In most LTD Plan Provisions the claims administrator may integrate and offset for any SSDI benefit increase that is attributable to “earnings” related computations.
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.
LEARN MORE about our Benefit Verification service.