Social Security Disability Fraud Investigations

The Social Security Administration uses Cooperative Disability Investigation (“CDI) Units to investigate potential fraud.  The CDI units work with the Office of Inspector General (OIG) as well as state and local law enforcement agencies.  Such investigations take place during the entire application process, and also during continuing disability reviews.  Investigations can be generated by state agency employees, SSA employees, private citizens, anonymous sources, and law enforcement agencies.  During the investigation, the CDI Unit can interview the application, interview third parties, conduct surveillance, and/or examine the claimant’s social media accounts.  It appears such investigations are expanding.

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Compliance with Medical Treatment: SSR 96-7p

Although SSR 96-7p permits SSA to consider compliance with recommended medical treatment as a factor in determining the credibility of the claimant, “The adjudicator must not draw any inferences about an individual’s symptoms and their functional effects from a failure to seek or pursue regular medical treatment without first considering any explanations that the individual may provide.”

Migraines can equal a listing

Per POMS DI 24505.015(B)(7)(b), a claimant with chronic migraine headaches may equal listing 11.03, Epilepsy, non-convulsive.  See: Mann v. Colvin, (N.D.Iowa April 23, 2015) and cases cited therein.

 

2015 COLA

There will be a 1.7% cost of living adjustment for Social Security and SSI beneficiaries in 2015.

  • SSI:
    • Individual: $733 per month
    • Couple: $1,100 per month
  • Trial Work Period: $780 per month
  • Maximum Taxable Earnings: $118,500
  • Earnings required for quarter of coverage: $1,220
  • SGA
    • non-blind: $1090
    • blind: $1820
  • Retirement earnings test exempt amount:

Video Hearing Opt-Out

A few months ago SSA published rules regarding video hearing procedures. The rules provide that SSA will notify the claimant prior to the hearing that the hearing may be conducted by video teleconferencing. The claimant has the opportunity to object to the procedure and demand an in-person hearing, but must do so in writing within 30 days.

Listing 12.05(C)

In Whitehead v. Comm’r of SSA, 2014 U.S.Dist. Lexis 112016, the District Court did a wonderful job of not only explaining Listing 12.05(C), but applying the listing to the facts of the case.   Listing 12.05C requires a valid IQ of 60 through 70 and a physical or mental impairment imposing an additional and significant work related functional limitation.  The Listing further requires intellectual disability manifested before age 22.  In my experience, there is a common misconception that someone who is mildly mentally retarded or intellectually disabled is unable to function in any manner whatsoever.  Thus, if a person with mild mental retardation has worked in the past, decision makers apparently feel it would be inappropriate to find the person disabled.  The truth is that individuals with mild mental retardation are usually able to live in the community, often independently (DSM, 4th).   Thus, it is improper to deny a claim that meets Listing 12.05 simply because the claimant has worked unskilled jobs in the past, or is able to watch television, drive, or take a bath.  “Individuals performing in the mild mental retardation range are capable of performing such activities.”  Whitehead, p. 14.      

New Ruling SSR 14-1p

SSR 14-1p should be consulted in any case involving chronic fatigue syndrome. If you suffer from Chronic Fatigue Syndrome and are unable to work, contact The Hamilton Firm for a free consultation.