Overpayments and SSDI and SSI Benefits ytiONLINE @ 2019 2.1 - - PowerPoint PPT Presentation

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Overpayments and SSDI and SSI Benefits

ytiONLINE @ 2019 2.1

Disability, Workplace, and Employment Support Practice Online Professional Development Courses and Certificate and Credentialing Programs

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Today’s Class

• What is an Overpayment and how does one occur?
• Reconsideration vs. Waiver of Overpayment
• Requesting Reconsideration
• Requesting a waiver
• Administrative Waiver
• What if I lose?

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Overpayments

• Overpayments occur when a beneficiary has

received more benefits than she was entitled to receive.

• “An overpayment is the total amount an individual

received for any period which exceeds the total amount which should have been paid for that period.”

• POMS GN 02201.001, 20 C.F.R. 416.537

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Common Ways That Overpayments Occur

• SSDI Work-Related Cessations
• SSDI Medical Cessations
• SSI Excess Resources
• SSI Excess Earned Income
• Failure to report income or resources

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Overpayments and Work

• For many reasons, we must expect that our

customers who return to work, or enter the workforce for the first time, will be assessed an overpayment.

• Preparing our customers for this eventuality

will go far in encouraging their work effort.

• Use of the SSA “call in” system and My Social

Security Account to report wages may minimize overpayments.

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Who Can be Held Liable for an Overpayment?

• The beneficiary
• The eligible spouse
• Auxiliary beneficiaries
• The estate of a deceased beneficiary or spouse
• An immigrant’s sponsor
• A representative payee–only if SSA has determined

that the benefits were “misused”

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Reconsideration vs. Waiver: The Great Debate

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Reconsideration

• Used to challenge the fact of and/or

amount of an overpayment.

• Must be filed within 60 days of receipt of

the notice.

• The 5-day mailing assumption applies.

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Reconsideration (continued)

• Use the standard reconsideration form (SSA-561-U2)
• r submit a letter challenging the amount or the

existence of overpayment to SSA.

• Work-related overpayments almost always require a

request for reconsideration as SSA field offices do not always know about or process all possible work- related deductions from earned income, i.e., Subsidies, IRWEs.

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Reconsideration (continued)

• Recoupment efforts can begin 30 days after the

notice of overpayment is received, but must cease once a request for reconsideration has been filed and must not be reinstated until SSA issues a decision.

• Following reconsideration, the challenge to the

fact of and/or amount of the overpayment will follow the standard administrative appeal process.

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Use of Reconsideration

• Reconsideration should be used to correct any

errors in the amount of overpayment assessed to a beneficiary, to apply IRWEs/subsidies, etc., and to correct wage information.

• SSA should be seen as a creditor at this point and

your efforts should be treated like any other effort to correct a bill you receive!

 Polling Question 1

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WAIVER OF RECOUPMENT OF AN OVERPAYMENT

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Waiver of Recoupment

• Used when an overpayment exists but the consumer states

that it wasn’t their fault and they cannot pay it back or it would be unfair to pay it back.

• There is no 60-day limitation to consider when filing a

request for waiver of recoupment of an overpayment.

• As a result, the beneficiary can feel comfortable processing a

Request for Reconsideration to correct the debt before requesting waiver.

• Why would anyone not try to waive an amount not actually
• wed? It stays on your “permanent record”!
• Request for waiver of overpayment recovery or change in

repayment rate form (SSA-632-BK).

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Requirements for Waiver

• 1. The beneficiary must be without fault,

AND

• 2. The beneficiary must be unable to afford to

repay without risking the ability to provide for basic needs, or, recovery of the overpayment would be against equity and good conscience.

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Waiver

SPECIAL NOTE: SSI beneficiaries are assumed to be unable to afford to repay an overpayment and, as a result, will not be required to complete any of the financial portions of SSA-632-BK. The only issue in an SSI related overpayment is FAULT.

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SA-632-BK: Page 1

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SA-632-BK: Page 2, Section 1 – Information about Receiving the Overpayment

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SSA-632-BK: Page 6, Monthly Household Expenses

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Waiver

• Filing a waiver request will also prevent all recoupment

efforts by SSA if filed within 30 days of the notice of

• verpayment. If filed later, recoupment will also stop and

no further adjustment can occur until a decision is issued.

• Once the request for a waiver has been filed, recoupment

can begin only after the claimant has been given an

• pportunity for an oral meeting and the waiver request

has been denied.

• This is normally provided only when SSA plans to deny the

waiver application.

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Fault

The first part of the two-part waiver test involves a determination of “fault.” If the beneficiary is determined to be “at fault”, the

• verpayment must be repaid.

The ability to repay becomes irrelevant.

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Fault (continued)

The regulations, at 20 C.F.R. 404.507 & 416.552, state that “fault” will be found if the beneficiary:

• Failed to furnish information which s/he knew or

should have known was material; or

• Made incorrect statements which s/he knew or

should have known were incorrect; or

• Did not return a payment which s/he knew or

could have been expected to know was incorrect.

Polling Question 2

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Circumstances That Must be Considered When Determining “FAULT”

When evaluating “failure to report”, “without fault”, “good cause”, and “good faith” on the part of the beneficiary seeking a waiver, “all circumstances” must be considered by SSA, including the beneficiary’s:

• Disability
• Age
• Education
• Comprehension of reporting requirements

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Ability to Pay

The ability to repay is the first alternative to the second, and mandatory, waiver eligibility test.

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Inability to Repay

• If the beneficiary receives SSI or other “needs based”

welfare benefits, SSA will assume that recovery of the

• verpayment will “defeat the purposes of the act.” Such a

beneficiary is assumed to be unable to repay. Fault is the

• nly issue.
• For Title II beneficiaries, SSA must consider a monthly

budget picture. If the beneficiary uses substantially all of his or her monthly income to meet “ordinary and necessary living expenses” then the inability to repay will be found.

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Inability to Repay (continued)

• If the beneficiary retains any of the overpaid

funds, recovery of these funds will not defeat the purpose of the act.

• These funds must be returned to the field office

and will be used to reduce the outstanding balance.

 Polling Question 3

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“Against Equity and Good Conscience”

• Waiver will be granted where the beneficiary is

without fault, AND

• Recovery of the overpayment would be

“against equity and good conscience.”

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“Against Equity and Good Conscience” (continued)

• SSA interprets this very narrowly—did the

beneficiary relinquish a valuable right relying on the overpayment?

• However, the notion of basic fairness must and

should be considered.

• MONEY/RESOURCES DON’T MATTER!!!

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Pre-Recoupment Hearing Regulation

• Individuals seeking a waiver will have the

right to an oral, pre-recoupment hearing prior to SSA’s denial of a waiver request.

• “Oral hearings” can take place via telephone
• r video conference.
• Applies to BOTH Title II and SSI waiver

requests.

• 20 CFR 404.506 & 416.557

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Administrative Waiver

If the overpayment is $1,000.00 or less AND a waiver or appeal is requested, SSA can “administratively” waive the overpayment as collection will “impede efficient administration”

• f the program.

20 CFR 416.555, POMS SI 02260.030

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Administrative Waiver

If the overpayment was the result of excess resources totaling $50 or less and there appears to be no indication of fault, an “administrative waiver” can be granted by SSA even without a beneficiary request.

20 CFR 416.555, POMS SI 02260.035.

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Administrative Waiver

Equity and good conscience exist to waive the remainder of any SSI overpayment resulting from excess resources, once SSA has first recouped the amount of money over the resource limit.

20 CFR 416.555, POMS SI 02260.035(E)

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What Happens Following a Final Unfavorable Decision?

Recovery by “adjustment

• f ongoing benefits”

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Adjustment of Ongoing Benefits

SSI BENEFICIARIES: “Adjustment” of ongoing benefits is limited to 10% of monthly income. Should the beneficiary be unable to meet “current and ordinary living expenses” adjustment can be reduced to less than 10% per month.

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Adjustment of Ongoing Benefits

Title II BENEFICIARIES: There is no 10% limitation for Title II beneficiaries. However, individuals may request a lower rate of recoupment due to hardship. Recoupment can be as much as 100% of the monthly benefit.

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Adjustment of Ongoing Benefits

CONCURRENT BENEFICIARIES: Cross program recoupment is now an option if there is an SSI

• verpayment. The SSI overpayment can be

recouped from Title II. However, cross program recoupment does not allow a Title II overpayment to be recouped from SSI benefits.

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Adjustment of Ongoing Benefits

Underpayment Recoupment to Satisfy Overpayment:

• The 10% limitation will not apply to past-due payments
• wed to the individual.
• 100% of these underpayments may be recouped.

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Adjustment of Ongoing Benefits

If the individual is found to have “willfully misrepresented or concealed material information”, there is no 10% limit on recovery and other federal benefits may be at risk of recoupment.

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Other Options

• Seizure of tax refunds
• Administrative Wage

Garnishment

• Lump-sum settlements
• A second waiver

application???

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Homework

• Included in your package for the next class
• Will be covered at the beginning of the next

class

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Ray Cebula rac79@cornell.edu

• K. Lisa Yang and Hock E. Tan

Institute on Employment & Disability Cornell University ILR School 201 Dolgen Hall Ithaca, New York 14853

• t. 617.312.3261
• f. 987.937.0799

Ed Lopez-Soto ejl44@cornell.edu

• K. Lisa Yang and Hock E. Tan

Institute on Employment & Disability Cornell University ILR School 201 Dolgen Hall Ithaca, New York 14853 Cooper Cebula ytiONLINE Mascot

• K. Lisa Yang and Hock E. Tan Institute
• n Employment & Disability

Cornell University ILR School 201 Dolgen Hall Ithaca, New York 14853