DISPUTE of State vs Local Agency Decision Regarding RETROACTIVE SS Disability Benefit

[slc1995]

What is the name of your state? New Jersey
My wife has been disabled since 1987. She recd benefits from 1987-1995 at which time her medical condition became significantly worse and impaired...she did not follow thru w/ filing updated medical info to SS hence her benefits were ceased.
She has continued to see doctors from her last entitlement (1995) to the present day (2005)....her disability continues and she is totally incapacitated.
I, her husband, was unaware of necessary filings.
Our circumstances have changed, which necessitated filing an applic to SS to reinstate her benefits.
SS (the State Agency) advised us as long as we can PROVE the window from 1995 till present day ...she would be entitled to receive a TEN YEAR RETROACTIVE BENEFIT.
We provided all necessary info and State agreed that her benefits should be reinstated and she was approved.
The LOCAL Agency agrees w/ decision BUT will only pay ONE YEAR back from this new applic filing......the State said this is NOT A NEW APPLIC....it is an OLD APPLIC
We have copy of ORIGINAL DOCUMENT from 1987 by an Administrative Law Judge finding that she was in fact totally disabled and approved total benefit.
****WE NEED CLARIFICATION OF SS LAW....who takes precedence here....the State Agency....or the Local Agency.
Do we have the right to appeal the decision from the Local Agency so as to
receive TEN YEAR RETROACTIVE BENEFIT as originally stated by State Agency.
We contacted our Congressman.....his constituent advised us that she worked on a case of a FIFTEEN year retroactive benefit and approved that client for total reimbursement....so there is case law precedence.
Thank you for taking the time to address our inquiry??.....will it necessitate hiring an experienced SS Lawyer to assist our appeal??
Either post message here....or please feel free to email me directly at:
[email protected]

 

[AWorkOfArt]

What do you mean, local and state agency? Social Security is not governed by the State. Social Security in every State is dictated by federal laws and policy. I think someone at the SS office gave you the wrong information. There is SSI benefits and RSDI benefits and they differ in how they are disbursed. SSI you simply get for being disabled and entitlement to benefits begin from the date of application. RSDI is different and goes by your work history and can be paid retroactively from the date you prove you were disabled. There is no retroactive benefits or otherwise that comes with SSI. Was your wife receiving SSI??

 

[slc1995]

Thx for your expedient reply Georgia.....my wife originally was approved in 1987 for SS Disability benefits as determined by ALJ (Admin Law Judge)....she continued to receive benefits until 1995...at which time....she underwent numerous surgeries....and was consumed w/ medical issues since her Neuromuscular disease became more progressive. As I had eluded to in my initial log....she did not continue to provide necessary updates...hence benefits were ceased from SS.
I, as her care giver....was unaware of necessary filings consumed w/ managing her daily needs...working....etc.

In view of our current financial circumstances.....and my wife still disabled....we elected to apply to SS for reinstatement of benefits from the date of LAST ENTITLEMENT.......SS requested her initial application from Washington....and we were advised that as long as we can demonstrate proof of the open window from 1995 till the present day.......she would not be considered a NEW APPLIC but an Old applic.....and be able to be awarded the RETROACTIVE TEN YEARs of Entitlements.
She was just approved for SS.....yet......what was stated to us initially how she would be entitled to retroactive reimbursement......the local office in our town...is stating that they are treating it as a NEW APPLIC......when we were advised in dealing with the State division of SS....that she would be entitled to full retroactive reimbursement.....we have names / numbers of exact people from the State division who advised us of their findings.......we decided to confer w/ our Congressman......and his constituents had eluded to the fact that they had a similar case in which w/ their intervention....they were able to get a 15 year RETROACTIVE entitlement for a claimant......this is why I posted here to get clarification knowing that SS is a FEDERAL AGENCY.....yet.....we are getting CONFLICTING INFO from the local office that processed the claim....and the State Office that made the determination.

Continue to APPRECIATE any response to this inquiry since there appears to be conflicting stories and info provided.

Thank you for your continued input!

 

[AWorkOfArt]

I wish I could help you but I don't see how you can be issused benefits when you failed to keep up with the eligibility requirements. I could be wrong though....I have heard of retroactive benefits being issued for people who never received and had to go through the appeals process but never heard of retroactive benefits being issued for a situation such as your. When you were advised to "demonstrate proof of the open window from 1995 untill present day" SS was advising you to do this for what reason? It's obvious there was a time period that your wife didn't receive benefits and they know when she did and didn't receive benefits. I would talk to the office that requested her initial application. Try to find out what they requested it for and did requesting the initial application help determine retroactive payments.

 

[slc1995]

Thx At Work of Art for your continued assistance......in answer to your inquiry:

The State Agency requested ALL BACK INFO regarding the initial determination that my wife was in fact APPROVED to receive disability benefits in 1987.....that is why they requested her ORIGINAL INFO from Washington....that being said.....the Supervisor of the State Agency (had directly stated)....if we could demonstrate PROOF....of the WINDOW
(the time frame from 1995 to the Present Day) that her disability continued...and she continued to see doctors from 1995 to Present for this SAME DISABILTY....then in fact....SHE WOULD BE ENTITLED TO RETROACTIVE BENEFITS......as long as she NOW MEETS THE CRITERIA to receive disability benefits for same said condition.

We provided all of this info.....and in fact she was APPROVED....they agree that there was enough documentation to support her disability....and they agreed that there was sufficient info provided during the OPEN WINDOW of time from 1995 to Present.......hence....they stated that she in fact would be entitled to RETROACTIVE BENEFITS from 1995 to Present.

Now that she was deemed medically disabled....meeting present day criteria.....and satisfying the OPEN WINDOW time frame....her applic
was transferred to the LOCAL office for processing to finalize payment processing. In conferring with this agency......they confirmed that her applic was APPROVED......and she would be entitled to 20months of payment .....vastly different info then what was provided by the STATE AGENCY SUPERVISOR.

The Local Office stated that they are treating this as a NEW APPLIC and can only go back one year prior......when I explained info rendered by the State Agency......they stated that their decision takes precedence??........which led us to confer w/ the Congressman's office......who supports our position and will itervene on our behalf to appeal this action.

This is why I had posted a Case Hx in which a 15 year Retroactive Award was approved after numerous appeals.

Your continued input is appreciated!

 

[AWorkOfArt]

If you're that sure you're entitled to retroactive payments. Tell the local office you want a hearing to dispute the application being considered as a new application when it should have been a continuation from her previous application. make sure they tell you the what can happen if the hearing is not in your favor. Where I work we will request a hearing to dispute the date of onset (the date SS establishes as the day a person become disabled) but we have to weigh in the fact that this can go against the client. For example if the date of onset has been established for 01/01/2005 and we need the clients benefits to start 12/01/2005 and we file a hearing, were taking a chance that the onset date can be changed to 02/01/2005 as easily as it can be changed to 12/01/2005. make sense?

 

[slc1995]

To At Work of Art......appreciate the time you have taken to address our concerns.

For starters......we have documentation from the ORIGINAL ADMINISTRATIVE LAW JUDGE from 1987 who deemed her totally disabled and entitled to full SS benefits at that time. We presented this letter along w/ her current application.

The State Determination Service stated that we provided AMPLE evidence to support that her claim was in fact the same as the initial claim and that she continued to be disabled from 1987 to Present.....hence their contention that this is NOT A NEW APPLIC but just reopening or reinstatement of an OLD APPLIC.......and directly stated that they are filing approval that she be rendered approval of benefits from 1995 to Present.

It was not until the applic was transferred to the Local Agency for processing when info somehow changed.....stating that they are treating it as a NEW APPLIC.

This is why we continue to need clarification of SS NJ Law......does the State Processing Agency take precedence here.....do we have a stand....we have direct names of contacts....dates...etc.......or does the Local Processing Agency preside in these matters.

The Congressman in our district believes that info provided is credible and has taken measures to intervene in our behalf.......in either case......they want the 20 months paid to us and then will take action to initiate the appeal process to dispute the current action. I think this is just RED TAPE but
would like to know if anyone on these postings have any experience w/ this matter.

The Congressman's office stated several cases in which RETROACTIVE AWARDS have been granted in the appeal process

Thanking everyone for their continued input in addressing our concerns.

 

[AWorkOfArt]

You wanted to know which office has the higher authority right? lets say the local office has the highter authority. Request a fair hearing to dispute your case with them. Your award notice tells you, you have the right to request a fair hearing if you'er not satisfied with their decisions. If you hopefully you haven't surpassed the time limit to request one.

 

[BL]

which led us to confer w/ the Congressman's office......who supports our position and will itervene on our behalf to appeal this action.

Then you should contact that Office . They are better equipped to search the Laws , and give you accurate advise , based on the case .

They , or other representative's Office they could contact , should be able to research the Laws and send you a copy .

I didn't see if the original benefits were SSI ( from not work history ) or SSDI ( From work history ) , because fro SSI on NEW application , they will only go back so far .

Maybe , you should have approached this from a different angle , if that's the case .

At any rate , you are working with the Congress reps Office , that's where you should continue this .

That Office has pull , and if anything that can be done to get all those years retroactive benefits approved , they will help the process along .

Again , IF you want case Law , request that Office to send you a copy ..

 

[slc1995]

Thank you for your REPLIES

Thank you for your assistance in addressing our posting.

It has been over SEVEN MONTHS....and we just heard....via the PHONE....that my wife was approved....and her claim is at the
Payment Center in Baltimore MD for processing.....that was two
weeks ago....and the red tape continues. The local SS branch
has tried to expedite processing this claim so a check can be
generated.....which is when we learned of the amount of the
award.....again....treating this as a new applic...rather than a
reinstatement of an old applic.....hence going back 20 months.

The contention that is raised......was DIRECT INFO provided by
the State Agency who processed the applic and requested her
records from Washington to confirm the validity of the claim.
In conferring w/ the Supervisor from this agency......she directly
stated that we have demonstrated ample evidence to support
the open time window (1995 to Present day) and hence her claim
is being processed as a reinstatement of her benefits from the
last date of her entitlement to now.

Only to learn now.....that when the claim was tranferred to the
local office for processing......they are treating this as a NEW APPLIC.

*****In answer to your posting.......she worked numerous jobs
prior to the onset of her disability and hence accumulated enough
work credits for SSD entitlement. We have not applied for
SSI benefits since we do not qualify.

I agree that conferring w/ the Congressional Office might be the best
approach in dealing with this matter.....since it will yield clarification
of SS Law. They just related a case to me in which they got a
claimant approved for a Fifteen year RETROACTIVE award after
appealing the original decision......so.....this might prove helpful
since there are other situation similar to ours to support case law
in contesting the decision.

 

[getitdone]

1. Social Security approved your wife's initial claim for disability benefits at the hearing level. When she started getting benefits she would have agreed to submit to reviews as required. This might have been on her application and she signed it.

2. Subsequent to that there was a review scheduled - as there is for every disability claim.

3. She failed to cooperate with the review procedure for whatever reason.

4. Her benefits were terminated.

Social Security does not terminate benefits on a whim. Your wife would have received a written request to submit to a review. She would have gotten a second request for the review. She would have gotten a letter from Social Security BEFORE her benefits were terminated telling her that because of her failure to cooperate, her benefits were going to be terminated. Thus, she had yet another opportunity to contact Social Security before benefits stopped.

She didn't do it. Apparently, you didn't do it for her, either. So her benefits stopped. And she would have been given appeal rights - again a chance to contact Social Security. It took 10 years for your wife to file another claim.

Here's the regulation: There is one year of retroactivity for payments. That's it. Your Congressman can call or write for you, but unless the regulations are changed, the only thing he/she can do for you is relay the same information. Everybody has to follow the law. Even your Congressman.

Social Security takes precedence over the State Agency. The various State Agencies actually work for and are under contract to Social Security.

Your local Social Security office is right.

 

[slc1995]

TO: GetItDone REPLY to your recent posting

Thank you (GetItDone) for taking the time to clarify our inquiry and posting. We appreciate you taking the time to answer our posting and concerns regarding this matter in more detail.

We understand your detailed explaination which helps to address our issue.

The confusing issues are the following:

1) The State SS Agency who processed her application specifically requested
her ORIGINAL APPLICATION from Washington dating back from 1987-1995. Based upon THEIR review....they determined that her disabling condition was in fact the same condition and hence was entitled to receive retroactive benefits based upon this premise.

2) The State Agency determined that she had enough SS credits in her acct to award a NEW ENTITLEMENT as long as we could provide proof of the window btwn 1995-Present.

a) This fact is important b/c UNLESS this was proven.....she would
not be entitled to any new awards since she has not worked
since 1987 and would not have enough SS credits in her acct
to justify a new entitlement award.

i) this point is important....b/c....if the decision was based
on her new application alone.....it would be automatically
denied since she no longer would be eligible since there
are not enough credits in her acct......this is why they
reviewed the OLD applic to justify the new entitlement

b) Based upon this premise.....they have approved that she does
meet all criteria.....and hence should be entitled to a retroactive
award........I am only repeating what was relayed to us from
the Central SS processing agency of the State Agency.

c) We also just learned that SS is now listing her NEW DATE
of entitlement to reflect March 2004.....one year prior to the
date of filing this application (Mar 2005).

3) I appreciate the fact of your stating in your post regarding the time
span it has taken to address the aforementioned issues involved.

a) in view of her deteriorating medical condition, our focus was
directed to addressing her medical issues

b) to our neglect, it unfortunately has resulted in this dilemma
in trying to have her benefits reinstated

c) although we are pleased she was approved and granted a new
entitlement.....we were only pursuing all leads b/c we were
given info from the State Agency that lead us to believe that
they are processing her application based upon the premise
of a retroactive entitlement since all documentation supported
this premise.

4) If what you present is accurate......we certainly will not pursue
this matter any further. However.....based upon credible information
relayed by the State Agency Social Security Supervisor.....along w/ our local
Congressional Representative......they have both advised us that
info provided would warrant a justified retroactive entitlement and we
should pursue this matter by filing an appeal to the decision w/in SIXTY days
so this matter can be clarified and resolved.

Your thoughts??

 

[getitdone]

It's common for a State Agency to request a prior file while deciding a new claim. And I don't doubt that they did find her disabled for the entire time - from the first entitlement to now. In fact, they HAD to find that her disability existed for all that time. If they couldn't establish that her disability existed the entire time, she would be denied (as you stated) because she would not meet the work requirement for this new claim.

A State Agency can find that someone has been disabled for many years (and that happens all the time), but retroactivity is limited to one year of payment.

There is a provision called Expedited Reinstatement and that might be what your State Agency is referring to. But your wife doesn't seem to qualify. Benefits have to terminate because the disabled person returned to work, then became disabled again (with the same ailment) and stopped working within FIVE YEARS of the time the first benefits terminated. Benefits in some cases can be reinstated without a whole new claim, but even then, payment won't be made for the entire time. Obviously, your wife doesn't fit into this category.

So, I really believe her payment will be limited to one year of retroactivity. Social Security's new date of entitlement of March 2004 is correct because it is one year prior to the filing date of the new claim.

Your wife has a very sympathetic State Agency Supervisor, but, really, I can't imagine how what he says could be accomplished. Same with the Congressman. He/she can be as sympathetic and caring as can be, but in the end, can only abide by the regulations. It would take an act of congress to change the regs. That takes YEARS.

Sorry. I hope for your sake I'm wrong, but I don't think I am. (I've had lots of experience processing claims just like this one.)

 

[slc1995]

TO GETitDONE....In response to Your Reply

Thank you once again for your expedient reply.....you appear to be very
versed and knowledgable regarding our inquiry....we truly appreciate the
time you have taken to address our concerns.

We will consider this matter closed based upon the information that you have provided........are there any resources that we can refer to that verify
the validity to your claims.....either via the internet......or via the local
Library.....ie....federal registers.....SS Law and Regulations....etc.

Your continued reply would be sincerely appreciated.

 

[getitdone]

I don't know. Nobody's ever asked me that before. I just googled Social Security regulations (I,m feeling lucky) to see what happens. It got me to the SSA website showing links to regulations. Maybe you can find something there.