FAQ

First, here is some information about overpayments and how to help prevent them in the future: Avoiding and Managing SSI/SSDI Overpayments. Reporting earnings is absolutely essential to prevent overpayments. SSA has some options for requesting waivers of overpayments and can set up payment plans if they deny the waiver request. 

Deciding whether to quit or cut back their hours depends on the person’s circumstances. No matter what, they need to report their earnings. Those earnings will impact SSI and SSDI differently (read some basic information about SSA Work Incentives). For some people, they can earn a lot more income by working and if they are feeling well and are able to work, that is probably what they should do (their decision!). For others, the stability of their SSDI payment is important and so they work under SGA each month to keep their benefit. Ultimately, I would recommend that they talk to a Benefits Counselor to discuss their options.

HIPAA requires medical providers to release the patient's records within 30 days after the request is received (https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/ind…). Some states have laws that require the release of medical records in fewer than 30 days.

If a person is approved for both SSI and SSDI they will maintain Medicaid because SSI benefits include Medicaid. However, some states require a separate Medicaid application, (https://www.ssa.gov/disabilityresearch/wi/medicaid.htm).

Medicaid coverage for services varies from state to state. Here is a link that will take you to your state's Medicaid agency: https://www.medicaid.gov/about-us/contact-us/contact-state-page.html.

SSDI benefits include Medicare, but there is typically a 24 month waiting period before the SSDI beneficiary can begin to have Medicare coverage (see Page 12 at https://www.ssa.gov/pubs/EN-05-10029.pdf).

Once the beneficiary has both Medicaid and Medicare, Medicare is typically the primary insurance.

The SAMHSA SOAR TA Center recommends that you don’t cite the Listing and Grid numbers, e.g.) Ms. Jones meets Listing 12.04, and the alternative Grid rule 203.03. Rather, at the DDS level (initial and reconsideration) we suggest providing a description of how the applicant meets a particular Listing(s) or Grid rule through specific examples from the medical records, applicant quotes, and other collateral sources.

Yes, you should file a SOAR-assisted application because even if you don’t have access to the medical evidence, DDS will request directly from prior treating sources and/or schedule appropriate Consultative Examinations (CE) to obtain diagnoses. Remember, SSA needs a diagnosis to make a disability determination. Remember, to write in the “Remarks Section” on SSA forms, about your efforts to obtain medical information so that DDS will know what they need to do to medically develop the claim.

You can obtain valuable insight into the reason an applicant was previously denied by reviewing the applicant’s electronic folder, or at minimum, obtaining the “Disability Determination Explanation” or denial notice. Most likely, you will have easy access to the denial notice from the applicant or, if you are the authorized representative, SSA should have mailed a copy to you. You can also request reason for denial by contacting your local SSA office. Learn more at Reviewing Denial Notices.

• The appeal must be filed within 60 days of receipt of the initial denial notice.
• The applicant must submit the following forms:
  • SSA-561: Request for Reconsideration
  • SSA-3441: Disability Report- Appeal
  • SSA-827: Authorization to Disclose Information to SSA
• Additional medical records and evidence can be submitted
• The application will be assigned to a different disability examiner and reviewing physician at DDS

Yes, we have a number of resources on the SOAR website to help provide information and guidance through the appeals process. They can all be found in the SOAR Library. I recommend starting with the article About Appeals and then checking out the Appeals Toolkit.

SSA does not allow an applicant to have multiple applications pending at the same time.  If the applicant chooses to have a new initial SOAR-assisted application for SSDI benefits submitted, then the applicant would need to withdraw their current application.  It is important that the applicant understands that the new application would create a new application date which may result in the loss of retroactive 'back' benefits based on withdrawing the current pending application.

"Questions for Direct Examination at SSA Administrative Law Judge (ALJ) Hearing," along with other helpful resources, can be accessed on the webinar "Hearing Tips for SOAR Practitioners."