Transcript Social Security Overview

Social Security Overview
December 2003
Terminology
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Social Security Benefits
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Title II
Supplemental Security Benefits
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Title 16
SSI
Social Security Benefits
Quarters of Coverage
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Quarter of coverage in 2003= $890
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Fully insured -- 40 quarters
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2004 = $900
Or one quarter for each year after age 21
Currently insured: 6 quarters within a 13
quarter period ending with the quarter you:
a) die or b) become entitled to disability or
old age insurance benefits.
Retirement
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Must be Fully Insured
Early Retirement
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Age 62
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2004- apx. 20% reduction
Born 1960 or later – 30% reduction
Regular Retirement
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2004 – Age 65 and 4 months
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Maximum benefits $1,825
Born 1960 or later – age 67
Dependent Benefits
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Children
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Insured entitled to old age or disability benefits or
deceased
Natural, adopted child, stepchild or
grandchild/step grandchild (parents must be
deceased or disabled at time insured became
eligible for benefits or died)
Under 18 or
In secondary school under 19 or
Disabled before age 22
Benefits for Spouses
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Spouses
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Insured entitled to old age or disability benefits
Valid marriage and
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married at least one 1 year or
child in common
Age 62 or older or
Caring for child of wage earner who is under age
16 or disabled
Divorce Spouses may qualify
Widow(er)s
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Insured was fully insured
Valid marriage and
Marriage lasted 9 months (some exceptions)
or
Natural or adoptive parents of a child
and age 60 or
age 50 and disabled
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disability must have began within 7 years of the
wage earner's death
Unmarried or remarried after age 60 or age
50 if entitled as a disabled widow(er)
Benefits for Widowed Parents
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Insured was fully or currently insured at
time of death
Widow or widower and marriage lasted
at least 9 months and
Unmarried
Caring for child of the insured who is
under age 16 or disabled
Surviving Parents of Wage
Earner
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Insured was fully insured and is
deceased
62 years old
Not married since insured person died
Must have been dependent on insured
for at least half of your support
Disabled
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Fully insured
Disabled within last date of insurance -20 quarters in a 40 quarter period and
disabled within that period unless:
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Under age 31 when become disabled or
Previously disabled under age 31 or
Statutorily blind and fully insured
SSI
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Age
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65 and
Meet the citizenship criteria
Disabled
Appeals Process
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Initial
Reconsideration
Hearing
Appeals Council
Federal Court
Appeal Deadlines
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60 days unless good cause shown
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SS presumes receipt 5 days from date of mailing
10 day rule for continuing benefits
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Applies for both reconsideration and hearing request
Reopening
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12 months of the initial decision for any reason
Good Cause
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2 years SSI
4 years SS
Adult Disability Definition
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The inability to do any substantial
gainful activity by reason of any
medically determinable physical or
mental impairment which:
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has lasted or can be expected to last for a
continuous period of not less than 12
months
or can be expected to result in death.
Adult Sequential Evaluation
SUBSTANTIAL GAINFUL ACTIVITY
NO
SEVERE IMPAIRMENT
Yes
LISITING
No
PAST WORK
No
Ability To Perform Other Work
Grid
or Vocational Expert
Resources Used by SSA in
Disability Determinations
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Listings
Grid
Bureau of Disability Determinations
Services – BDDS
Medical Experts
Vocational Experts
Rules
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Statute
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Regulations
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42 U.S.C. §§ 401 et seq., 1381 et seq.
20 C.F.R. §§404 et seq., 416 et seq.
Rulings
POMS
HALLEX
Definition of Disability
for Children
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A physical or mental condition (or a
combination of conditions) that results
in marked and severe functional
limitations and:
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The condition must last or be expected to
last at least 12 months or
be expected to result in the child's death.
Children’s Sequential
Evaluation
Substanital Gainful Activity
Severe Impairment
Listing
Functional Equivalent
To Listings
Functional Equivalence - Six
Domains
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Acquiring and using information
Attending and completing tasks
Interacting and relating with others
Moving about and manipulating objects
Caring for yourself
Health and physical well-being
Functional Equivalence
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Need one extreme limitation or
Two marked limitations
Can also be functional equivalent if no
listing exists for condition or
combination of impairments “equals” a
listing
Medical Improvement
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All cases are given a diary date
Sequential evaluation different
Appeal within 10 days to preserve
benefits
Drug and Alcohol Cases
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Basis for the disability must be
independent of drug or alcohol
condition
Payee will be appointed
Can require treatment
Amount of Benefits - 2004
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SSI
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$564 individual
$846 disabled couple
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Couple includes “holding yourself out as married”
Paid on the first of the month
Title 2
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Maximum $1825
Usually at least $20 more than SSI if disabled or
aged
Medicare deduction – $66.60
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Don’t forget IDHS programs to pay premium
Payments dates vary
Reduction/Nonpayment of
Benefits -SSI
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Income
 Unearned income disregard ($20)
 Child support disregard (1/3 of support)
 Earned income disregard ($65, and ½ of balance.)
 Inkind Income
 Deeming
Asset limitation
 $2000 individual
 $3000 eligible couple
Residents in public institutions
Failure to comply with drug or alcohol treatment
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Fleeing felons
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Reduction/Nonpayment of
Benefits – Social Security
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No asset limitation
Earned income
 Does not affect Retirement benefits if 65 or older
Disability benefits
 Trial work period- any 9 months where you earn
$580. Extended period of eligibility- 36 months, no
payment if earn more than $810
 Receipt of Other Title 2 benefits -reduced $ for $
Workers’ compensation
Aliens who leave the country for more than 6 months
Failure to comply with drug or alcohol treatment
Nonpayment while serving time for a felony
Payment of Benefits
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Lump Sums
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Transitional Assistance and P3 offset- both
SSI and SS disability
SSI only
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Reduction for receipt of TANF
Restricted account for children’s lump sum
Overpayments
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Reconsideration
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60 day time limit
Appeals within 30 days stays action until
reconsideration issued.
Appeals after 30 days stops action until
reconsideration issued.
Amount Recouped
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SSI – 10%
SS- No limit, but can be negotiated
Waivers
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No time limit
All recouped money returned if successful
Must establish not at fault and
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Defeat the purposes of the SSI program to collect
the overpayment or
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presumed for an individual receiving SSI
Against equity and good conscience or
Impede efficient or effective administration of
program
Ticket to Work
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Voluntary program to assist Title II disability
and SSI disability recipients
Using a ticket will not result in a continuing
disability review (“CDR”)
No CDR for working after 24 months on
benefits
Expedited Reinstatement for Individuals
whose benefits stop due to working
Expanded medical coverage
Immigrant Restrictions Qualified Immigrants
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Legal Permanent Residents
Refugees, Asylees, Cuban/Haitian entrants,
Amerasians, victims of trafficking, and those
whose deportation is being withheld.
Lawfully present active duty members of the
U.S. Armed Forces and their spouses and
dependent children.
Lawfully present veterans with an honorable
discharge and their spouses and dependent
children.
Qualified Immigrants Who Arrived on
or Before 8/22/96
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Eligible for SSI
Eligible for SS
Immigrants Who Arrive After
8/22/1996
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SSI - Distinction between LPRs and
other Qualified Immigrants
SS - Qualified Immigrants Eligible
LPR’s Who Arrive After
8/22/96
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Bar on SSI
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Only eligible if can be credited with
40 quarters (after a 5 year wait)
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Credits can be from worker, spouse, or parents
while they were children
No quarters counted after 12/31/96 if individual
received “federal means tested public benefit”
during the quarter
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Includes TANF, Medicaid, KidCare, Food Stamps
Resources
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Social Security Website
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http://www.socialsecurity.gov/
Includes Handbook, POMS, Rulings, HALLEX, CFR
Dictionary of Occupational Titles (DOT)
Diagnostic and Statistical Manual IV-TR
Social Security Claims and Procedures McCormick
Medical Proof of Social Security - Hirshman
Video tape library