Office of Quality Review (OQR)

October 29, 2018

The Office of Quality Review (OQR) selects cases for Federal QR during the Disability Determination Services (DDS) case closure process and prior to effectuation of the DDS’s determinations.


Offset: Windfall Elimination Provision (WEP)

October 9, 2018

There is a number of offsets which could reduce social security payments, including:
(1) Windfall Elimination Provision (WEP), (2) Government Pension Offset (GPO), (3) Workers’ Compensation and Public Disability Benefit and (4) Treasury Offset Program (TOP).

 


Offset: Government pension offset (GPO)

October 7, 2018

There is a number of offsets which could reduce social security payments, including:
(1) Windfall Elimination Provision (WEP), (2) Government Pension Offset (GPO), (3) Workers’ Compensation and Public Disability Benefit and (4) Treasury Offset Program (TOP).

Government pension offset (GPO).

A provision that reduces Social Security spousal and widow/widower’s benefits, if they’re based on the earnings record of a worker who spent part of his or her career in government employment not covered by Social Security.

The GPO is a reduction to spousal or survivor benefits if you have a pension where you did not pay Social Security taxes. The reduction is 2/3 of your pension amount! For example, if your pension is $3,000, the SSA will subtract nearly $2,000 from any spousal or survivor benefits before you are paid. This large reduction often completely wipes out any benefit for which you are eligible.

If you have a pension from ‘mixed’ earnings, the entire pension amount should not be used in calculating the 2/3 reduction! Only the amount that came from the months where you did not pay Social Security taxes should be used.

The Social Security rules make this clear: “Some entities may pay a pension based on both government employment and private employment. For pensions based on a combination of federal, state, or local government employment and private employment (i.e., non-government employment), GPO applies only to the portion of the pension based on government employment. [emphasis added]

Example. John receives SSA of $1600/mo. Mary had worked as an educator for the Austin, TX unified school district and receives pension of $1000/mo. If John passed away, what is the net SSA benefit that Mary would receive? $1,600 less (2/3 x $1,000) = $1,600 – 667 = $933

Further readings: https://secure.ssa.gov/poms.nsf/lnx/0202608400

 

 

 


Offset: Workers’ Compensation and Public Disability Benefit

October 6, 2018

There is a number of offsets which could reduce social security payments, including:
(1) Windfall Elimination Provision (WEP), (2) Government Pension Offset (GPO), (3) Workers’ Compensation and Public Disability Benefit and (4) Treasury Offset Program (TOP).

Workers’ compensation is a state-mandated insurance program that provides benefits to employees who suffer job-related injuries and illnesses. The benefits are paid for by employers or paid by government agencies (e.g. Public Disability Benefits, PDB: California State Disability Insurance (SDI or CASDI)).

The insurance provides five basic benefits:

  • Medical care;
  • Temporary disability benefits: Payments to compensate for lost wages;
  • Permanent disability benefits: Payments if you don’t recover completely;
  • Supplemental job displacement benefits: Vouchers to help pay for retraining or skill enhancement if you don’t recover completely and don’t return to work for your employer;
  • Death benefits: Payments to your spouse, children or other dependents if you die from a job injury or illness.

If you receive Social Security disability benefits, the amount receive will be offset by workers’ compensation.

Social Security figures your average current earnings in one of three ways:

  • method 1. The Average Monthly Wage Formula: Social Security uses your average monthly wages to calculate your disability benefit amount.
  • method 2. The High-Five Formula: Social Security uses the average monthly wages from your five highest-paid consecutive calendar years.
  • method 3. The High-One Formula: Social Security uses the average monthly wages from the your single highest-paid calendar year during the previous five years.

The High-One formula is used in the vast majority of cases, although Social Security will use whichever method is most favorable to you.
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In Social Security terms, an individual’s pre-disability income is referred to as his/her “average current earnings” (or “ACE”). 42 U.S.C. 424a(a) provides three methods of calculating an individual’s ACE:

  • method 1 by computing the “average monthly wage”, a figure which is computed primarily (but with some additional considerations) by dividing the total of all wages and self-employment income by the number of months in the span of time over which the wages and self-employment income were earned;
  • method 2 by computing 1/60th of the total of wages and self-employment income for 5 consecutive calendar years after 1950 for which such wages and self-employment income were highest;
  • method 3 by computing 1/12th of the total of wages and self-employment income for the calendar year in which the individual had the highest such wages and income during the period consisting of the calendar year in which he/she became disabled and the 5 years preceding that year.

Using one of these three methods (the one which generates the highest number), the Social Security Administration calculates the individual’s ACE, reduces the ACE by 20%, and then compares the resulting amount to the sum total of the individual’s monthly workers’ compensation payment plus his/her monthly Social Security disability entitlement. Where the ACE (after reduction by 20%) is less than the sum total of the disability payments, a dollar-for-dollar offset will be applied to the overage.

Reduction of SSDI. First Social Security calculates 80% of the average current earnings (or uses 100% of the total family benefit, if that is higher) to come up with the applicable limit. Then it adds the monthly SSDI benefit to the monthly worker’s compensation benefit. If the benefit total exceeds the applicable limit, Social Security will reduce SSDI until it reaches the applicable limit.

Case #1. Social Security award’s letter dated 10/10/20×8 [disabled 4/29/20×6, 5mos: M-J-J-A-S, month of entitlement (MOE): 10/20X6]
We found that you became disabled under our rules on April 29, 20×6. To qualify for disability benefits, you must be disabled for five full calendar months in a row. The first month you are entitled to benefits is Oct 20×6. What we will pay and When. $317.80 10/29/20×8; due for 12/20×6 through 9/20×8. Monthly benefits $53.40, see computation follows:

 

 

 

 

 

 

 

 

 

 

 

 

 


Offset: Treasury Offset Program (TOP)

October 4, 2018

There is a number of offsets which could reduce social security payments, including:
(1) Windfall Elimination Provision (WEP), (2) Government Pension Offset (GPO), (3) Workers’ Compensation and Public Disability Benefit and (4) Treasury Offset Program (TOP).

What is the Treasury Offset Program (TOP)?

The Treasury Offset Program (TOP) is an agency established to maintain and collect debts under applicable laws, and is administered by the Bureau of the Fiscal Service’s Debt Management Services. TOP is a centralized offset program that collects delinquent debts owed to federal and state agencies.

If you owe certain governmental agencies any amount of money greater than $25, that governmental agency will submit this debt to TOP. TOP maintains the debt information in its database and informs the SSA of debts you may owe. For example, let’s say you are awarded monthly disability benefits, but it is discovered that you owe past-due taxes to the IRS. TOP will maintain that debt information, notify the SSA of the debt owed, and legally intercept some of your monthly benefits until the debt is fully satisfied.


SSA 3288 Consent for Release of Information

September 30, 2018

Consent for Release of Information, Form SSA-3288.


SSA 2459 BPQY

September 30, 2018

Benefits Planning Query (BPQY), Form SSA-2459

The Benefits Planning Query (BPQY) is part of the Social Security Administration’s (SSA) efforts to inform Social Security Disability Insurance (SSDI) beneficiaries and Supplemental Security Income (SSI) recipients about their disability benefits and the use of the work incentives.

  • Cash Benefits – For both SSDI and SSI shows the Type of Benefit, Current Status, Statutory Blindness, Date of Entitlement, Full Amount, Net Amount, Others Paid on This Record, Total Family Cash Benefit, Overpayment Balance, and Monthly Amount Withheld.
  • Health Insurance – Shows Medicare or Medicaid eligibility, and for Medicare (both Part A Hospital and Part B Medical) the date of coverage, premium amounts, and State Premium Buy-In.
  • Medical Reviews – For both SSDI and SSI, shows the Next Scheduled Medical Review, the Medical Re-Exam Schedule, and if deferred due to the Ticket to Work Program.
  • Representation – For both SSDI and SSI, indicates whether you currently have a Representative Payee or Authorized Representative.
  • SSDI Work Activity – Shows Trial Work Period months start date, end date, and months used, month of cessation, and current SGA level.
  • SSI Work Exclusions – Identifies any of the SSI work incentives that exclude earned income, with dates and dollar amounts, including Blind Work Expenses (BWE), Impairment Related Work
  • Expenses (IRWE), Student Earned Income Exclusions (SEIE), and PASS Exclusion.
  • Recent Earnings on Record – Shows all lifetime yearly work earnings from wages and self-employment, as well as monthly earnings for the most recent two years.

Who would request this planning tool and how it is used?

  • This form is generally requested by Employment Networks (ENs) and the State Vocational Rehabilitation (VR) agencies.
  • It is used to verify:
    • The type and amount of Social Security disability benefits(s) received;
    • Medicare and medicaid information; and
    • Information about past work and work incentive usage.

To obtain a copy of BPQY, either call Social Security Administration or contact us.

  • Two signed Consent for Release of Information, Form SSA-3288, must be submitted to Social Security if the BPQY will be sent to anyone other than the beneficiary and/or representative payee.
  • The SSA-3288s should be pre-filled with recommended language for release of Social Security and Internal Revenue Service records – refer to BPQY handbook.