Greeman & Toomey asked:

Types of Social Security Disability Benefits

The Social Security Administration has established a number of different types of disability programs. Although the medical rules are similar under each program, the technical rules on eligibility set each program apart. What program you may be eligible for depends on a number of factors, including your work history, age, household income and marital status. You may be eligible for more than one type of benefits, but generally SSA will pay you the higher benefit amount of any one program you may be entitled to.

Disability Insurance Benefits: This program, also known as “DIB” or Title II benefits, awards benefits to individuals who, because of a physical or mental impairment, are unable to work at a “substantial” gainful level, and their condition has existed or is expected to exist for at least a 12 month period. By “substantial,” SSA means the claimant would be unable to earn over $900.00 per month because of their disability. This dollar amount increases slightly every year. To be eligible for DIB, a claimant must have worked long enough and paid enough into Social Security through their FICA taxes to be “insured.” As a general rule, if a claimant worked at least five of the last 10 years, he would be “insured” for purposes of DIB. How much a claimant receives each month if found disabled and entitled to DIB is based on how much he “paid into” the system during his working life. Generally, the longer someone has worked and the higher his earnings, the more he would be paid if found disabled. Individuals found disabled and entitled to DIB benefits may be awarded retroactive benefits. Retroactive benefits can only go back one year from the date of the initial application. There is a five-month waiting period from the date the claimant is determined to be disabled until entitlement to DIB benefits begin. To illustrate this, if a claimant files a claim for DIB on January 1, 2006 alleging disability as of February 2005, and SSA determines he is disabled and his disability began February 1, 2005, he would be eligible for retroactive benefits starting in July 2005. In addition to receiving individual DIB benefits, your minor children may also qualify for auxiliary benefits based on your disability. These benefits are granted in addition to any benefit you receive. To ensure any minor children are awarded any benefits they may be entitled to, it is important you furnish the names and Social Security numbers of any minor children you have to SSA. The children do not have to live in the same household to be eligible for auxiliary benefits.

Supplemental Security Income: This program, also known as SSI or Title 16 benefits, is a “needs-based” program in which individuals with little or no resources or assets may receive disability benefits. The medical criteria for SSI eligibility is the same as that used for DIB — a physical or mental impairment which prevents you from working at a “substantial” gainful level, and the condition has existed or is expected to exist for at least a 12 month period. Effective January 2007 the SSI payment for an eligible individual is $623 per month and $934 per month for an eligible couple. There is no retroactive eligibility for SSI benefits: benefits can go back only to the month in which your claim was filed. Unlike DIB, there is no five-month waiting period for entitlement to SSI, so your eligibility would begin the month in which you filed your claim or were determined to be disabled, whichever is later. A claim for SSI benefits can also be filed on behalf of any minor children with a disability; however, as with Adult SSI claims, to be entitled to SSI benefits the household income must be below certain limits.

Disabled Adult Child: This program provides disability benefits to adult children of deceased or disabled parents. In addition to the medical requirement that you have a physical or mental impairment which prevents you from working at a “substantial” gainful level, and the condition has existed or is expected to exist for at least a 12 month period, you must also show that your condition has existed and has been disabling since before your 22nd birth date. In addition, you must be the adult child of a parent who is currently receiving DIB benefits, or the Adult child of a parent who is deceased and was “insured” for purposes of eligibility for DIB benefits. It is not necessary that the adult child ever worked because benefits are paid on the parent’s earnings record. The adult child must not have worked and earned “substantial earnings” for an extended period at any point after turning 22; however, certain expenses the adult child incurs in order to work may be excluded from these earnings. An adult child already receiving SSI benefits should check to see if benefits may be payable on a parent’s earnings record. Higher benefits might be payable and entitlement to Medicare may be possible.

Disabled Widow’s/Widower’s Benefits: If you are a disabled widow or widower age 50 or older you may be able to receive benefits off your spouse’s (or former spouse’s) Social Security record. If you are a widow or widower from a spouse you were divorced from, to be eligible for benefits you need to have been married to your spouse for 10 years or longer and your disability must have started before age 60 and within seven years of the date in which the worker died. If you were married to your spouse when they passed away, Social Security does not require that you were married for 10 years. In either case, you will need to provide proof of relationship in the form of your marriage certificate or divorce decree, along with your spouse’s death certificate when you file for benefits. If you file a claim for Disabled Widows/Widower’s benefits and DIB or SSI benefits, you will receive only the higher monthly benefit amount of the two programs.

Medical Insurance: Once you are found disabled and entitled to Social Security disability benefits, you will also be eligible for medical insurance though Medicare or Medicaid. If you filed a claim for DIB, Disabled Adult Child or Disabled Widow’s/Widower’s benefits, you may be eligible for Medicare. However, eligibility for Medicare does not start until you have been disabled for 25 months. If you are approved for Social Security benefits under any of the above-listed programs, SSA will contact you approximately two months before your eligibility for Medicare begins. If you have already been disabled for 25 months, be sure to keep a record of all medical bills as you may be reimbursed by Medicare for these expenses. There is no waiting period for Medicaid; however, your income and resources must be very low to qualify. If you have applied for and have been approved for SSI you probably qualify for Medicaid. You may think that Medicaid and Medicare are the same, but actually they are two different programs. Medicaid is a state-run program that provides hospital and medical coverage for people with low income and little or no resources. Each state has its own rules about who is eligible and what is covered under Medicaid. Some people qualify for both Medicare and Medicaid. For more information about the Medicaid program, contact Social Security or your local social services or welfare office.

This article has been written to give you a general overview of the Social Security disability programs and the disability process. As this article may not address all questions you might have, please contact us for further information.

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Maribel Roncales asked:

Social Security Fraud refers to the act of dishonestly claiming of benefits. Due to the increasing number of fraudulent claims, the US government enacted a law that will protect individuals from these illicit conducts.

What constitutes Fraud under the Social Security Act?

The Social Security Act provides an outline for actions that are considered fraudulent. Some of those acts are the following:

• Knowingly and willfully makes or causes to be made any false statement or representation of material facts in the application for benefits under this title;

• Knowingly and willfully makes or causes to be made any false statement or representation of a material fact for use in determining any rights to the benefits;

• Having knowledge of any event affecting

o His  or her right to the benefit

o The initial or continued right to the benefit of other individual in whose behalf he or she has applied for or is receiving benefit

o Having made an application to receive any of such benefits for the use and benefit of other and having receive it, knowingly and willfully converts the benefits for the use other than for what is intended

Information needed in filing Social Security Fraud

When planning to file a Fraud complaint, you need the following data:

• Name

• Address

• Social security number of the person you are reporting.

• Description of potential fraud incident

In cases where the Social Security number is not known, you need to secure his or her date of birth, age and the name of the parents. However, if you are reporting a concealed activity you need the name of the employer and its address and phone number.

How to report Social Security Fraud incident

The Social Security Administration takes seriously any report regarding Social Security Fraud. The Office of the Inspector General is the one who investigates incidents of Social Security Fraud. If you have any knowledge regarding these incidents, you can report it immediately by:

• Calling the Social Security Office hotline number

• Use the on line fraud reporting form

• Write to Social Security Office.

Yet, if you have been the actual victim of a fraudulent act, seeking legal assistance from a competent Social Security Fraud attorney is advisable. An attorney with sufficient in handing these cases can help you prosecute the law violators.

What is the Office of the Inspector General?

The Office of the Inspector General is the one directly responsible for meeting the statutory mission promoting economy, efficiency and effectiveness in the administration of Social Security programs. It is also responsible for preventing and detecting fraud, waste, abuse and mismanagement in such programs and operations.

OIG also searches and reports systematic weaknesses in SSA programs and operations and make recommendations for improvements and corrective actions.

Penalties for the violation of the Act

Any person found guilty for Social Security Fraud shall be:

• Fined under the United States Code

• Imprisoned for not more than five years or both

The federal court in sentencing the defendant may in addition to any other penalty order restitution.

When can there be restitution?

The court orders restitution in any of the following instances:

• The Commissioner of Social Security order payment that should not have  been made

• An individual suffers financial loss due to defendant’s violation of this Act.

Our Los Angeles attorneys are proven experts in handling Social Security Fraud cases. For free evaluation of your case, log on to our website and contact our legal staff.

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