Posts in:December, 2018

The Beginning of the End for Prototype States

Posted December 18, 2018 by Premier Disability Services, LLC®

Before a case for Social Security disability benefits may be filed in federal court, claimants must give the Social Security Administration (SSA) an opportunity to review the claim and render a final agency decision. Administratively, there are typically four stages of review: initial determination, reconsideration, a hearing before an administrative law judge (ALJ), and review by the Appeals Council.

The initial determination in each state is made by Disability Determination Services (DDS), which applies strict guidelines set forth in the Programs and Operations Manual (POMS). If a claim is denied initially, most states have a reconsideration process which allows a different examiner at DDS to review the case again before the claimant may file a request for a hearing.

In 1997, the SSA introduced a redesign program to bypass the reconsideration process, allowing claimants to file a request for a hearing immediately after the initial determination in ten (prototype) states, including New York, Pennsylvania, Alabama, Michigan, Louisiana, Missouri, Colorado, Alaska, and parts of California. The intent was to achieve earlier decisions and shorter wait times. Yet, in a 2010 statement before the House Ways and Means Commission, the SSA found the opposite was true of its implementation in prototype states.

This past summer, the SSA announced plans to reinstate the reconsideration process in those prototype states, citing to data from a 2001 detailed study of the prototype procedure as well as the need for a uniform process. The announcement spurred opposition from legislators in both parties, who criticized the 2001 data as obsolete and cited to shorter wait times in the prototype states since the inception of the redesign program. Without more recent data and analysis from the SSA, it may be difficult to predict the likely effects. Still, others have suggested that such broad changes to our Social Security program ought to be handled by a duly appointed Commissioner confirmed by the Senate, though there has not been one since the Bush Administration.

Several prototype states will now be instituting reconsideration on January 1, 2019: California (Los Angeles North and Los Angeles West), Colorado, Louisiana, New Hampshire and New York. This means that for any case in which an initial denial is issued on or after January 1, 2019, in those states, the next level of appeal is to file a request for reconsideration, not a request for an ALJ hearing.

Reconsideration is scheduled to be reinstituted in Pennsylvania on April 1, 2019. Alabama and Michigan are scheduled to start reconsideration on October 1, 2019; Missouri on January 1, 2020; and Alaska on March 1, 2020.

By: Joyce Trudeau of Premier Disability Services, LLC®

Working and Receiving Disability Benefits

Posted December 17, 2018 by Premier Disability Services, LLC®

Federal law defines disability as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. According to the Social Security Administration (SSA), SGA is generally defined as work that generates a certain amount of income per month. In 2018, that amount is $1,180 for non-blind disabled applicants and $1,970 for blind applicants. An individual who generates more income than the SGA limits will likely be ineligible for Social Security Disability benefits. However, there are exceptions to this rule:

Trial Work Period

To be eligible for disability benefits, your injury must be expected to keep you from working for at least one year. After becoming disabled, it is often difficult to know whether you will be able to return to work. To help disability applicants determine whether they will be able to return to work, the SSA will allow disability applicants to engage in a work trial period for nine months. During this time, you can receive disability benefits in full, regardless of how much income you make.

According to 2018 standards, any month that you earn at least $850 counts as a trial month. Similarly, if you are self-employed, any month where you work more than 80 hours (or earn more than $850) is considered a trial work month. Your trial period will continue until you’ve worked nine months within a rolling 60-month timeframe. The trial months do not need to be consecutive. If you earn more than $850 for more than 9 months within a 5-year period, your disability will be deemed to have ended and your benefits will stop.

Extended Period of Eligibility

Once you have completed your trial work period, the SSA does provide resources in the event that you are still unable to consistently work. You can receive Social Security Disability benefits for any month where your earnings fall below the SGA amount, within a 36-month window following the completion of your trial period. This is referred to as an extended period of eligibility.

Following your trial work period, if your Social Security Disability payments stop because your income exceeds the SGA amount, you still have a five-year period in which you can receive benefits without filing a new disability application. This is known as expedited reinstatement and can save you significant time should your condition worsen—or if you become re-injured—in the future.

Offset your Earnings with Expenses

If you are consistently earning more than the SGA limit, it is very possible that you are ineligible for disability benefits. However, the SSA will deduct certain disability-related expenses, potentially allowing your overall income to fall below the SGA threshold. Depending on your unique situation, certain activities or expenses could be deducted to help your income remain below the SGA threshold.

If you or someone you know is unable to work due to a medical condition, please contact us for a free evaluation of your claim!

By: Joyce Trudeau of Premier Disability Services, LLC®

Spousal Benefits when Married to a Disability Recipient

Posted December 7, 2018 by Premier Disability Services, LLC®

If your spouse receives Social Security Disability Insurance (SSDI), you may be entitled to Social Security spousal benefits under certain circumstances. You may be eligible for benefits if you meet one of these three requirements:

  • You are at least 62 years of age (unless the total benefits you would receive from your earnings record is higher),
  • you are caring for your spouse’s minor child (under the age of 16), or
  • you are caring for your spouse’s disabled child (regardless of whether or not they are over the age of 16).

If you are eligible for spousal benefits, you and any dependent children may receive up to 50% of the total SSDI benefits your spouse receives. This means that the sum total of benefits you and your dependent children receive will equal no more than 50%—you and your dependent children do not each receive up to 50% of the total benefits earned by your spouse.

The Social Security Administration (SSA) will first pay you any benefits you have earned from your own earnings record. If the amount of benefits you would receive based on your spouse’s disability benefits is higher, however, the SSA will combine the benefits to ensure you receive the greater amount of benefits. It is important to note that, although you may be eligible for spousal benefits at the age of 62, your benefits will be permanently reduced if you apply for them prior to your full retirement age. This does not apply if you are caring for a dependent, however.

If you were previously married to an individual who received SSDI, you may still be entitled to spousal benefits. In order to be eligible, the following must apply to your situation.

  • You must have been married for at least 10 years,
  • you must be at least 62 years old,
  • you must be unmarried (unless your new spouse is also eligible for SSDI benefits)
  • and you cannot receive any benefits based on your personal earnings record in an amount greater than or equal to your former spouse’s.

Individuals who receive SSDI and have an ex-spouse who is eligible for spousal benefits should note that, should they remarry, any benefits their new spouse receives will not be impacted by the benefits their former spouse receives.

If you believe you are eligible for spousal benefits, you must contact the SSA. The SSA will require your birth certificate, Social Security number, marriage certificate and information about any previous marriages, if applicable.

From: Joyce Trudeau of Premier Disability Services, LLC®