A television station in Nyack, NY reports on a woman who had to go through a long fight to get approved for Social Security disability benefits but didn't receive her back benefits until seven months later and then only after the television station started asking questions. Of course, all this delay caused the poor, sick woman great financial problems.
I don't know enough about the case to say what happened but I can say the most common cause for this sort of delay is what I call a phantom windfall offset. At the very beginning, when the claimant first contacts Social Security, the field office takes both a claim for Disability Insurance Benefits (DIB) and Supplemental Security Income (SSI). The SSI claim is quickly denied because of excess income or resources. There was no point in the claimant ever filing the claim except that the field office is assigned staff based in part on how many claims they take so they have an incentive to take useless SSI claims. (Yes, I've heard field office staff say, no, they're just trying to protect claimants but I'm not buying it.) Even though it's been denied, the SSI claim remains active in Social Security's computer system. Once the DIB claim is approved, the back DIB benefits aren't paid because the payment center is waiting to find out how much SSI was paid. However, there's no action on the SSI since it was long since denied. The payment center just does nothing. The field office which would implement the SSI if it were being paid and which is supposed to tell the payment center if no SSI is being paid does nothing. Maybe somebody at Social Security realizes there's a problem and resolves it. Maybe nothing happens until the claimant complains. Maybe nothing happens even if the claimant does complain because everybody is so busy. How often do phantom windfall offsets happen? I'd guess a few hundred thousand times a year. Social Security certainly knows about the problem. Why can't they get it fixed? Everybody is just so busy. Problems that cause delays in benefit payments aren't nearly so important as the pointless search for another Eric Conn. (Hint to Social Security: There isn't another Eric Conn out there.)
The Windfall Offset Workload is so complicated, few employees understand how to process the calculations. It is so complicated, in fact, that Windfall Offset calculations have resulted in the enormous Steigerwald v Berryhill judgement. 20 years ago, Title II benefits were paid before SSI benefits. None of the problems associated with Windfall Offset existed. Then, someone changed policy so that SSI benefits were paid first (so the person might receive some Medicaid benefits). It seems there would be a better way to still pay Title II first but get the person some Medicaid benefits. At least, there would not be the delay in receiving Title II retroactive benefits.
ReplyDelete@11:33
ReplyDeleteI thought paying SSI benefits first was because SSI comes from general fund, and DIB comes from trust fund. SSA has an interest in ensuring no more money goes out of trust funds than is necessary.
Then again, assuming the individual is in fact eligible for SSI, I do not see why it couldn't be handle through simple reimbursement from the general fund to trust fund once SSI eligibility is verified. No reason to delay processing on the front end.
to 11:33
ReplyDeleteNo, they are not that complicated that the entire process could not be automated. But, for whatever reason, the SSA has never managed to do that.
So, they leave it for staff in the DO to manually do the offset, with the help of a program that should be able to do it on its own. But, in cases like this, where there is no SSI, or where the claimant withdraws the SSI because the T-2 benefit is much higher for the entire period. no one bothers to coordinate with the payment center. They send emails but no one just picks up the phone and calls."We can't do it that way"
If you replace Claimant with Representative, you can better understand the outrage.
ReplyDelete12:55, in the story from Nyack the rep already got paid. It's still outrageous that the claimant hasn't.
ReplyDelete--a rep.
I don't think the DOs take SSI cases so they get more staff. Missing staff is not being replaced anyway. Many people have resources when they apply but they are rapidly used up before the five full month waiting period is over. When it is likely benefits will be ultimately awarded at the initial level a presumptive disability decision can be made. That said the field office generally does not make the I and R decision until the DDS makes a favorable decision at times resulting in a waste of money after the DDS has spent hundreds of dollars acquiring MER, CEs etc. in this lady's case it seems she was self- employed and worked part time after becoming disabled so there may have been more problems for SSA to sort out. If she is as destitute as stated in the article she could have been eligible for SSI.
ReplyDeleteIt's a problem between the FO and PC because on initial claims and reconsiderations, a CR can override windfall as long as there doesn't have to be a manual award (A101). I have cleared some where the person filed and was denied SSI 10 years ago and PC will still put windfall on the T2 manual award, even though I asked them not to do so.
ReplyDeleteI would estimate I have to make at least one call a week about this type of situation. Well more like three calls. One to the PC to find out why client's money hasn't been released, then to the field office to find out why they haven't responded to PC's request, then another back to the PC to say that the field office says they never received any request. There has to be a more efficient and effective way to deal with this issue.
ReplyDeleteIf it goes back more than a year and there was a COLA will be A101. If you don't know what that means, it means that the CR basically has to right the computer code (vintage code) and submit it. If it is wrong, it doesn't get fixed by PC that know how to do it, it gets kicked back to the CR.
ReplyDeleteAnother reminder that CRs are doing way more than just DIB claims, RIB daily, some offices have to use CRs to help SR staff due to shortages of staff, they are doing Medicare stuff, earnings record problems, and on and on and on. OHO is a joke compared to the DO and FO duties, but due to the excessive whining about wait times they get more ALJs and staff while the CRs go under.
Many of us reps have developed our own contact list to call when payments are unreasonably slow. I consider two months too long.
ReplyDeleteThis and other issues need to be fixed by Congress. Where is the leadership? Instead of fixing problems, Congress wants issues. Vote out the Pelosi, Ryan, etc. types. Bring in only people that want solutions, like Trump. Vote out the lawyers.
ReplyDeleteSolutions?Trump???
ReplyDeleteAs a last resort, my congresspersons have been helpful. I know what @6:50 means.
3:15 PM . I have made multiple communications and visits to 2 Senators and one Congressional offices. Hasn't changed a thing! I have a new member of Congress ... I don't anticipate any difference. Vote out 535!
ReplyDeleteAlleged: CRs taking unnecessary SSI claims.
ReplyDeleteTruth: Nope! This is minimal to nothing. More likely the LAS in the PSCs assuming every DIB claim or low PIA has SSI involved, even that is doubtful. Only the smallest and lowest foot traffic offices would do that. Majority of offices don't want to deal with unnecessary SSI inquiries if not even eligible.
Alleged: Claims in PSC being processed with windfall after ALJ reversal.
Truth: Yep! Some Claims have no idea how to prepare a manual award which is required for any back pay of $50k or more. But put it in this Windfall Offset status, and the system will automate it (and the notice won't make since because the system doesn't even check if a SSI claim was taken).
Alleged: PSCs sending claims back.
Truth: They are not supposed to for coding issues. Only thing ever going back is where DOFA is involved and the field doesn't even have proof to allow, say proof of marriage for a disabled widow (has happened!). Everything else can and should be fixed in the PSC. They get more time in training than the field for a reason.
Why doesn't this happen? Because nobody plans for the future. The poor workers end up training the new hires and bad practices that move the case.
Unalleged but common: Attorney or rep completes 1696 and checks the Title II/XVI box when no SSI was filed! Every person who has to check it before paying the fee sees that and immediately assumes the SSI claim was missed and places them in SSI status.
But sure...we can look the other way and blame the field for the delay.
6:51 a light of truth in a dark world. Well done!
ReplyDeleteMy claim was sent to the payment center August 11. I applied in 2011. My local office says they can’t see what’s going on because I went to federal court so my info is in a different system. Supposedly they were using a manger to manager system to fix this; now when I call I’m told they were barred from doing this and there’s nothing they can do and no way to find out what the holdup is.
ReplyDeleteI wonder if this might be part of the issue. When I first applied they required me to apply for ssi even though I knew I didn’t qualify.
Regardless of the reason I’ve gone 8 years without income due to problems outside of my control. It’s very frustrating!
About 90 days after the SSI claim is denied for excess resources, the SSID goes into terminated status (T51) as opposed to active denied (N04). Once the terminated status is posted, very little can be input to the SSI record.
ReplyDeleteIf the windfall hold code is put back on the SSDI record (AACT), an active SSI record gets a windfall diary which shows up on a list the FO needs to resolve. If the SSID is terminated, the diary does not post and the FO is not notified. So those cases do fall through the cracks.
There is a specific system that is used to communicate between the FO and the PC about windfall offset. Those cases do get worked on faster than other methods.
But it is also true that there are a limited number of employees in each office who understand windfall offset. Not all cases will automate because not all SSI cases automate. There is still a huge number of 'systems limitations' that require the FO to divide the record into two parts, manually computing part of the payment. T2 has their A101's; T16 has their Start Dates and T33 cases. Those cases cannot be fully automated.
@620--have you gotten an award letter or any money at all? If so, then this may be the problem. If not, the payment center may still be working on your claim which doesn't mean you won't have this problem after they finish. Actually, if you did file SSI at the beginning, then you likely will have this problem when it is processed.
ReplyDelete