Thursday, March 6, 2014
There is often confusion about Social Security and Supplemental Security Income (SSI) because you apply for both programs with the Social Security Administration. But, the programs are different.
The Social Security "DISABILITY" benefit programs are “entitlement” programs. This means that workers, employers and the self-employed pay for the benefits with their Social Security taxes. The taxes that are collected are put into special trust funds. You qualify for these benefits based on your work history (or your spouse or parent). The amount of the benefit is based on these earnings.
Meanwhile, "SSI" is a needs-based program for people with limited income and resources. Resources are assets or things that you own. The program is paid for by general tax revenues -- not from the Social Security trust funds. The benefit amount is based on Federal and State laws which take into account where you live, who lives with you and what income you receive.
Look at the chart below to help you understand the difference between the two programs.
Wednesday, March 5, 2014
How long will it take for SSA to decide my case?
How will the SSA Judge likely rule on my case?
FIND OUT HERE: SSA PUBLISHES NEW DATA
Public Data Files
The Office of Disability Adjudication and Review (ODAR) is the component of the Social Security Administration charged with providing hearings and reviews of hearings for claimants whose applications for benefits have been denied at the first two levels of adjudication.
One Time Report
• Hearing Requests Pending by Format - FY 2006 through FY 2012 (Electronic Folder/Paper Cases)
Monthly Data Files
Public data files one through six below contain information on workload indicators within ODAR’s hearing offices. Updated monthly, these reports contain hearing office information such as average wait time for a hearing to be held, total average processing time and numbers of hearing requests received, completed and pending. Disposition data by individual administrative law judges (ALJ) is also provided. There are two reports ranking the hearing offices from best to worst in two workload areas as well. Finally, there is a report on how hearings are held in each hearing office, whether by video or in person.
1. Average Wait Time Until Hearing Held Report - FY 2014 (Month of January 2014)
2. Hearing Office Workload Data - FY 2014 (Through January 2014)
3. ALJ Disposition Data - FY 2014 (Through January 2014)
4. Hearing Office Dispositions Per ALJ Per Day Ranking Report - FY 2014 (Through January 2014)
5. Hearing Office Average Processing Time Ranking Report - FY 2014 (Through January 2014)
6. Hearings Held In-Person or Via Video Conferencing - FY 2014 (Through January 2014)
Quarterly Data Files
Public data files 7 and 8 are updated and posted quarterly with monthly and summary numbers. Both of these reports refer to workloads administered by the Appeals Council and Report # 7 shows the number of receipts, dispositions and pending requests for review of an ALJ decision. Report # 8 shows the same workload information for new court cases filed against SSA and court remands returned to SSA/ODAR by the courts.
1. Appeals Council Requests for Review - FY 2014 (Through December 2013)
National New Court Case and Court Remand Activity - FY 2014 (Through December 2013)
Monday, March 3, 2014
Yes and other non-medical services as well.
The Office of Workers’ Compensation Programs (OWCP) may pay for seeing eye and hearing dogs, as well as for their training and maintenance costs, on prescription of the attending physician if this service is required because of blindness in both eyes or severe deafness (at least 80 percent binaural loss) resulting from factors of the employment.
Change in Locality. Where a physician recommends that an injured employee visit or move to another climate to alleviate symptoms of the employment-related condition, the expenses incurred may be authorized if OWCP finds that such a move is likely to cure, give relief, reduce the degree or period of disability, or aid in lessening the amount of monthly compensation.
Health Club/Spa Membership. Membership in a health club or exercise facility, or treatment at a spa, may be authorized when recommended by the attending physician as likely to cure or give relief. Only the facilities required should be authorized (for example, if swimming is prescribed, the approval should not include use of exercise equipment as well) and the least expensive facility in the area should be used. Procedures for developing and adjudicating requests for health club/spa membership are provided in The OWCP Procedures Manual Chapter 2-810.15.
Friday, February 28, 2014
Yes the government can, and will, and does do this quite frequently.
While using the exact same medical records the US government can on hand find you 100% disabled and entitled to federal benefits and at the exact same time find you not disabled and not entitled to federal benefits.
Here is a common and recent scenario that discusses the conflict between VA, SSA and OPM disability claims and who is to blame for this confusion.
Simpkins v. OPM (US Fed.Cir. 03/08/2013) Simpkins was an honorably discharged Navy veteran. Due to his in-service illness affecting his heart he was found to be 100% disabled by the VA and fully entitled to VA service connected compensation benefits.
Years later, Simpson had gone to work for the US Department of Labor. Due to his ongoing heart problems, he could no longer physically do his job and applied for his medical disability retirement with the Office of Personnel Management (OPM). He submitted as proof his ongoing VA medical records and the government’s own ruling in his VA claim that he was 100% disabled.
The same government using the same medical records denied he was disabled in his OPM claim. The government ruled that a finding of disability under the OPM must be based on medical evidence; in this case Simpkins’ VA records. The government then ruled that while Simpkins’ was disabled under VA rules, he was not disabled under OPM rules.
The Court blamed the US Congress for this conflict as the Congress did not bother to write into the rules that a finding of disabled by one federal agency must be recognized by another federal agency. So the OPM was not bound by the VA’s 100% disability ruling even though the OPM used the very same VA medical records to find Simpkins’ not disabled for OPM.
The Court also reported that the same type of conflict and outcome would result in a social security disability case.
Referring to Trevan v. OPM Trevan was a postal employee. He filed for OPM medical disability retirement claiming he could not longer work due to his heart condition.
Trevan had also applied for social security disability benefits using the same medical records. The government in his SSA claim found that based on the medical evidence Trevan was disabled from doing his past postal job as well as any other job and awarded him SSA disability benefits.
Meanwhile the government in his OPM claim, using the same medical records, found that Trevan was not disabled and could return to his postal job.
Trevan appealed and specifically cited the government’s finding in his SSA claim that he could not do his postal job or any other job and was disabled.
The Court on appeal agreed with the OPM.
The Court once again pointed the finger of blame to the US Congress for this conflict. The Court even admitted and recognized that the SSA’s rules finding that Trevan was disabled were much more stricter than OPM’s rules. However, the Court noted that the US Congress in writing the rules again did not bother to mention that a finding of disability by one federal agency must be recognized by another federal agency. The Court indicated this is a legislative matter for Congress to fix and not the Courts.
So far the Congress has refused to fix these legislative conflicts.
Thus, even though the government in the SSA claim found that Trevan was completely disabled from doing “any” work of any kind, including his postal job, the very same government using the very same medical evidence in his OPM claim could legitimately find that Trevan was not disabled and could do his postal job.