Citizens Disability Integration provides an array of services that benefit the LTD claims administrator and enhance risk management. Each of these services adds value to the overall LTD carrier social security program:
Because our disabled claimants are well-served, the LTD carriers will benefit from a cooperative and appreciative insured. Thus, Social Security offsets and overpayment recovery are constructive outcomes.
Citizens provides representation services throughout the nation; our team is thoroughly familiar with SSA field office and hearing office practices and preferences. We handle more SSDI cases than any other group in the country.
Our representatives are professional yet personable, and are highly committed to our work. We take pride in the being the nation’s premier social security disability advocacy group.
Citizens Disability provides a skillful and committed staff dedicated to the task of coordinating and providing timely integration of Social Security awards.
We can make overpayment recovery more efficient for our LTD claims partners, as well. Because a satisfied claimant is generally a cooperative insured, the work we do and the results we get for the claimant puts us in a great position to be able to work with them on recovery issues.
Our tried and proven service model benefits the LTD claims manager in that timely and accurate computations of initial entitlement amounts and subsequent earnings related increases are made available for consideration in the overpayment calculation.
Many LTD Plan Provisions provide for offset for dependent benefits payable on the record of the insured. Citizens works with the LTD claims manager to address this potential offset as well.
There may be issues of “Living in the Same Household” (LISH) for documentation purposes if your plan provisions provide for dependent offset.
Citizens Disability will work with you to customize a process and provide documentation that is most useful to your claims management processes.
Many Social Security Notices Of Award (NOA) that are a result of Initial Application or Reconsideration awards will not have current or prior year earnings available for inclusion in the initial benefit computation. This is because employers are not required to provide W-2 forms until the end of January in the year following.
Citizens Disability maintains system controls which flag for benefit review once Social Security posts and provides benefit increases due to the inclusion of additional earnings in the computation. These “earnings” related increases are often effective with the initial month of entitlement or in January of the following year.
The Social Security Administration often imposes a “HOLD” on retroactive benefit when there is potential for what is termed “Windfall Offset”. Unless SSI is specifically excluded at the time of initial application a “HOLD” on retroactive SSDI benefits may occur as addressed n the Notice Of Award (NOA). Even when specifically excluded on the application SSA may erroneously withhold retroactive benefits. Citizens maintains jurisdiction of the claim until this “HOLD” is resolved. LTD overpayment recovery efforts are contingent on the release of SSDI retroactive funds.
Post SSDI Award events will often impact the SSDI benefits payable. Citizens maintains controls/diaries to alert and manage these events as well.
- Earnings Increases – to inclusion of lag earnings being posted to the earnings record. As alluded to these Annual Earnings Recalculations (AERO) can be anticipated in Initial and Reconsideration awards.
- Triennial Recalculations – When Workers Compensation Offset to the SSDI benefit is applicable the Social Security Administration will provide recalculations of the average earnings index every three years. This increases the net SSDI benefit payable. Your plan provisions may allow for offset for this earnings related increase.
- Workers Compensation Offsets – Initial Notice of Awards (NOA) can have unresolved benefit calculations as SSA awaits verifications or completes calculations.
- PDB (Public Disability Benefits) – If a clamant is in receipt of PDB or State Disability there can be delays in the calculations or release of retroactive SSDI benefits.
- Continuing Disability Reviews (CDR): Citizens can provide representation in which your insured receives an adverse notice indicating SSA has determined that “medical Improvement” has occurred and SSDI benefit termination is proposed.
Return To Work Counseling
While many disabilities are chronic, progressive, or even terminal there are significant numbers of SSDI beneficiaries that would like to eventually return to work (RTW).
The fear previously encountered was the potential loss of benefits and medical insurance coverage (Medicare) at risk by a RTW. Social Security’s Ticket-To-Work program provides incentives for an effort to RTW despite continued impairment(s). Citizens provides counseling during the claims and appeals process on measures and opportunities to futuristically test their ability to RTW without losing their monthly SSDI benefit and Medicare coverage. Should the claimant not have recovered such that SSA’s medical improvement standard has not occurred they can participate in the Ticket-To-Work program.
The Ticket to Work (Ticket) program is a free and voluntary program that can help Social Security beneficiaries go to work, get a good job that may lead to a career, and become financially independent, all while they keep their Medicare or Medicaid. Individuals who receive Social Security benefits because of a disability and are age 18 through 64 probably already qualify for the program.
Benefit Interpretations and Verification
Citizens Disability has the technical expertise and services available to assist LTD claims administrators in attaining and maintaining accurate SSDI entitlement data.
An ability to thoroughly digest and provide interpretations and analysis of Social Security’s Master Beneficiary Record (MBR) & or NOA data provides beneficial information enhancing LTD claims management practices.
Entitlement to Medicare coverage is dependent on the entitlement date to SSDI cash benefits. For most beneficiaries this requires a 24 month period of cash benefits before Medicare coverage is offered. Citizens pursues the earliest disability onset period based on insured status, work dates, and medical severity. For claims with disability onset dates 30 months or more in the past there is potential Medicare coverage upon receipt of the Notice of Award (NOA). Because Citizens Disability maximizes retroactivity in entitlements it becomes a win-win-win situation for the claimant, LTD insurer and the health insurance provider.
For claimants that will have future entitlements to Medicare Citizens maintains a diary in our systems so Medicare and health insurance coordination can be effectuated.