Legal News

We realize it may be a stretch for ordinary people to want to keep up with the comings and goings of the Social Security Administration, but sometimes circumstances permit where someone does want to follow the latest news regarding the agency due to a possible retirement or disability interest. This blog is a piecemeal of recent stories that have involved Social Security. Some are tidbits and some are important things that should be known in the world of retirement or disability and others are just interesting stories and nothing more. The latest figures on the number of employees the Social Security Administration has on-hand to do the work of the agency was recently released. As of March 2016 there were 64,264 employees at Social Security. This is the lowest employee total at Social Security since June 2014 when the total number was 62,651. Some people may applaud the fact that the agency’s number of employees is being reduced, but considering there is more work for the employees than at any other time it seems like a bad decision to continue to reduce the total number of employees. As we have said previously, there are more than 1 million Americans waiting for disability hearings across the country, something that has never previously happened before. Social Security has revised its Listings for neurological disorders. The new listings go into effect September 24, 2016. Social Security’s Listings are a set of impairments and their severities related to the rules of disability. Some of Social Security’s Listings have not been changed in quite some time. Because a new diagnosis and how it impacts people can change over the years, and the understanding of certain conditions change, it is important for Social Security to review and revise its Listings to make them more relevant to today’s standards. The last time Social Security revised the Listings for neurological disorders was December of 1985. To learn more about the changes to the Listings click here. Social Security recently closed a district office due to some graffiti being written on the outside of the building. The words spray painted on the building were “Bomb the System.” The Green Bay, Wisconsin Social Security office was closed June 28 after the graffiti was discovered. Police said the decision was made by Social Security to close the office, but the agency cannot really be held accountable for closing the office after a threat is initiated no matter how small the perceived threat is. The knucklehead who decided to deface the building is the one who made hundreds of people have to waste their time going to Social Security that day when the office was closed. There are a lot of good services to be accessed at Social Security’s website – www.ssa.gov – but the agency’s website is not without its glitches. In late June there were reports that people were having difficulty accessing any kind of service on the website. We too have noticed some recent issues with the site while trying to complete appeals for clients. The good thing is Social Security usually resolves any sort of technologic problem with its website rather quickly and the problems did not persist for too long. Social Security now provides its own blog on the agency’s happening at its website and also provides another section on the latest news impacting the agency. Considering Social Security is in charge of this information you probably won’t find any negative information here.

Many of our clients are curious as to what they can do to positively impact on their Social Security Disability and Supplemental Security Income claims. While our office can never guarantee you will be awarded benefits, there are several things that a claimant could do to help improve their chances. The Social Security Administration (SSA) bases the majority of a disability decision on medical evidence. It is very important that if you treat for your conditions, if you are able to do so. Unfortunately, many people lose their medical insurance once they become unable to work. If you do not have any insurance and cannot afford to pay the out of pocket expenses for medical treatment it can be helpful to look for any state or county medical assistance programs you may be eligible for.  Another option would be to look for free and sliding fee scale clinics in your area. It is important that you let your case manager know where you are treating. If your claim is pending at the Initial Application or Reconsideration level your case manager will need to inform the SSA, so that the medical reports from each facility may be requested. If your claim is pending for a hearing please advise your case manager about where you are treating so that our office can request those records for your hearing. If you are regularly treating with medical providers let your doctors know that you have filed a claim for Social Security Disability. If there is a doctor who would support your claim advise your case manager right away. Our office can mail that doctor an assessment regarding any physical or mental restrictions and limitations you may have. These assessments can be very helpful. It is also important to respond to any correspondence sent by the SSA as quickly as possible. Many documents that the SSA sends have strict deadlines. Not responding to the SSA may result in a denial on your claim. If your phone number or address changes please advise your case manager as soon as possible. Due to the deadlines and time sensitive responses required by the SSA it is important that our office be able to get in touch with you.

The Republicans in Congress have made several attempts to repeal the Affordable Care Act, better known as Obamacare, but all attempts have failed after a few Republicans defected in approving repeal efforts after the Congressional Budget Office (CBO) estimated that repeal of the law would result in tens of millions of Americans losing healthcare coverage. It would be naïve to believe the Republicans have altogether given up their efforts to repeal Obamacare, but for now the Affordable Care Act appears to not be going away anytime soon. One of the major roadblocks to a successful Social Security disability claim is the limited access to healthcare some claimants experience. If a claimant has impairments they can’t treat for, it is very difficult to prove the impairments that limit their ability to work. One resource all claimants who lack healthcare coverage need to consider is Obamacare, which can provide low-cost access to healthcare coverage. Each year there is an open-enrollment period for the Affordable Care Act. More information about enrollment can be found here. This open enrollment period, which is November 1 to December 15, 2017, for 2018 is for new people who are not currently enrolled in Obamacare as well as those who need to renew their plans. There are many questions new enrollees have about cost and what types of programs are available, so it is valuable to provide some information that may help people navigate their options. The Health Insurance Marketplace This is where you will find all different sorts of plans that have different coverage and are variably priced. There are a few things people who are looking for plans should consider and have ready when looking over plans, sort of a marketplace check list: Information about your household size. Figure out who in your household should apply before you start your application. Visit HealthCare.gov/income-and-household-information/household-size for help figuring out who needs coverage; Home and/or mailing addresses for everyone applying for coverage. Information about everyone applying for coverage, like addresses and birth dates; Social Security Numbers; Information about the professional helping you apply (if you’re getting help completing your application). Visit HealthCare.gov/help/whos-helping-me-complete-my-application for more information; Document information for legal immigrants. Visit HealthCare.gov/help/immigration-documenttypes for more information. Information on how you file your taxes; Employer and income information for every member of your household (for example, from pay stubs or W-2 forms—Wage and Tax Statements). Visit HealthCare.gov/income-and-householdinformation/income to learn more about what types of income to include and not include. Your best estimate of what your household income will be in 2018. Visit HealthCare.gov/incomeand-household-information/how-to-report for help estimating your income; Policy numbers for any current health plans covering members of your household; A completed “Employer Coverage Tool” for every job-based plan you or someone in your household is eligible for. (You’ll need to fill out this form even for coverage you’re eligible for but don’t enroll in.) Visit HealthCare.gov/downloads/employer-coverage-tool.pdf to view or print the tool; Notices from your current plan that include your plan ID, if you have or had health coverage in 2017.

Social Security instituted a special insurance status rule for people who are young than age 31in processing a disability claim because it is more difficult for younger people to have adequate work credits to qualify for the Social Security Disability Insurance (SSDI) program. What Is Special Insured Status? “Special insured status” allows an option to the “20 credits in 40 quarters” provision (20/40 rule – See §207). Individuals disabled before age 31 can qualify for disability insurance benefits or establish a period of disability. (See §201.2 for additional requirements if you are an alien worker and you were assigned an original Social Security number on or after January 1, 2004.) When Do You Have Special Insured Status? You meet the special insured status requirements if, in the quarter your disability is determined to have begun or in a later quarter, you: Have not yet turned 31; Are fully insured as explained in § 203; and Have credits in at least one-half of the calendar quarters: During the period beginning with the quarter after the quarter you turned 21; and Ending with the quarter that you became disabled. The credits must be earned in this period. If the number of elapsing calendar quarters is an odd number, the next lower even number is used. What Is The Minimum Number Of Credits You Need For Special Insured Status? You need at least six credits in order to have special insured status. If you became disabled before the quarter you turned 24, you must have six credits in the 12-quarter period ending with the quarter your disability began. In this case, the quarters counted will go back before the quarter in which you turned age 21. Can You Obtain Special Insured Status If You Become Disabled Again At Age 31 Or Older? If you are age 31 or older and become disabled again, you may obtain special insured status if you meet the following conditions: You had a previous period of disability established before you turned 31; You met and currently meet the special insured requirements (as set out above); You do not meet the 20/40 rule in the quarter your current period of disability begins; You are fully insured as explained in §203. (See §201.2 for additional requirements if you are an alien worker and you were assigned an original Social Security number on or after January 1, 2004.) Are There Any Special Provisions For The Blind? A person disabled because of blindness may qualify for entitlement to disability benefits if he or she is fully insured as explained in §203. Blind workers are not required to meet “20 credits in 40 quarters” or “special insured status” tests. (See §201.2 for additional requirements if you are an alien worker and you were assigned an original Social Security number on or after January 1, 2004.)

Social Security is going to try something new in its never-ending pursuit of reducing the backlog of disability cases that are waiting to be scheduled before an Administrative Law Judge (ALJ). Despite the fact it is encouraging to see Social Security try new things to reduce the more than 1.1 million disability case backlog, there are definitely questions as to whether the agency’s new pre-hearing review protocol will put a dent in the backlog. Wait times across the country for a disability hearing are averaging well over a year, in some locations it is a lot closer to two years. The main problem with the new pre-hearing review is that the process of the review allows for the same agency that recently denied a disability claim to conduct the review. According to the new rules, Disability Determination Services, which will likely be conducting most of the pre-hearing reviews may be given a bit more leeway to approve cases by considering cases “based on a preponderance of the evidence,” rather that stick to Social Security’s stringent listings. We shall see if this new pre-hearing review system works well enough to do what it is intended to do. Pre-hearing Case Review By Other Component General After a claimant files a request for hearing but before an administrative law judge (ALJ) holds a hearing, an ALJ may, under the circumstances outlined in subsection B below, forward a claim for a pre-hearing case review to the Disability Determination Services or other component that issued the determination the claimant is appealing. On receipt of the claim(s), the receiving component will decide whether to revise the determination based on a preponderance of the evidence. See 20 CFR 404.941 and 416.1441. Under these procedures, the Social Security Administration may only issue a revised determination if it is fully or partially favorable to the claimant. NOTE: While a pre-hearing case review is pending, the ALJ retains jurisdiction of the claim and will not dismiss the request for hearing. When an ALJ May Refer a Case for Pre-hearing Case Review As set forth in 20 CFR 404.941 and 416.1441, an ALJ may refer a case for a pre-hearing case review if: Additional evidence is submitted; There is an indication that additional evidence is available; There is a change in the law or regulation; or There is an error in the file or some other indication that the prior determination may be revised. In screening cases for the regulatory criteria, the ALJ will only refer cases for a pre-hearing case review in which application of the criteria may result in a fully or partially favorable decision. When to Schedule a Hearing After a Case Is Sent for Pre-hearing Review The hearing office will retain claims sent for a pre-hearing review in the Master Docket by date of receipt. When a claim sent for a pre-hearing review is ready to be scheduled for a hearing, the ALJ may not delay the scheduling of a hearing unless all parties to the hearing agree to continue the review and delay the hearing. See 20 CFR 404.941 and 416.1441. If all parties agree to a delay, the ALJ will ask the parties to indicate so in writing. The ALJ will then associate the writing(s) with the claim(s) file. If a party to the hearing objects to a delay in scheduling the hearing, the ALJ will schedule the hearing. However, when administratively efficient to do so, the pre-hearing review may continue during the time between the date the hearing is scheduled and the date of the scheduled hearing. If the reviewing component cannot complete the pre-hearing case review before the scheduled date of the hearing, the component must return the case to the ALJ for a hearing unless the component is preparing a favorable revised determination and all parties to the hearing provide written consent for the ALJ to delay the hearing.