wait for the local office to advise them of the disposition of the SSI claim, and that is very difficult to accomplish because every office within the PCs jurisdiction is trying to contact the PC. Consequently, the only option for the local SSA office is to leave a telephone message or send a memo and hope that someone gets the message.

On July 30, 2010, SSA announced that phones to PC-7, an office in Baltimore where Social Security disability claims for the New York region are implemented, are being turned off. Benefit Authorizers, employees who implement disability allowances are 90 days behind. Claims Authorizers, a different category of employees who implement disability allowances are 115 days behind.(3) This is a direct consequence of SSA’s bogus SSI claims policy, which turns every claim into a Windfall Offset case.

The communication problem is compounded by the requirement that SSA pay the disability claimant within 60-days of receiving a Favorable Decision on a claim. The PCs meet this requirement by releasing the recurring monthly benefit and withholding the past due benefit until they learn the status of the SSI claim.

Once the PC does that, the clock stops ticking on the claim and the payment of the past-due benefit is no longer a priority. The PC can — and will — delay processing the past due benefit for an indefinite period. If the PC isn’t prompted (by a claimant’s congressional representative, for example) to pay the past due benefit it could take six months or more for the claimant to be paid. And it doesn’t take a “Rocket Scientist” to figure out that an individual who has been unable to work for a year or two — or more — is in desperate need of all the benefits due to them; and delaying the payment of past-due benefits is nothing less than malfeasance.

Sources:

1. Joint Hearing on Eliminating the Disability Backlog : The Honorable Patrick P. O’Carroll, Jr. Inspector General Social Security Administration , March 24, 2009

2. John Oertel, “Missouri manager “cooks the books,” Unity, January 2010 (published by AFGE Council
220) 26105 Hickor y Lane, Olmstead Falls, OH 44138 – email antelopetd@ameritach.netas

3. Shane A. Henry, “Social Security Paying 90 Days Out,” Published: July 30, 2010 http://www.shanehenryandassociates.com/2010/07/social-security-paying-90-days-out/

In the News:

Tough times create delays in Social Security disability

People seeking Social Security benefits face huge backlog, long delays

How to appeal a denied disability claim

Note: Social Security allows 60 days from the date of denial (plus 5 days grace for mailing time) for an appeal to be at the Social Security office. Don’t delay.

In many states the first appeal available to a Social Security Disability Insurance (SSDI) or SSI disability applicant, whose claim has been denied, is the “reconsideration.”

In a reconsideration review (sometimes called a case review), a different disability claims examiner at the DDS (Disability Determination Services) reviews your application and medical records with the help of a medical consultant.

Many people familiar with SSA’s disability appeals process consider the “reconsideration” a time-wasting delay in resolving a disability claim. More than 85 percent of reconsideration requests are denied.

Fortunately, here in New York State the reconsideration step has been eliminated: an applicant who has been denied benefits can immediately request a disability hearing.

The easiest way to file an appeal is to send a letter requesting an appeal to your local Social Security Office.

Or you can request a hearing before an Administrative Law Judge (ALJ). To request a hearing, you may use Form HA-501.

With your request for a hearing form, or after you submit it, you will need to submit the following forms to Social Security:

Disability Report- Appeal, Form SSA-3441
Authorization to Disclose Information to SSA, Form SSA-827

After you have completed the above forms, send them to your local office to be forwarded to SSA’s Office of Disability  Determination and Review, also known as ODAR,  who will send you a notice informing you that they have received your request for a hearing and a copy (CD) of your disability file.  Be patient.  It can take as long as 4 to 6-weeks for ODAR to log in your appeal request and contact you.

If you don’t feel comfortable handling the appeal yourself you can hire a representative to help you with your claim.

Do you have to to hire an attorney or non-attorney representative to help you with your appeal. No, you don’t, but the odds of winning a disability claim before an Administrative Law Judge (ALJ) are markedly decreased when a claimant does not have a representative.

An experienced disability representative can greatly improve your chances of winning your claim. In fact, statistics show that a disability claimant (applicant) who has the assistance of a skilled representative at the hearing level is twice as likely to be approved than an unrepresented claimant.

Your claim will be won  or lost on the strength of your medical evidence.

There is no legal trickery to get around that.  If your medical records are incomplete, or there are inconsistent reports or gaps in your treatment history, your appeal may be denied. Therefore, one of the most important services a disability representive can perform is insuring that the proper medical records are submitted to the court. Although you can request records yourself, your representative will know what specific medical evidence is needed — what should not be submitted to the court — and when your medical records need updating.

A disability representative will review your records in detail and decide if they should be submitted to the SSA. This is important because it allows the representative to determine whether your case needs additional medical evidence, whether any key evidence is missing or spot other issues that may cause you problems at the hearing.

In addition, your representative can help you avoid the long wait for a hearing to be scheduled and go straight to an approval if you are eligible for an on-the-record decision (OTR. An OTR decision is based on the written information that is provided to the judge before a hearing — OTR is actually short for a decision based “on the medical records.”

A Reminder:  Social Security allows 60 days from the date of denial (plus 5 days grace for mailing time) for an appeal to be at the Social Security office. Contact SSA as soon as possible and tell them you want to appeal your case — you don’t need a representative to do that, and you don’t have to complete all the appeal forms until you decide whether or not you want to hire a representative.