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Social Security Work Processes

Social Security Work Processes. Connie DaValt SSA John Benbow ERI. AWIC – Area Work Incentives Coordinator. Connie DaValt connie.davalt@ssa.gov (866) 807-5995 ext. 26030 Provide outreach and training on work incentives to the public and SSA personnel

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Social Security Work Processes

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  1. Social Security Work Processes Connie DaValt SSA John Benbow ERI

  2. AWIC – Area Work Incentives Coordinator Connie DaValt connie.davalt@ssa.gov (866) 807-5995 ext. 26030 • Provide outreach and training on work incentives to the public and SSA personnel • Assist with disability work-related issues in WI SSA offices

  3. WIL – Work Incentive Liaison • Each Social Security office has a WIL who is a technical expert in all SSA work incentives • Participate in local outreach activities/provide technical advice to their local SSA staff • Serve as a primary point of contact for local organizations on work incentives

  4. Unsuccessful Work Attempt (UWA) • An effort to do substantial work (SGA) that stops or is reduced below the SGA level within a limited time due to the impairment or removal of special conditions. • POMS DI 11010.145

  5. UWA: When applicable • Earnings are excluded during an UWA in making SGA decisions in…  - Initial claims for both SSDI and SSI (used for establishing disability onset date), or - Continuing disability work reviews • UWA does not apply when counting TWP months or after the cessation month. • May apply during the EPE if no prior cessation

  6. UWA: Time Limits Work attempt has to be discontinued or reduced below SGA within 6 months to be disregarded. Work effort of more than 6 months cannot be considered an UWA. Work attempt lasting 3 months or less: Work must have stopped due to either… • Impairment, or • Removal of special condition(s)

  7. UWA: Time Limits Work attempt lasting 3 to 6 months: Work must have stopped because of impairment or removal of special condition plus… • Frequent absences, or • Unsatisfactory performance, or • End of remission of impairment, or • Work has been under special condition(s)

  8. UWA: Counting Months Months are counted using actual dates of work Example 1: If work started 11/5/11 and ended before 12/5/11, it would count as one month Example 2: Work from 11/5/11 through a date no later than 2/4/12 would be 3 months or less. Work from 11/5/11 through 2/5/12 but no later than 5/4/12 would be between 3 and 6 months.

  9. UWA: Special Conditions • Special assistance from other employees • Irregular hours or frequent rest periods • Special equipment or work especially suited to impairment • Specially arranged circumstances • Work performed at lower standard of productivity or efficiency than other employees • Family relationship, past association with employer, or other altruistic reason which created the opportunity to work

  10. UWA: Period of Work • Significant break in continuity of work must occur before the work attempt can be considered unsuccessful. For example: - work discontinued or reduced below SGA for at least 30 consecutive days, or - person forced to change to another type of work or another employer • Multiple UWAs are possible

  11. UWA Example Sid, an SSDI beneficiary, completed TWP 2/12; earnings below SGA in 3/12 so no cessation. Starting 5/12 Sid increased his hours of work despite his impairment. From 5/1/12 – 9/15/12 he earned $1300 mo. In 9/12 Sid had to reduce his hours of work now earning $900 because of his impairment. His employer felt that he was not doing satisfactory work. Is this an UWA? What months is he due SSDI payments?

  12. Averaging Countable Earnings • When work earnings vary from month to month with some months over SGA and some under, SSA may average countable earnings for purposes of determining SGA • If earnings average below SGA, then SGA months are disregarded in the cessation decision • Averaging can be used in initial claims (SSDI and SSI) and after TWP • Averaging cannot be used in determining TWP months, after an SGA cessation, or during IRP months (in an EXR case) • POMS DI 10505.015

  13. Averaging: Period of Work • SSA averages monthly countable earnings during distinct periods of work • Earnings are averaged over a period when: - pattern of work is continuous, and - no significant change in earnings, and - no regulatory change in SGA level

  14. Averaging Earnings • Months from TWP can be used in averaging if they are part of distinct period of work. • In multiple work activities, average jobs separately and then combine. • When employment has just started , SSA looks at the expected work/earnings pattern and anticipates its continuance – if anticipated pattern of SGA does not occur, SSA may revise the decision.

  15. Averaging Example: Pam, an SSDI beneficiary began working in 8/11 • 8/11-1/12 $850 mo (6 twm) • 2/12 $980 7 • 3/12 $1020 8 • 4/12 $990 9 • 5/12 $1020 (potential cessation mo) • 6/12 $1015 • 7/12 $1010 • 8/12 $1020 • 9/12 $900 • 10/12 con’t $900

  16. Pam’s Decision • Average earnings 1/12 – 10/12 $970.50 • Cessation? No • Decision will be revised after 12/12 earnings are reported

  17. SSDI Cessation Medical Cessation • Impairment has improved since the most recent favorable determination and the impairment together with the vocational profile does not prevent the individual from engaging in SGA. Work Cessation • The first month after completion of the TWP that the beneficiary demonstrates ability to engage in SGA. Beneficiary is still eligible but payments are suspended for any month of SGA during the EPE.

  18. SSDI Termination Medical Termination • Eligible and payable month of cessation and two additional (grace) months followed by the termination month Example: cessation month March benefits paid Mar/Apr/May, terminated June Work Termination • Benefits terminate with the first month of SGA after the cessation month/grace period and the end of the EPE

  19. SSDI EPE and Termination • When disability ceases due to SGA prior to the end of the EPE, the termination month is first month of SGA after the 36th month of the EPE. Example: TWP ends 1/2009 (EPE 2/09-1/12) SGA begins 6/11 and continues Cessation 6/11 (benefits payable) Grace months 7/11, 8/11 (benefits payable) Termination 2/12

  20. SSDI EPE and Termination • When disability ceases due to SGA in or after the 36th month of the EPE, benefits are paid that month and the next two (grace) months, followed by the termination month. Example: TWP ends 1/09 (EPE 2/09-1/12) SGA begins 5/12 Cessation 5/12 (benefits payable) Grace months 6/12, 7/12 (benefits payable) Termination 8/12

  21. SSDI Reentitlement • To regain SSDI entitlement after a medical cessation and termination, a new application necessary • To regain SSDI entitlement after a work cessation and termination, either a new application or an EXR claim (SGA stopping within 60 months of termination) is necessary

  22. Presented by Wisconsin’s Disability Benefits Network (WDBN) • Employment Resources, Inc. • More about WDBN online at www.eri-wi.org/WDBN.htm • John Benbow: benbow@eri-wi.org

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