Author: Attorney Desk Reference Manual
Last updated: December 2009

Benefits
Termination of Benefits
          Trial Work Period
          Continuing Disability Reviews
Representative Payee
American Recovery and Reinvestment Act of 2009

Benefits

RSDI: Persons found eligible for RSDI benefits based on disability can receive benefits as far back as 12 months prior to their date of their application if SSA finds that the onset date of the disability was 17 months or longer before the application date.  SSA does not pay benefits for the first five months after the date of onset for RSDI disability benefits.

SSI: Due to changes in federal law in 1996, persons found eligible for SSI are entitled to payments starting the month after they meet the eligibility criteria.  SSI benefits are not payable in any months prior to the date of application.  There are also new limitations in what newly eligible recipients can receive as a lump sum back award.  Different past due benefits rules apply to adults and to children.

Past Due SSI Benefits for Adults:  Back awards exceeding 12 months worth of benefits are paid out in not more than 3 installments at 6 month intervals. The first two installments cannot exceed 12 months worth of benefits. There is an exception for persons who have an impairment that is expected to result in death within 12 months or who is ineligible for benefits now and is likely to remain ineligible for the next 12 months.  Persons who have outstanding debts for food, clothing, shelter, medically necessary services, supplies or equipment, or who are purchasing a home may receive an increase in the amount of the installment up to the full amount of the debts or expenses.

Past Due SSI Benefits for Children:  Benefits that exceed 6 times the current payment amount ($603 --2006 value) must be deposited in a separate account that is designated only for certain uses for the child.  The regulations specify that these funds can only be used for medical treatments and education or job skills training or items related to the child’s impairment such as personal needs assistance, therapy or rehabilitation, equipment, etc.  In general, it is a good idea to have questionable expenses approved by the local SS field office before they are incurred.  This may avoid an overpayment.

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Termination of Benefits

SSA conducts periodic disability reviews of persons found eligible for SSI or Title II benefits.  Recipients may be found no longer disabled as a result of such a review. Other reasons for termination include:

• Recipient cannot be located;
• Failure to follow prescribed treatment which may restore ability to work;
• Other failure to cooperate;
• Fraud;
• Performance of substantial gainful activity beyond the trial work period.

Hearing: Recipients have the right to a face to face hearing at reconsideration.  These hearings are conducted by a state hearing officer.

Trial Work Period: Recipients are entitled to a trial work period of up to nine months.  The earliest month of the trial work period is a month for which the recipients receive benefits.  The nine months need not be consecutive.  Any month during which the recipient earns $720 (2010 value) counts.  Recipients can have only one trial work period during any period of entitlement to benefits.

Continuing Disability Reviews

SSA periodically reviews disability recipients to determine if their condition continues to be disabling.  In cases where improvement is expected, review can be as early as 18 months after the most recent decision.  All other cases should be reviewed at least every three years, except cases involving permanent disability which are reviewed every five to seven years.

The Social Security Act establishes a "medical improvement standard" which must be applied in disability termination cases.

The Medical Improvement Regulations

Medical improvement is defined as any decrease in the medical severity of impairments present at the time of the most favorable medical decision as demonstrated by changes (improvement) in the symptoms, signs, and laboratory finds associated with the impairment.  20 C.F.R. §§ 404.1594 and 416.994.

To make the determination, evidence is compared at two points in time, at the time of the continuing disability review and on the date of the most recent prior medical decision finding the person disabled.

Only impairments that existed at the time of the last review will be considered.  The review will not focus on new impairments which have developed since that time.

Once medical improvement is found, it must be determined whether it is related to the ability to work.  This determination is made by comparing the residual functional capacity at the last evaluation with the residual functional capacity for those same impairments at the time of the current evaluation.  The evidence must show that there has been an increase in the residual functional capacity that supports a finding that the improvement relates to the ability to work.

NOTE: Claimants who are notified that their benefits are going to be cut-off as a result of a continuing disability review can request continuation of benefits through the ALJ level.  For RSDI claimants who request continuation of benefits, there will be no back benefits out of which to pay a private attorney, so some legal services offices will accept these cases even though they involve Title II benefits.

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Representative Payee

For persons who are unable to manage their benefits, SSA may appoint a representative payee.  20 CFR §416.601.  The determination should be based on medical evidence or other substantial evidence, such as a judicial determination of lack of capacity.  The recipient is entitled to advance notice of any such determination, and the right to appeal it or the individual or entity appointed by SSA to serve as representative payee.

A representative payee may be either a person or an organization.  SSA has established an order of preference for appointment of representative payees.

For recipients older than 18, the order of preference is:

• A legal guardian, spouse or relative who has custody of or shows strong concern for the welfare of the recipient,
• A friend who has custody of or demonstrates strong concern for the personal welfare of the recipient,
• A public or nonprofit organization having custody of the recipient,
• A private institution operated for profit and licensed under state law that has custody of the recipient,
• Other persons who are qualified to carry out the responsibilities of a payee and who are willing to serve as payee.

A non-profit community based organization appointed to serve as payee for at least five recipients concurrently may charge a monthly fee for serving as payee, provided it is bonded to serve as payee; it is not a creditor of the recipient; and it seeks authorization from SSA for charging the fee.

Duties of a representative payee:

• Use benefits for cost of present needs first, then pay debts, help dependent, etc.
• Maintain records of how funds are used
• Keep recipient's funds in a separate account
• Submit periodic reports to SSA

A payee cannot be required to use benefits to satisfy the recipient's debts if the debt was incurred before the recipient became eligible.

Stopping Representative Payee Status

A recipient may request that representative payments be stopped.  S/he must show that he or she is mentally and physically able to manage or direct the management of payments.  A physician statement, a court order dissolving a guardianship or other evidence of ability to manage may be sufficient.

Impact of the American Recovery and Reinvestment Act of 2009 (ARRA) on SSI

The ARRA provides a one time stimulus payment and other relief in the form of funds to SSA to expedite processing of claims which are now taking on appeal and average of two years:

$250 one-time payment goes to almost everyone who receives:

• Social Security,
• Supplemental Security Income (SSI), and/or
• Railroad Retirement Benefits, and Veterans, Disability Compensation or Pension Benefits.

As long you received a benefit in November, December 2008 or January 2009 (Spouses each get a one-time payment.) If you are found retroactively disabled and entitled to benefits for these months, then you are eligible because the stimulus payment can be made until December 31, 2010.

• You owe state or federal agencies money or you are delinquent in child support
• If you are not legally a US citizen
• You are living overseas
• You are on SSI in a nursing home or governmentally run facility.
•  You were denied benefits because you made false or misleading statements.
• You were in prison or violated parole or probation
• You are a child receiving Social Security (through a deceased or disabled parent)

SSA is making the payment automatically and the one-time payment will be made separately from regular monthly benefit payments. Payment method will be the same as for monthly benefit (direct deposit or mailed check).

• Payment won’t count as income for purposes of determining eligibility for or amount of any federal, state, or local benefit. Payments are not taxable income and there is no tax return required in 2010 because of getting this one-time payment.

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