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Countdown to Medicare Annual Enrollment

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Are you a Medicare beneficiary?  If so, your annual opportunity to learn about next year’s Medicare health plan options is coming up quick!  The Annual Enrollment Period is just around the corner, beginning on October 15th and continuing through December 7th.  Even if you are currently enrolled in a Medicare Advantage plan, you can use this Annual Enrollment Period to shop around for a plan that may be more appropriate for your needs. 

We know that with the variety and sheer volume of plans available to you depending on where you live, the process of weeding through them all can be overwhelming and confusing.  That’s why we now offer a service where a licensed and certified Medicare Specialist can provide you with a thorough analysis of the plans available to you, taking into account your preferred doctors and prescription drugs.  In fact, if we can find a plan that you like, we may be able to enroll you into that plan right over the phone.

For more information about your Medicare options and the Annual Enrollment Period, contact one of our agents at (877) 406-5160.  Additionally, you can find more information by visiting www.medicare.gov or by calling Medicare directly at 1-800-MEDICARE.

Heading into Independence Day

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Short article from The Washington Times heading into the Fourth of July holiday weekend.  A few highlights from the story:

  • Of the 316.2 million Americans, approximately 1 in 5 has some kind of disability, and 1 in 10 has a severe disability.

  • The official Social Security Administration website indicates that there are “8.8 million disabled workers who are social security recipients.”

  • “Just over 1 in 4 of today’s 20 year-olds will become disabled before reaching age 67.”

  • Approximately 10,000 persons turn 65 each day, and this is estimated to continue for the next 20 years.

SSA Proposes Changes to Video Hearing Scheduling

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On Thursday, June 27th, SSA published a Notice of Proposed Rulemaking in the Federal Register to change the procedures for objecting to hearings via video teleconference (VTC).  In addition to in person hearings, SSA also holds hearings via video teleconference in order to promote efficiency, convenience and utilization of resources.  That said, a claimant who has been denied benefits has an absolute right to request a hearing in person.  Currently, when a VTC hearing is scheduled, the claimant can object and request that the hearing be held in person.  As you can imagine, this creates scheduling issues for SSA’s hearing offices. 

Where a claimant or their representative objects to a VTC hearing, SSA makes every possible effort to have the originally scheduled judge attend the in person hearing in order to prevent “judge shopping,” whereby  a claimant or his/her representative might object to a VTC hearing solely for the purpose of avoiding a judge with a lower approval rate.  However, this then means that remotely scheduled ALJs have to travel out of area in order to provide an in person hearing close enough to the claimant’s residence.  Of note, this was not an issue when SSA was withholding ALJ names

In an effort to overcome this administrative challenge, SSA’s proposed rule would require a claimant to object to a hearing via VTC before the hearing is scheduled.  According to the rule, SSA would notify each claimant of this option while the claim is pending at the hearing office but prior to scheduling.  The notice would explain that a hearing may be scheduled via VTC and that if the claimant intends to request an in person hearing, they have 30 days to notify the hearing office of this request from the date of receipt of the notice.

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Supreme Court Rules on DOMA

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Clarence Thomas, Antonin Scalia, John G. Roberts, Anthony M. Kennedy, Ruth Bader Ginsburg, Sonia Sotomayor, Stephen Breyer, Smauel Alito Jr., Elena KaganOn Wednesday, June 26, the United States Supreme Court struck down the federal Defense of Marriage Act (DOMA) as unconstitutional. 

Enacted in 1996, DOMA defines “marriage,” for purposes of over a thousand federal laws and programs, including Social Security, as a union between a man and a woman only.  In overturning the Act, the Supreme Court explained that the states have traditionally had the responsibility of regulating and defining marriage, and that some states have chosen to allow same-sex couples to marry in order to provide them with the protection and dignity associated with marriage.  By denying recognition to same-sex couples who are legally married, DOMA discriminates against them to express disapproval of state-sanctioned same-sex marriage. 

Today’s Supreme Court decision means that same-sex couples who are legally married under state law must now be treated the same under federal law, including the Social Security Act, as married opposite-sex couples. 

For purposes of Social Security benefits, this will mean that same-sex spouses who are married under the laws of their states of residency will be eligible for spousal Social Security benefits.

Grassley Pushing SSA for Answers on CDRs

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us-senateContinuing Disability Reviews (CDRs) have been a major pressure point for the Social Security Administration (SSA) over the past few years.  The purpose of these periodic reviews is to allow the SSA to evaluate a Social Security Disability Insurance (SSDI) recipient’s continued entitlement to benefits.  According to SSA’s estimates, every $1 spend on CDRs results in an estimated $9 return on investment by ensuring that only those who are truly disabled continue to benefit from the program.

Last week, Republican Senator Charles E. Grassley, Ranking Member of the Committee on the Judiciary, authored a letter to SSA’s Acting Commissioner, Carolyn W. Colvin, inquiring into SSA’s plans to increase the number of CDRs to support maintenance of program integrity and reduction of improper payments.

In the letter, which can be read in its entirety on Senator Grassley’s website, the Senator from Iowa  addresses head on the fact that SSA included in its 2014 budget request (see page 63 of SSA’s 2014 Budget Overview) a legislative proposal to bolster SSA’s integrity initiatives through the creation of a Program Integrity Administrative Expenses (PIAE) account.  According to SSA’s budget overview, the proposed legislation “would provide a dependable source of mandatory funding to significantly ramp up our program integrity work, which ensures that only those eligible for benefits continue to receive them.”  (more…)

New Hearings on the Horizon for Queens, NY Class Members

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As previously reported here back in February, the class action lawsuit brought against several named Administrative Law Judges in the Queens, NY ODAR alleging “general bias” against Social Security Disability applicants has reached a potential settlement, pending a fairness hearing which will be held in July. 

While the settlement is not yet completely signed, sealed and delivered, this week we began receiving notices from the Social Security Administration indicating that our clients who received unfavorable hearing decisions from the named ALJs will soon have the opportunity for new hearings with different judges.  This included any of our clients who received an unfavorable or partially favorable decision during the period from January 1, 2008 to the present and continuing for 30 months after the final settlement date. 

According to the terms of the proposed settlement, class members who received an unfavorable or partially favorable decision after January 1, 2008 from one of the five named ALJs will receive a new hearing with a new ALJ.  Additionally, as an added safeguard, class members who receive an unfavorable or partially favorable decision in the 30 months following finalization of the settlement will receive automatic review by a specialized group at the Appeals Council. 

Whether or not you are a client of The Advocator Group, we can provide representation if you are a class member with an opportunity for a new hearing.  If you think that you may have this opportunity and you are in need of an advocate, you can reach us toll-free at (877) 261-1947.

The more things change, the more they stay the same

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Social Security Trustees Annual Report 2013Every year around this time, the Social Security Board of Trustees issues a report, hundreds of pages long, detailing the current state of the Social Security Retirement and Disability trust funds.  Typically the following week, we see a slew of media reports expressing concern and anxiety over the future solvency of the programs. 

Last Friday, the 73rd annual report was released to the public and as usual, it has brought with it an onslaught of stories about how the trust funds are running out of money and will go broke within a few years.  Interestingly, however, this year’s report was pretty much the same as last year’s, indicating that in the absence of legislative action, the disability insurance trust fund would be insufficient to pay full benefits as of 2016.  Also similar to last year’s report, though, the trustees point out that “[i]n the absence of a long-term solution, lawmakers could choose to reallocate a portion of the payroll tax rate between OASI and DI, as they did in 1994.” 

The trustees make it clear that in order for the trust funds to remain solvent over the long term, major change is needed.  Either revenues to the program must be significantly increased, scheduled benefit payments must be significantly reduced, or some balanced combination of the two approaches must be adopted.   

All of that said, the last sentence of the Trustees’ Conclusion sums it up best:  “With informed discussion, creative thinking, and timely legislative action, Social Security can continue to protect future generations.”

Update to Social Security Regs

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The Social Security Administration (SSA) is changing its regulations regarding how an Administrative Law Judge may allow the appearance of someone (other than the claimant) to appear at a hearing, other than in person.  These changes are being made in response to recent Federal District Court decisions holding that expert testminony could not be taken by telephone over a claimant’s objection if the claimant did not have prior notice that the expert would be appearing by phone. 

This is a positive change for claimants and their representatives in that the regulations now dictate that if an ALJ determines that testimony will be by telephone, the ALJ must notify the claimant prior to the hearing, allowing the claimant or his/her representative to object.

These changes will allow the claimant and the claimant’s representative to exercise discretion while developing their strategy prior to the hearing.  If it is determined that facing an expert that is scheduled to appear will result in more fruitful cross examination and more accountability, they can make that argument to the ALJ and the ALJ will be forced to rule on the appearance.  Further, parties to the hearing will no longer be caught off-guard when the expert invited to testify relative to the claimant’s medical or vocational characteristics is not actually at the hearing, but present via speaker phone from a home or office.

SSA Goes Mobile

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SSA Mobile SiteThe Social Security Administration announced yesterday that “the agency is offering a new mobile optimized website, specifically aimed at smartphone users across the country.  People visiting the agency’s website, www.socialsecurity.gov, via smartphone (Android, Blackberry, iPhone, and Windows devices) will be redirected to the agency’s new mobile-friendly site.” 

According to the release, and apparent after visiting the site, “visitors can access a mobile version of Social Security’s Frequently Asked Questions, an interactive Social Security Number (SSN) decision tree to help people identify documents needed for a new/replacement SSN card, and mobile publications which they can listen to in both English and Spanish right on their phone.”  On the other hand, however, the majority of online services, such as benefits applications and accessing your “my Social Security” account, are still better experienced on a traditional desktop machine.

Social Security’s move to encourage use of its site via handheld device comes in response to the fact that each year, more than 35 million of its web views occur on smartphones.

Contrary to Recent Reports, Getting On SSDI Isn’t Easy

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In its March 2013 member newsletter, the National Organization of Social Security Claimants’ Representatives (NOSSCR) published data on allowance rates at the Initial and Reconsideration levels for Fiscal Year 2012.  Based on recent media reports of individuals gaming the system and the ease of which claimants are approved for benefits, you would think these rates would be through the roof. 

In reality, however? 

Initial Level – 33%. 

Reconsideration level – 12%.

These low approval rates demonstrate not only the difficulty associated with the process, but also the fact that only the most severely disabled workers qualify for benefits under the strict medical standard applied by the Social Security Administration.

Other recent reports and studies have made the case that utilization of professional representation at these levels has relatively little impact on the likelihood of an early award, when in many cases an advocate will nearly double your chances at being awarded at one of these first two levels.