John filed an initial application but lost his housing and became homeless before a determination was made on his claim. DDS denied the claim and SSA sent
... [Show More] the notice to his previous address. John did not receive it and when he goes into the SSA Field Office to find out about the status of his claim, they tell him that it was denied three months ago. He comes to you for help. What are his options? - ANSWER-*Good Cause For Late Filing*
Since the determination is now final (remember administrative finality?), he could start over with a new application, however his alleged onset date cannot be before the date of the initial determination, meaning he would lose potentially thousands in back due benefits if approved. A knowledgeable and experienced representative such as yourself, realizes that if John can prove that he was homeless and did not receive the notice, he can argue that he had good cause for a late appeal. You advise him to get a statement from the shelter he was staying at during the time the notice was mailed. Perhaps a director at the shelter can confirm that he did not receive mail forwarding, or any mail at all, while staying at the shelter. You sign on as John's representative, help him get the statement and submit a statement of good cause for late filing, with the letter from the shelter, along with the Request for Reconsideration. This action is one reason it is important for claimants to have representation. If John started over at initial instead of appealing it, he could have potentially lost months or years of benefits.
The claimant was born September 15, 1991. He began work at age 21 for a company owned by a friend of his father. He loaded trucks at a grain storage warehouse. He traveled across State lines from his home--where he lived with his parents--to the job site each day. He made enough money to be credited with four (4) quarters of coverage in 2013. He made enough money to be credited with two (2) quarters of coverage in 2014. In May, 2014 the business owner was indicted for tax fraud and the company closed. Claimant was unable to find work thereafter. He has no other work history. On New Year's Eve, 2015 the claimant was jogging near his home when he was struck by a driver and sustained multiple leg and back injuries. Was he insured at the time of his accident? - ANSWER-*Special insured status*
Yes. He turned 21 in 9/2012, one quarter after turning 21 = 12/2012 (404.130(3). Onset is 12/31/2015. Between the 4th quarter of 2012 and the 4th quarter of 2015 there are 13 quarters. If the number of quarters is odd you subtract one, which leaves us with 12 quarters. Half of 12 is 6. He has 6 QC's total and is insured for disability insurance benefits. His date last insured (DLI) is 12/31/2015.
If Sam applies for benefits on 12/3/2017 and says that he became disabled on 11/8/2014 (assuming he is awarded SSDI as of that alleged onset date of 11/8/14), the five-month waiting period would begin when? - ANSWER-7/1/2016 - 17 full months before date of filing
If Marie applies on 7/1/2016 and claims her onset of disability was 3/3/2016, she would not be eligible for benefits payments until when? - ANSWER-9/1/2016. Due to the full five-month waiting period, March cannot be counted as a full month because she did not become disabled on the first day of March.
Mark's established onset date of disability was March 15, 2018. When will his Medicare access begin? - ANSWER-*Medicare Waiting period*
September of 2020- March 2018 does not count as a full month, so the 5-month waiting period begins 4/18. (April, May, June, July, August= waiting period) His benefits begin September 2018 and his Medicare will begin 2 years later in September, 2020.
Test Tip: Include the 5-month waiting period in your calculation and count 29 months forward from established onset date to get the date the Medicare eligibility would begin.
Susan is seriously injured in a motor vehicle accident two days after her 19th birthday and is expected to have permanent loss of much of the use of her arms and legs. Susan was in college at the time of the accident and has never worked and was not married. Susan's father was a bank executive, but died when Susan was only 11 years old. Will Susan be eligible for DAC benefits? - ANSWER-*Disabled Adult Child (DAC)*
Yes, she meets all the criteria: unmarried, 18 or older, disabled before age 22, meets listings with loss of use of four extremities, and no work record of her own. If Susan had been married, then she might be eligible for SSI, but not for DAC benefits.
Mrs. Smith is 55 years old this year, 2019. Mr. Smith was working and fully insured when he died of cancer in 2011. Since then, Mrs. Smith has struggled to pay the bills with her job as a Walmart greeter. This year she had to quit her job because she was put on oxygen 24/7 due to advanced COPD. Can she apply for disabled widow's benefits? - ANSWER-*Disabled Widow Benefits (DWB)
No. Mrs. Smith meets all the criteria for DWB except that her disability began more than 7 years after her husband died. Mrs. Smith may be eligible for SSI.
Jake filed an initial application and received a Notice of Denial dated May 2, 2017 on May 5, 2017. When is the appeal due? - ANSWER-Start counting with the date after the date of the notice (5/3). 5/3 plus 60 days = 7/1. BUT...we have to add in the 5-day assumption to get to the technical due date. 7/1 plus 5 = 7/6/2017. Jake has to submit an appeal 7/6/2017 or earlier for it to be considered timely filed.
Jack, who has not done any work since 2012 and has been on the Ticket to Work program since 2014, feels better due to new medication. He is able to find a job and starts working full time on June 15, 2018. He earned $789 the month of June and $2378 in July. The stress of working got to him and he had to stop on August 4th making his total earnings in August $182. How many trial work months did he use during this work attempt? - ANSWER-He only used one. The work done in June and August was under SGA and therefore did not count as a TWP month.
Morgan is twenty years old and currently lives with her mom and step-dad and they do not require her to pay rent or contribute to buying groceries. What would SSA consider [Show Less]