vcu benefits assistance resource center overview of ssa work-related overpayments
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VCU Benefits Assistance Resource Center Overview of SSA Work-Related Overpayments. John Coburn, Consultant Virginia Commonwealth University. Overpayment Basics: What You Need to Know as the BPAO Project. Overpayments Happen. - PowerPoint PPT PresentationTRANSCRIPT
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VCUBenefits Assistance Resource Center
Overview of SSA Work-Related
Overpayments
John Coburn, Consultant
Virginia Commonwealth University
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Overpayment Basics: What You Need to Know as the
BPAO Project
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OverpaymentsHappen
– For many reasons, individuals receive overpayments from Social Security Administration when they become employed.
– The best defense is a good offense----beneficiaries must report work income on a regular basis.
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OverpaymentsHappen
– There is a difference between MORAL fault and LEGAL fault. While some may feel it is unfair to collect an overpayment from them, the law may still allow SSA to do so.
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What is theBPAO Role?
• Advise consumer that currentdecisions about employment will not impact overpayment decisions.
• Provide support to consumer.
• Advise consumer of options and deadlines.
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What is theBPAO Role?
• Refer consumer for representation to PABSS, if applicable, or other legal services organization.
• Provide evidence to build consumer’s case.
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Consumer’s LegalOptions in…
Dealing with an Overpayment
• File a Request for Reconsideration
• File a Waiver
• Negotiate a Payment Plan
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Request for Reconsideration
• SSA-561-U2 Form: “Request for Reconsideration” or Letter
• “The overpayment amount is incorrect and/or I was not overpaid.”
• Must be filed within 60 days unless good cause (5 day mailing rule applies).
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Request for Reconsideration
• SSA will not recoup amount of overpayment until AFTER decision is made on Request for Reconsideration.
• When possible, a Request for Reconsideration should be filed.
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Request for Reconsideration • Consumer and/or their advocates
must be proactive in filing a Requestfor Reconsideration.
• BPAO staff can be particularly helpful in providing evidence for a Request for Reconsideration.
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Analysis of aReconsideration Case:
What Might the BPAO Know that Will “Make the Case.”
• Are the SSI calculations correct?
• Did SSA properly determine the Trial Work Period, Extended Period of Eligibility etc.?
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Analysis of aReconsideration Case:
What Might the BPAO Know that Will “Make the Case.”
• Did SSA know about and consider IRWEs, the Student Earned Income Exclusion, Subsidies, etc?
• Could the individual have reapplied for benefits during the overpayment period?
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Request for Reconsideration:
Appeals Process
• Administrative Law Judge
• SSA Appeals Council
• Federal Court
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Request for Waiverof Overpayment
• Form SSA-632-BK: “Request for Waiver of Overpayment Recovery or Change in Repayment Rate”
• May be filed at ANY TIME.
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Request for Waiverof Overpayment
• SSA will cease recoupment when filed. Therefore, recoupment will not begin if filed within 30 days of notice.
• Administrative Waiver: $500 or less.
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Request for Waiverof Overpayment
• Current SSI beneficiaries do not have to complete entire waiver form.
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Requirements to ReceiveFavorable Waiver Decision
PART 1
Was the Beneficiary without FAULT in Causing the Overpayment?
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Waiver Fault Test
• SSA will consider individual’s age and intelligence as well as any physical, mental, educational, or linguistic limitations.
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Waiver Fault Test
• SSA will find fault if the overpayment resulted from:
– An incorrect statement made by the individual which he/she knew or should have known to be incorrect;
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Waiver Fault Test
– A failure to furnish information which he/she knew or should have known to be material;
– An acceptance of payment which he/she knew or could have been expected to know was incorrect.
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Requirements to Receivea Favorable Waiver Decision
PART 2
Three Alternative Questions:
1. Would Recovery Defeat the Purpose of the SSI/SSDI Program?
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Requirements to Receivea Favorable Waiver Decision
PART 2
Three Alternative Questions:
2. Would Recovery be Against Equity and Good Conscience?
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Requirements to Receivea Favorable Waiver Decision
PART 2
Three Alternative Questions:
3. Would Recovery Impede the Effectiveand efficient Administration of the SSI Program?
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Waiver Test Part 2: Undue Hardship
• SSI Beneficiaries automatically meet this test.
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Waiver Test Part 2: Undue Hardship
• SSDI Beneficiaries must prove hardship:
• Resources less than $3000
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Waiver Test Part 2: Undue Hardship
• SSDI Beneficiaries must prove hardship:• All income is used to meet ordinary and
necessary living expenses: food and clothing, rent, mortgage, utilities, maintenance, insurance, taxes, medical expenses, expenses to support others (legal responsibility), other expenses reasonably considered past of standard of living
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Waiver Test Part 2:
Equity and Good Conscience
• Financial Circumstances Irrelevant
• Change position for worse or relinquish valuable right because of reliance
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Waiver Test Part 2:
Equity and Good Conscience
• SSI Resource Recoupment ($50 rule and limited collection rule) Change position for worse or relinquish valuable right because of reliance
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Waiver Test Part 2:
Efficient Administration of SSI
• Amount of overpayment is less than cost of collection.
• $500 Rule for SSI and SSDI.
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Waiver AppealProcess
SSI Beneficiaries--
Request for Reconsideration
ALJ Hearing
Appeals Council
Federal Court
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Waiver AppealProcess
SSDI Beneficiaries--
If personal conference held, you can go straight to ALJ stage. There is no Request for Reconsideration stage. Otherwise, sameappeal process as SSI.
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Waiver &Recoupment
• For both SSDI and SSI, recoupment will stop when a waiver request is made.
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Waiver &Recoupment
• For SSDI beneficiaries, recoupment cannot begin until AFTER the individual has been given an opportunity for a personal conference and declined, or the waiver is denied after personal conference is held.
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Waiver & Recoupment
• For SSI beneficiaries, recoupment cannot begin until AFTER the determination of the waiver is made, unless a Request for Reconsideration of that waiver denial is filed within 30 days.
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Adjustmentof Benefits
• SSI: 10% or less rule.
• SSDI: All can and will be taken. Hardship exception.
• ALWAYS WORK OUT A PAYMENT PLAN!
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NEGOTIATION
• Always an option at any stage in the process.
• Highly encouraged as SSA is very reasonable in coming up with a payment plan.
• Informed decision about waiving of rights.
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Other Methodsof Recoupment
• Tax Refund
• New Wage Garnishment Rules