OIG Report On Use Of Averaging When Determining SGA

     From a recent report by Social Security's Office of Inspector General (OIG):

When a disabled beneficiary has earnings from work activity, SSA conducts a work continuing disability review (CDR) to determine whether the beneficiary engaged in SGA. SGA describes a level of work activity and earnings. Work is “substantial” if it involves significant physical or mental activities and earnings exceed the SGA threshold. The Code of Federal Regulations states SSA can average earnings for a period of work when it determines whether a disabled beneficiary engaged in SGA. During the period for which SSA averages earnings, the beneficiary must have worked continuously, without a significant change in work pattern or earnings. SSA has not established a monetary earnings amount that represents a significant change. However, policy directs staff to consider whether the beneficiary changed positions, job duties, or hours when determining whether a significant change occurred. If SSA finds the beneficiary’s monthly earnings average is below the SGA threshold, it pays benefits for all months. ...

Of the 200 sampled beneficiaries, we identified 58 for whom SSA applied averaging inconsistently or incorrectly when it made SGA determinations. Of these, SSA made questionable payments to 51 based on its SGA determination. SSA issued or withheld payments totaling over $651,000 because it did not apply averaging provisions consistently. As a result of the questionable determinations, SSA

• paid benefits, totaling more than $607,000, to 40 beneficiaries and
• withheld benefits, totaling more than $44,000, from 7 beneficiaries. 

SSA’s policy allows employees to exercise their own judgment and discretion when deciding whether to average earnings. As a result, the policy for averaging earnings results in decisions that are not consistent and equitable among beneficiaries.We estimate SSA applied averaging provisions inconsistently tomore than 30,000 beneficiaries. This led to questionable benefit payments or withholding totaling almost $419 million.

     I'm sympathetic to the agency on this one. I don't see how they can come up with truly objective standards nor how they can ensure completely consistent application of any standard. These are just difficult to do. Almost always you have limited information about the exact dates of earnings. The earnings are often highly variable. The regulations have to give agency employees discretion to deal with the million and one situations that come up but whenever you give discretion you're going to have people applying the rules in differing ways. OIG can come in after the fact and say that you should have done something different in many cases but it's not like OIG's judgment is the gold standard. If anything, I'd trust the field office staff to make the right judgment calls more than I'd trust OIG personnel who don't do this kind of work on a regular basis.

Legislative Hearing On Social Security 2100 Act

     The House Social Security Subcommittee has scheduled a legislative hearing on the Social Security 2100 Act for July 25. I don't know what a "legislative hearing" is. Apparently, this isn't a markup session where Subcommittee members approve the final language of a bill. Will the Subcommittee be hearing from members of Congress who aren't on the Subcommittee?

     This bill won't be enacted in this Congress. It may never make it out of the full Ways and Means Committee and it will certainly won't get a vote in the Senate. This is about setting a Democratic agenda for the future, especially if Democrats gain the White House and Senate after the 2020 election.

    Here's a summary of the Social Security 2100 Act from the Chairman of the Subcommittee, John Larson of Connecticut:

• Benefit bump for current and new beneficiaries – Provides an increase for all beneficiaries that is the equivalent of 2% of the average benefit. The United States faces a retirement crisis and a modest boost in Social Security benefits strengthens the one leg of the retirement system that that is universal and the most reliable. [Sec. 101]

• Protection against inflation – Improves the annual cost of living adjustment (COLA) formula to better reflect the costs incurred by seniors through adopting a CPI-E formula.  This provision will help seniors who spend a greater portion of their income on health care and other necessities.  Improved inflation protection will especially help older retirees and widows who are more likely to rely on Social Security benefits as they age.  [Sec. 102]

• Protect low income workers – No one who paid into the system over a lifetime should retire into poverty.  The new minimum benefit will be set at 25% above the poverty line and would be tied to wage levels to ensure that the minimum benefit does not fall behind.  [Sec. 103]

• Cut taxes for beneficiaries – Over 12 million Social Security recipients would see a tax cut[ii].  Presently, your Social Security benefits are taxed if you have non-Social Security income exceeding $25,000 for an individual or $32,000 for couples.  This would raise that threshold to $50,000 and $100,000 respectively. [Sec. 104]

• Holding SSI, Medicaid, and CHIP Beneficiaries Harmless – Ensures that any increase in benefits from the bill do not result in a reduction in SSI benefits or loss of eligibility for Medicaid or CHIP. [Sec. 105]

• Have millionaires and billionaires pay the same rate as everyone else – Presently, payroll taxes are not collected on wages over $132,900. This legislation would apply the payroll tax to wages above $400,000.  This provision would only affect the top 0.4% of wage earners. [Sec. 201, 202]

• 50 cents per week to keep the system solvent – Gradually phase in an increase in the contribution rate beginning in 2020 so that by 2043, workers and employers would pay 7.4% instead of 6.2% today. For the average worker this would mean paying an additional 50 cents per week every year to keep the system solvent. [Sec. 203]

• Social Security Trust Fund Established – Social Security provides all-in-one retirement, survivor, and disability benefits funded through the dedicated FICA contribution paid by workers. There are technically two trust funds, Old-Age and Survivors (OASI) and Disability Insurance (DI), and that are usually referred to as the Social Security Trust Fund. This provision combines the OASI & DI trust funds into one Social Security Trust Fund, to ensure that all benefits will be paid.  [Sec. 204]

Banks To Get Easier Access To Social Security Number Database

     From Bloomburg:

Banks fighting the fastest-growing financial crime in the U.S. have found an unlikely ally: the Social Security Administration.

Banks have spent years lobbying Congress for better access to the agency’s data as a way to fight costly forms of identity theft. Now, the agency has invited lenders and other firms to join a planned real-time electronic system for verifying that credit applicants’ names match their Social Security numbers.

The system would help banks eliminate sham identities created when fraudsters apply for credit cards using Social Security numbers that aren’t in use. Known as synthetic identity fraud, it is the fastest-growing financial crime in the U.S., according to a report this month by the Federal Reserve. U.S. lenders lost $6 billion from this type of fraud in 2016, according to consultant Auriemma Group. ...

The Social Security Administration has long required handwritten consent from consumers to allow lenders to confirm identities. Under that system, banks pay a one-time $5,000 enrollment charge plus a fee every time they look up someone. ...

Action On Two Sets Of Listings Changes

     The Office of Management and Budget (OMB), which is part of the White House, has finished work on two proposals for changes in Social Security's Listing of Impairments, used in determining disability. One set of changes for "Digestive Disorders, Cardiovascular Disorders, and Skin Disorder" was cleared by OMB. Expect to see it published in the Federal Register in the near future for public comments. Another, just for Cardiovascular Disorders, was withdrawn by the Social Security Administration. It could have been withdrawn because it faced opposition at OMB or because the agency changed its mind. There's no way of knowing. There's also no way of knowing at the moment what is or was in either set of proposals.

Expect A Lower COLA This Year

     By the Motley Fool's calculations, if things stay on their current course, Social Security's Cost of Living Adjustment (COLA) for this year will be about 1.4%, which is half of last year's 2.8% increase.

Social Security Records Get Prisoner Off Death Row

     From the Washington Times:

Bruce Webster has been on death row for 23 years. Last month he got a stunning reprieve.

A federal judge ruled that new evidence had come to light suggesting Webster has a mental disability, making him ineligible for execution. It’s the first time someone has been saved from the death penalty by a post-conviction diagnosis of mental infirmity from newly discovered evidence, his lawyers say. ...

At the original trial in 1996, Webster’s attorneys argued their client was mentally challenged, but the government had its own expert witnesses who claimed the defendant was faking his disabilities to escape liability. ...

His lawyers at the time had tried to find government records to back up their disability claim, but failed. More than a decade later, his appellate lawyers were able to get Social Security records showing Webster had applied for disability benefits a year before the murder, and had been deemed disabled because of a low IQ and psychological deficiencies. ...

fter looking back over Webster’s evaluations from the Social Security records, Judge Lawrence ruled executing him would run afoul of the Constitution under a 2002 ruling from the Supreme Court, which held the 8th Amendment’s prohibition on cruel and unusual punishment prevents putting persons with mental disabilities to death.

In that dispute, Atkins v. Virginia, the defendant had IQ scores around 59. Webster’s scores ranged from 48 to 77.

“The scores themselves were obtained over a period of 25 years and consistently demonstrate that Webster has an IQ that falls within the range of someone with intellectual deficits,” Judge Lawrence ruled. ...

Pressure On New Commissioner On Labor Unions

     A number of important Congressional leaders, all Democrats, including the ranking members of the Senate Finance Committee and Senate Homeland Security and Government Affairs Committee and the Chairmen of the House Ways and Means Committee and House Oversight and Reform Committee, have written Andrew Saul, the new Commissioner of Social Security, to urge that he reject anti-employee union actions which took place before he was sworn in and to return to the bargaining table.

     I don't know exactly what's going to happen but if Saul doesn't change the course of the labor-management relationship at Social Security he's going to face massive conflict with Congressional Democrats and they are in a position to make his life difficult. There should be a House Social Security Subcommittee hearing with Saul in the near future. It will go a lot easier for Saul if the main employee union at Social Security, AFGE, believes that Saul wants to work with them instead of trying to destroy them.

Inconsistent Handling Of Veterans' Disability Claims

     From a recent report by Social Security's Office of Inspector General (OIG):

SSA [Social Security Administration] policy provides for disability claims filed by current and former military service members to be expedited. SSA identifies these claims as Military Casualty/Wounded Warrior (MC/WW) and Veteran 100 Percent Permanent and Total (VAPT) disability claims. ... VAPT classifications do not guarantee an allowance for SSA disability benefits. VAPT recipients must meet SSA’s disability medical eligibility and entitlement requirements. ... 

SSA does not define “expeditious” for processing MC/WW and VAPT claims, have processing time goals, or perform regular analysis of the MC/WW and VAPT claims to identify trends. Therefore, to assess the MC/WW and VAPT processing times, we compared them to the average processing time for all disability claims at the various stages of review nationally and by State. We found the following.

• At the initial claims level, SSA processed MC/WW and VAPT claims only 1 day faster than it processed all disability claims.

• SSA processed MC/WW and VAPT claims from 37 to 315 days more quickly than all disability claims at the reconsideration, hearing office, and Appeals Council levels.

• Average processing times varied across States.

There were processing delays attributable to SSA as well as delays outside SSA’s control.

Finally, SSA designed and implemented internal controls to identify and flag MC/WW and VAPT claims to prioritize the processing of those claims. However, SSA could not provide us evidence that it followed its policies and procedures to ensure staff and management properly tracked or monitored MC/WW and VAPT claims.

     By the way, I've seen the same sort of thing with other categories where Social Security is supposed to speed review, such as homeless claimants. A "critical case" designation seems to mean nothing at the initial and reconsideration levels but usually a lot at the hearing or Appeals Council levels.

Social Security Disability And The Homeless Population

     From Investigating Inequities In Accessing Social Security Disability Insurance And Supplemental Security Income For Adults Experiencing Homelessness, an M.S. thesis presented by Anna Booras at Boston University:

... The primary objective of this research study was to investigate applicant and application characteristics associated with disability outcomes among patients at the Boston Health Care for the Homeless Program (BHCHP) Barbara McInnis House (BMH) Medical Respite Unit and to explore the effect of advocacy in increasing access to benefits for those who qualify. ... 

It was shown that advocacy and assistance with the application process for SSI and SSDI produced an allowance rate for people experiencing or at risk of homelessness considered in this study that was almost twice the allowance rate for the homeless population in the state of Massachusetts and was significantly higher than the state general population. Despite the increase in allowance rate, the application determination times were significantly longer for the population of interest in this study as compared to the general population. ... Medical advocacy letters were found to aid in access to benefits for those with mental health primary diagnoses. ... 

In general, consultative examinations were associated with extremely lower odds of approval with only a 16.67% allowance rate overall. ...

     Programs such as Ms. Booras was investigating are great but there's not enough of them to make a dent nationally in the disabled homeless population. Private representation is critical for this population. For a long time, I've been telling colleagues who practice Social Security law that homeless clients may present some challenges but that you can win their cases and make money by helping them. This study is proof of what I have seen in my practice. My name and telephone number gets passed around at the South Wilmington Street Homeless Shelter in Raleigh, the biggest one locally. I'm happy to have the business. If you practice Social Security law, don't shy away from homeless clients.

NADE Newsletter

     The National Association of Disability Examiners (NADE), a voluntary organization of the personnel who make disability determinations for Social Security at the initial and reconsideration levels, has issued its Summer 2019 newsletter. Here's one item from "NADE's Top Issues for 2019":

Reduction in 15 Year Work History: Due to vast changes in the occupational landscape, it is unfair current regulations allow claims to be denied on the basis claimants have an ability to perform a job they performed previously but which no longer exists, or a job they would no longer recognize.