The Social Security “offset” is a key element in the LTD Claim Administrator’s risk management program. But what happens when the insured contacts you to report that they have received an overpayment notice from the Social Security Administration? Worse yet, what if they have been notified that their SSDI benefit has been either suspended or terminated?
Most likely, they will expect you to remove the SSDI offset and resume paying an un-reduced LTD benefit.
To make matters even more adversarial, they’ll likely want you to remove the SSDI offset that was imposed for the period that the Social Security overpayment was imposed. In response, you’ll request a copy of the Social Security Overpayment Notice so you can adjust the period that SSA claimed your insured was overpaid.
But is that the end of it?
There are not only appeal rights, but also waiver provisions that may be applicable. If the determination was based on erroneous facts or misinformation, then perhaps the overpayment and cessation/termination proposals are subject to appeal or even correction.
Even if the overpayment and/or cessation actions are appropriate, there may be opportunities to have the Social Security overpayment waived. If your insured requests benefit continuation during the appeal (within 10 days of receiving the notice of planned action) the SSA will continue benefits during the appeal.
If your insured was not at fault in the creation of the overpayment, and recovery would defeat the purpose of the program or be against equity and good conscience, then a waiver of the Social Security overpayment is possible. And an approved waiver for your insured is also a waiver for the LTD Claim Administrator.
The Citizens Disability team can represent your insured when an appeal of benefit cessation or a Notice of Overpayment is received. You may not need to remove the SSDI offset or repay LTD benefits which were erroneous offset. This can not only save you money, but also can go a long way to keeping your insured happy with you and your brand.