VCU Benefits Assistance Resource Center Overview of SSA Work-Related Overpayments

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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----beneficiarie
  s 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 consumers case.

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Consumers 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 advocatesmust 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 individuals 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 2Three Alternative Questions
• Would Recovery Defeat the Purpose of the SSI/SSDI
  Program?

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Requirements to Receivea Favorable Waiver
Decision

• PART 2Three Alternative Questions
• Would Recovery be Against Equity and Good
  Conscience?

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Requirements to Receivea Favorable Waiver
Decision

• PART 2Three Alternative Questions
• 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, same
• appeal 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