- CSR initial claims with caller/beneficiary, set up appt
- At the appt, the Claims Representative set up claims via (a) MCS and (b) eView
- DDS exams the claimant and make medical determination as to disability or not; sends letter.
- If deemed medically approved, the FO will review non-medical qualifications.
- If deemed “NOT” disabled, the beneficiary can appeal: recon, ALJ, ODAR. A new entries are setup in eView.
SSDI benefits cease, (3 months) grace months for payment are 10/2022-12/2022.
SGA? CLMT pays for his work transportation of $350/mo. There is a medical need for him to take a taxi. SSA deducts the cost of his transportation expenses as impairment-related work expenses (IRWE). SGA = 2000 – 200 -350 = 1,450, which is over the SGA level of 1,180 for 2018.
- Alleged onset date (AOD)
- Blind Work Expenses (BWE, vs IRWE)
- Concurrent: filing for both T2/SSDI and T16/SSIDI
- Extended Period of Eligibility (EPE) = TWP + 36mos = Sept 2022 + 36mos = Sept 2025
- EPE consists of 36mos during which a beneficiary may receive a full cash benefit for any
- month the person does not perform Substantial Gainful Activity (SGA). As long as the individual continues is disability, their entitlement to benefits doesn’t fully terminate until EPE ends. [DI 13010.215]
- Expedited reinstatement (EXR): see discussion follows.
- Extended Medicare = TWP + 93mos = Sept 2022 + 93mos = July 2030. 93 mos = 7 years, 9 months
- Grace period = TWP + 3mos = Sept 2022 + 3 mos = Dec 2022
- Substantial gainful activity (SGA)
- Impairment-related work expenses (IRWE vs BWE)
- Trial Work Period (TWP) = 9 months. Ends Sept 2022
– – – –
Given: SGA in 2018 is $1,180
NOTE. How does the claimant’s work activity affect his SSI benefit (Title XVI)?
SGA rules are different for SSI. For SSI disability benefits, we only consider SGA when the initial claim is filed (unless the disability is blindness, then we do not consider SGA at all). We do not consider SGA after a person becomes eligible for SSI. However, we must determine whether the person continues to meet the non-disability requirements, including income and resources. We determine the effect of the claimant’s earnings on his SSI eligibility and payment amount on a month-by-month basis.