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DMEC Boston Chapter Meeting October 16, 2014. Dan Shaughnessy, Chapter President. Our Mission. To advance strategies and resources that improve workforce productivity by minimizing the impact of absence and disability. Diamond Sponsor. - PowerPoint PPT Presentation
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Our MissionTo advance strategies and resources that improve workforce productivity by minimizing the impact of absence and disability.
OR - Join online: Login to www.dmec.org » Membership» Join
Get the rest of 2014 and all of 2015 for the single year price.
If you join today, your membership will be good through December 31, 2015. The sooner you join, the more you save!
• Talk with your chapter board officers about the many benefits they receive from their membership.
Special Membership Offer:
Pick up an application from this meeting and submit today!
• Connecting you and your company with today’s leading disability and absence management professionals.
• Providing the trusted and proven tools, knowledge and resources that you need to successfully manage employee disability and absence.
• Delivering timely and topical webinars, conferences, white papers and other resources which allow you to effectively manage employee disability, absence and return to work.
Join today at www.dmec.org!
Chapter Board Positions AvailableGive back to your industry!
● Expand your network● Focus on your expertise● Be part of your professional community● Feel good about yourself while helping others● Add to you skill set while building your portfolio
Talk with a board member during this meeting, or visit the chapter’s Home Page at dmec.org for contact information.
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Follow us on Twitter and be the first to find out about legislative updates, new articles and resources, upcoming events, and other topics relevant to your job!
@DMECAbsenceMgt
Tools and Tactics WebinarsFREE to Members!
DMEC’s Tools & Tactics Webinars provide practical and actionable information and cost-effective, innovative solutions focused on integrated disability, absence management, and return to work strategies.
Each session delivers valuable take-aways that participants can use immediately.
DMEC members enjoy this benefit free of charge. Past webinars are recorded and archived and made available for download to members.
For 2014 Schedule: Go to dmec.org » Conferences & Events » Calendar
▪ Networking▪ Conferences▪ Local Chapters▪ Online education▪ Books▪ White Papers
▪ @Work magazine▪ Monthly newsletter▪ Legislative updates▪ Career center▪ Discounts on certification▪ Cost savings
Support your chapter’s ongoing member development campaign! Please write this chapter’s name on top of your new member application; or after you submit an online application, email chapter treasurer so the chapter receives credit.
Virtual Education Forum (VEF)
Sponsored by:
Save the dates: Go to dmec.org » Conferences & Events » Calendar
The Virtual Education Forum webinar series explores how to develop and successfully manage disability, absence management and return to work programs.
Sponsored by Unum, each webinar brings together DMEC member employers, suppliers and industry experts to share their knowledge and experiences in a convenient online format.
To update your professional information:Login to www.dmec.org » Your Member Portal » My Account
• Have you changed employers?• Do you have a new email address?• Is there a change in your title or position? • Has the company name or address changed?
Its easy to make these changes in your Member Portal.
Members: Update Your Profile!Stay in the loop and continue receiving important
information.
Visit our Bookstore for Useful Resources!
Tools of the Trade: Compilation of Programs and Processes for the Absence, Disability, Health and Productivity Professional
Tools to help build the business case for programs and move projects forward. Including illustrations, charts, statistics, best practices, employer checklists, and references to credible industry sources in an easy-to-use desk reference.
Foundation for Optimal Productivity: The Complete Return to Work Program Manual
Numerous industry experts, case studies and flow charts provide the information to set up a new program or improve an existing plan.
Order online from dmec.org » Resources & Info » Bookstore
Chapter Sponsors
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Consider becoming a Meeting Partner for our next chapter event. Contact the chapter board president to discuss further!
OR/SW Washington
Chapter Sponsor
A professional designation in disability and absence management developed by IEA and DMEC.
CPDM offers an in-depth curriculum devised by industry experts, providing the unique skills required for effective disability and absence management.
Three courses:
CPDM 1 - Essentials of Disability ManagementCPDM 2 - IDAM Tools and ConceptsCPDM 3 - Disability Management Implementation and Sustainability.
Learn more at dmec.org » Resources & Info » Certification
Certified Professional in Disability Management (CPDM)
Thank You to ourNational Sponsors
Make a point to say hello to our National Sponsors and thank them for their ongoing support of DMEC member programs and services.
DMEC Boston Chapter Meeting
Social Security Past, Present, and Future
October 16, 2014
Presenters:Barbara Mountain,Doherty, Cella, Keane LLP
Vic Arruda, Esq.Social Security Advocates for the Disabled
25
Agenda
• The Past– What is Social Security– Why was it created
• The Present– How does Social Security affect other types of
benefits– Disability Benefits– Why apply: the advantage– Who is receiving benefits
• The Future– Opportunities, Options, and Obstacles
• Questions/Discussion
26
Social Security History
• 1935 Social Security signed into law by Franklin D. Roosevelt– Creation of an Insurance Program for Workers– Age 65 - Retirement benefits
• 1939 Amendments– Dependent benefits added for spouse and children of a
retired or deceased worker
• 1950 Amendments– Cost of Living Adjustments began– 1954 Disability Freeze began, but not monthly benefits– 1956 Disability benefits for age 50-64
27
Social Security History (continued)
• 1960 Disability Benefits for all ages• 1961 Retirement could now be taken at 62
• For women this changed in 1956• 1965 Medicare • 1970 – Social Security Administration began to administer Supplemental Security
Income• 1980’s The First Social Security Financial Crisis
– Reagan – Greenspan Commission – Numerous “tweaks”
• Taxation of SS benefits• Including taxation of Federal Employees• Increase in Retirement age in next century (those born 1938)• Children Benefits end at age 18 or 19 if still in high school • Allowed Inter-fund borrowing
28
t
How does SS affect other types of benefits?
Coordination of Benefits• Long Term Disability
– Most Group Contracts and some Individual Contracts have a Social Security Offset Provision• Primary Offset is only for what the claimant receives from SS• Family Offset is for what claimant receives and any dependent
receives based on the claimants SS Disability or Retirement benefit
• Workers Compensation– Typically when a person receives Social Security disability
and Workers Compensation, the Social Security Benefit is reduced based on the WC• However there are 10 Reverse Offset States, in which the WC
may be reduced by the receipt of Social Security benefits – Florida, Colorado, Minnesota, Wisconsin, Louisiana, New
Jersey, Oregon, North Dakota, Washington, Montana, and Ohio
29
Social Security Disability Insurance
Income replacement program for disabled workers
• Not at your Full Retirement Age (FRA)• Meets Insured Status (Fully Insured)• Disability Insured (5 out of 10)• Filed an Application• Disabled
– Disability expected to last at least 12 months or result in death
– Can not perform any substantial, gainful work ($1040 month)• 5 month waiting period• Medicare 24 months after the date of entitlement
– ESRD and ALS almost immediately
30
Social Security Dependent Benefits
Aged Spouse Benefits Age 62 or older Not entitled to own benefit amt. greater than 50% of the primary
amount
Child in Care Benefits Have a child under the age of 16 in household 50% of the
primary award
Children’s Benefits Child of the Claimant Unmarried Under 18 or 19 and still in high school 50% of the primary award
31
Advantages to Filing
Medicare Health Insurance after 24 months - critical protection for your
clients and their employees Disability Freeze
Drops out the years of low earnings from future computations. COLA
More money in the claimant’s pocketDependent Benefits
Protection for Family Members Children, Aged Spouse, Child in Care Additional income through COLA’s
Work Incentives
32
Asking a Claimant to File For Social Security
Communication is the key to avoiding a mixed message:
Filing for SS is a requirement in the contract/policy Completely separate program from STD or LTD No effect on the action plan of the LTD claim The goal is RTW, if appropriate: however,
Social Security is extremely important protection for the claimant, customer and the carrier if the claimant is unable to return to work.
But why would a claimant want to file?1. Know the Advantages to filing, and 2. Understand how a SS Representative can help
33
DI 13010.105 RTW within 1 year of onset
Work performed within 1 year of onset should be reviewed and possibly revised for either a denial of benefits or a later onset if RTW was unsuccessful
Work performed on or after month of entitlement and after 12 months of onset is protected by TWP
Work performed after 5-month waiting period and after final determination date is protected by TWP
34
DI 13010.105 Date of Final Determination
The date the Notice of Decision was received by the Beneficiary
Presume notice was received on the 5th day following the date notice was mailed, unless the exact date notice was received can be established.
Decision is typically SSA’s Notice Of Award
35
Example: Maurice
63 YO Male, Post Graduate Degree, Myelofibrosis
Date Last Worked: Oct 15, 2013Date Application Filed: Mar 14, 2014Date RTW: Apr 28, 2014 (PT)Date of SSDI Award: Jun 9, 2014
Is Maurice’s Work Activity in April Protected By TWP?
38
Maurice is not protected by TWP
Onset is October 15, 2013
Statutory Waiting Period Ends March 31, 2014
Decision is Dated June 9th 2014
RTW is April 28th (after 5-Month Waiting Period, but before date of Decision)
39
Example 2: Linda
56 YO Female MD, Post Graduate, Breast Cancer
Date Last Worked: Dec 10, 2013Date Application Filed: May 26, 2014Date RTW: Sep 2, 2014 (PT)Date of SSDI Award: Jul 13, 2014
Is Linda’s Work Activity Protected By TWP?
41
Linda IS protected by TWP
Onset is December 10, 2013
Statutory Waiting Period Ends May 31, 2014
Decision is Dated July 13th
RTW is September 2nd (after 5-Month Waiting Period and after date of Decision)
42
Who is Receiving Social Security?
Social Security Beneficiaries 59 million beneficiaries in pay
A record 9 million workers—over 5 percent of the U.S. workforcewere receiving SSDI benefits at the conclusion of 2013.
Who is Receiving Social Security Benefits
44
Then and Now: Growth in the SSDI Program
Over the past 40 years, the number of disabled workers who receive benefits from the SSDI program has increased more than six-fold.
45
What Are the Drivers of SSDI Growth?
• 5 Factors Account for the bulk of Growth in DI Rolls• Population Growth• Population Aging• Growth in women’s labor force participation• Rise in retirement age• Increase in women’s rate of receipt
• Other Factors that have Contributed to DI Growth• Legislative Changes• Economic downturn• Lower death rates (beneficiaries stay on the rolls longer)• DI Recovery Rates (less funding for continuing disability reviews)
46
SSA Award Rates 2013
SSA Award Rates 2012
SSA Award Rates 2011
SSA Award Rates 2010
Initial Level
33% 33% 34% 35%
Recon 11% 12% 12% 13%
ALJ Hearing
48% 52% 58% 62%
Appeals Council
1% 2% 2% 2%
• The ratio of new SSDI awards to the new SSDI applications has been trending downward since the late 1990s. The ratio was 41% in 2001 and 33.5% in 2013
• From 2001 to 2010 the number of applications for new SSDI benefits rose by 92 percent, from 1.5 million in 2001 to 2.9 million in 2010.
• Since 2011 applications are decreasing falling to 2.6 million in 2013
>700,000 claims backlogged awaiting a hearing (average workday 19)
Social Security Disability Award Rates
48
Questions Regarding the Future of the SSDI Program
Is the SSDI program facing a crisis?
What if the Social Security Disability Insurance Trust Fund runs out of money?
Will the Social Security Disability Insurance Trust Fund run out of money?
What options are the Congress and the President considering – or likely to consider?
49
Social Security Board of Trustees 2014 Annual Report
The DI Trust fund will have sufficient assets to pay scheduled disability benefits only until some point in the 4th quarter of 2016, absent action to forestall Trust Fund asset depletion. At that point 81% of benefits payable
If the Trust Funds are reallocated full benefits are payable until 2033 At that point if nothing is done, 77% of benefits are
payable
52
Recent Anti-Fraud Legislation
Democratic Bill H.R.4090 The SS Fraud & Error Prevention Act February 2014 Rep. Xavier Becerra (D-CA)
Overview A secure stream of dedicated administrative funding without the
need for annual appropriations Advanced IT improvements to detect fraud Cooperation with other Agencies, state and local governments &
private business (LTD Insurers?) Developing a Culture of prevention & detection Rewarding SSA staff who detect and refer fraud
53
Anti-Fraud Legislation Cont.
Republican Bill H.R. 5260 The Stop Disability Fraud Act of 2014 July 2014 Rep. Chairman Sam Johnson (R-TX) Targets Representatives
74% of Claimants are represented as opposed to 37% in 1977 SSA paid $1.5 Billion to representatives in 2013
Overview
Establish CDI (Cooperative Disability Investigations) units in all 50 states (currently 25 units in 7 states)
Prohibit the consideration of any unlicensed or sanctioned physician or health practitioner
Criminalize conspiracy to commit SS Fraud Doctors, Lawyers, interpreters, SSA employees
54
H.R. 5260 Continued
Representative Sanctions Immediate disqualification for a felony or crime of moral turpitude
in a Federal or State court Suspension is immediate (current process is the reverse)
Fine and sanction representatives for failure to comply with Commissioner's Rules & Regulations
Civil fine of not more than $7,500.00 for knowingly: Charging Demanding Receiving Collecting Representative Fee in excess of the maximum fee proscribed by Commissioner
55
H.R. 5260 Continued
Strengthen Program Integrity Conduct a pre and post quality effectuation review of ALJ
decisions to ensure compliance with regulations and other guidance (emphasis supplied)
Increased Transparency with SSA and American Public Productivity Times Processing Times Pending workloads Decision outcomes Broken down by individual, hearing office, SSA Region, SSA
Commissioner can refer denied individuals to appropriate private or public entity for: Employment Services Vocational Rehabilitation Other services
56
What to do about 2016 DI shortfall?
Trust Fund Reallocation Since 1956 it has been done 11 times
In light of the projected depletion of the DI Trust Fund in 2016, the Trustees again call upon Congress to act:
Therefore, legislative action is needed as soon as possible to address the DI program’s financial imbalance. Lawmakers may consider responding to the impending DI Trust Fund reserve depletion as they did in 1994, solely by reallocation the payroll tax rate between OASI and DI. Such a response might serve to delay DI reforms and much needed corrections for OASDI as a whole. However, enactment of a more permanent solution could include a tax reallocation in the short run
57
The Social Security System Needs Reform
8 Proposals for long term solvency -Pros and Cons
1. Raise Full Retirement age (18-44%)
2. Recalculate COLA (16-23%)
3. Increase Payroll Tax Cap (36%)
4. Eliminate the Payroll Tax Cap (86%)
5. Means Test for High Earners (11%)
6. Increase Payroll Tax Rate (64%)
7. Tax Flexible Spending Accounts (10%)
8. Cover all new Government Workers (8%)
58
Unemployment Compensation (UI) & SSDI
July 2012 GAO Report
In Fiscal Year 2010, 117,000 Americans Received both SSDI and UI
The combined payout was over $850 Million Funding for Unemployment comes from Federal Unemployment
Tax Act (FUTA)
Current SSA and Federal Regulations provide no authority for SSA Commissioner to treat receipt of UI as a Public Benefit
Worker’s Compensation deemed Public Benefit Long Term Disability deemed Private Benefit
59
Legislation to close UI SSDI Loophole
Senate Bill S. 1099 The Reducing Overlapping Payments Act June 2014 Sen. Tom Coburn (R-OK)
Overview Bill would suspend SSDI for any month in which claimant
received Unemployment Benefits SSDI is generally higher than UI
Coburn estimates individuals would forgo the receipt of UI in favor of the higher SSDI benefit
SSA estimates a savings of $2.9 Billion from 2014 – 2023
60
Unemployment Legislation Cont.
House Bill H.R. 1502 The Social Security and Unemployment Benefits
Double Dip Elimination Act April 2013 Rep. Sam Johnson (R-TX)
Overview Bill would treat receipt of Unemployment as engaging in SGA for
that calendar month. SSDI Onset would be amended to a point after UI benefits
terminated. Entitlement to Medicare affected as well Effect on Quarters of Coverage? Receipt of UI would be considered 1 month of TWP
SSA estimates a savings of $8 Billion in SSA benefits from 2014 – 2023 and $2.3 Billion in UI benefits
61
Unemployment Legislation Cont.
Amendments to Existing Bills Senate Amendment 2631 in Emergency Unemployment
Compensation Act January 2014
Overview SSDI benefits are reduced dollar-for-dollar by receipt of UI during
any calendar month beneficiary received both
SSA estimates a savings of $1.17 Billion in SSA benefits from 2014 – 2023
62
Continuing Disability Reviews (CDR)
Initial determination is made at DDS level
Beneficiary informed that Disability Terminated as of X date
Cash benefits continue for 2 additional months
Beneficiary has 10 days to elect interim SSDI benefits pending appeal
63
CDR (Interim Benefits) cont.
Right to Interim Benefits is statutory
Matthews v. Eldridge (1976)
Congress granted right to Interim Benefits in 1984
20 C.F.R. 404.1597
Interim benefits are not authorized for a RTW CDR
64
CDR (Interim Benefits) cont.
Right to continue Interim Benefits must be made at each level of the appeal process
Good Cause for late request is available
Only Beneficiary can request. Claimant’s Representative cannot make request.
A Representative Payee can make the request as both will be responsible for the
Overpayment
65
CDR (Interim Benefits) cont.
SSA Form-795 Right to Interim Benefits
I understand that if I lose my appeal, I will be asked to pay this money back including all checks I received after my period of disability ended through the month such benefits were received if the appeal is not decided in my favor.
66
Interim Benefits Strategy For LTD Insurer
Option 1Revert to paying a full Un-reduced LTD Benefit
pending the outcome of the appeal??
OR
Option 2Encourage claimant to continue interim SSA
benefits pending outcome of appeal?
67
OPTION 1 Full Un-reduced LTD Benefit
LTD reverts to Paying Full Unreduced benefit?
MIB Due Client SSDI offset Net Pmt$3,000.00 $00 $3,000.00
Appeal is resolved in 10 Months
68
OPTION 1 Full Un-reduced LTD Benefit Cont.
10 Months Later
Appeal is DENIED by ALJ(SSDI Benefits Terminate)
Impact on LTD Carrier?None,
Carrier continues to pay full un-reduced LTD benefit pending appeal of ALJ’s decision
Does carrier initiate a follow up Any Occupation analysis?
69
OPTION 1 Full Un-reduced LTD Benefit Cont.
10 Months Later
Appeal is Successful(ALJ Continues SSDI Benefits)
SSA Pays claimant a lump sum of $20,000.00 and continues monthly SSDI benefits.
Claimant incurs a $20,000.00 LTD Overpayment.
70
OPTION 2 SSA Pays Interim Benefits
SSA pays claimant Interim Benefits pending appeal
MIB Due Client SSDI offset Net Pmt$3,000.00 $2,000.00 $1,000.00
Appeal is resolved in 10 Months
71
OPTION 2 Interim SSA Benefits
Encourage claimant to elect interim benefits? 10 Months Later
Appeal is Successful(ALJ Continues SSDI Benefits)
No Change for LTD Carrier ~ Carrier resumes paying reduced LTD benefit
72
OPTION 2 SSA pays Interim Benefits Cont.
Appeal is DENIED by ALJ(SSDI Benefits Terminate)
SSA immediately issues Overpayment letter to claimant
$20,000.00 SSDI O/P($2,000./mo x 10 months)
73
OPTION 2 SSA pays Interim Benefits Cont.
$20,000.00 SSDI Overpayment
How does claimant repay SSA?