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.

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:

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.      

2013 Appeals Council Statistics

In fiscal year 2013, the Appeals Council took approximately one year to process requests for review. Almost 77% of the requests were denied by the Appeals Council.  In other words, the Appeals Council refused to review almost 80% of the requests filed. Approximately 17% of the requests resulted in a remand. About 1% of the requests for review by the Appeals Council resulted in a favorable decision.

If the claimant is denied, the decision on whether to re-file for benefits or appeal the decision to the Appeals Council is very difficult.  If you decide to appeal to the appeals council, it will probably take at least a year to get a decision, and about 80% of those requests will not even be reviewed.  If you decide to appeal your claim to the Appeals Council, make sure your attorney or representative is able and willing to consider taking the case to Federal Court.

Headaches and Disability

A common problem I see in disability claims is the evaluation of headaches.  So long as there is evidence to support the presence of possibly disabling headaches, the ALJ must address the issue.  2014 U.S. Dist. Lexis 8450

 

Consideration of VA benefits in an SSDI claim

A recent case from a local district court that resulted in remand addressed a number of important issues, including the issue of a VA disability determination in the context of a SSDI claim.

According to the Commissioner’s own rules and regulations, a decision by any governmental agency about whether an individual is disabled must be considered evidence. 20 C.F.R. § 404.1504. While such evidence may not be binding on the Administration, various Circuit Courts, including the Sixth Circuit, have held that the Commissioner must give the decisions of other agencies evidentiary weight.

. . . .  Furthermore, the Fourth, Fifth, Ninth, and Eleventh Circuit Courts have held that a VA ratings decision was entitled to “great weight.” . . . .

Reynolds v. Colvin, 2014 U.S. Dist. Lexis 8450 (E.D.Tenn. Jan. 3, 2014)