TELLING THE TRUTH IN
DISABILITY HEARINGS
Social Security Hearings
By: Pitt
Dickey - Attorney
In any proceeding before the
Social Security Administration (SSA) in which a person seeks to
obtain Disability Insurance Benefits (DIB) or Supplemental
Security Income (SSI) benefits the applicant is under an
obligation to tell the truth in connection with his application.
This column will take a look at what can happen if an applicant
doesn’t tell the whole truth and nothing but the truth when
applying for Social Security Disability benefits.
In my practice I have frequently
had clients who are applying for disability benefits who have very
real health problems and are frustrated because they have heard
about someone "who lied about their health problems and are
on disability."
The system certainly is not
perfect. Some people who should get benefits are denied. Some
people who ought not to have disability benefits get those
benefits. On the whole the system does a good job in processing
claims considering the sheer magnitude of the number of claims
that are filed each year.
In an effort to prevent fraud and
abuse of the system, the SSA recently issued final rules imposing
penalties on applicants who make false and misleading statements.
These rules have been in effect on a temporary basis since July
2000 but are now final and appeared in the Federal Register on 29
April 2002.
The final rules apply to the two
basic types of disability benefits which pay a monthly income that
are available under the SSA; Disability Insurance Benefits and
Supplemental Security Income. These two programs are discussed
very briefly below.
Disability Insurance Benefits
DIB benefits are paid to
applicants who have a medical impairment (either physical or
mental) that prevents them not only from being able to do the type
of work they did in the past but also prevents them from doing any
other type of work that exists in the national economy.
In addition to meeting the
medical/legal test described above, the person must also have
worked a certain amount of time and paid FICA taxes into the
system. There is no limit to amount of assets that a person who is
eligible for DIB may own or income received from sources other
than working himself.
Supplemental Security Income
The same medical/legal test is
applied to SSI applicants that DIB applicants must meet. SSI
benefits are paid to applicants who have a medical impairment
(either physical or mental) that prevents them not only from being
able to do the type of work they did in the past but also prevents
them from doing any other type of work that exists in the national
economy.
However SSI applicants are not
required to have worked any quarters at all or to have paid FICA
taxes into the system. SSI is essentially a welfare type program
for disabled individuals who have not worked long enough to be
eligible for DIB. There are strict limits to how much property a
person may own and the amount of income he may receive regarding
SSI eligibility.
ADMINISTRATIVE
PENALTIES FOR FALSE STATEMENTS IN DISABILITY APPLICATIONS
The SSA will penalize an
applicant who "knowingly makes a statement that is false or
misleading or omits a material fact" in applying for a right
to monthly benefit payments or in connection with determining the
amount of such monthly payments. The penalty for such false
statements is nonpayment of benefits payments for a specified
number of months to a DIB or SSI applicant.
A person who would otherwise be
eligible for disability benefits due to health problems who makes
such false statements will be penalized 6 months of disability
payments for a first offense. A second offense of making a false
statement to the SSA will result in a 12 month period of no
disability payments. A third or subsequent offense of making false
statements will result in a loss of benefits for 24 months for
each such offense.
A false statement by a person
applying for one type of disability benefits will also prevent
that person from being able to receive the other type of benefits
during the forfeiture period.
Penalties imposed by the SSA will
run consecutively and not concurrently. For example, if Joe makes
a false statement about his medical treatment he will lose 6
months of benefits. If he later makes another false statement
about his application he can lose an additional 12 months of
benefits for the second statement for a total of 18 months.
The penalty does not actually
begin to run until the person is otherwise eligible for disability
benefits. For example if Joe loses his disability eligibility and
goes back to work during the 18 months he is ineligible for
benefits and earns above the amount that is permitted for disabled
workers then his 18 months no benefits period will not start to
run during the time that he is working.
In other words he can’t just go
back to work for 18 months to wait out his period of disability
suspension and then reapply and get reinstated for disability
benefits. He’ll have to actually lose 18 months of benefits he
would have otherwise have been eligible for.
The penalty period of no
disability benefits only applies to the applicant who made the
false statements. While Joe would not be able to receive
disability benefits during his 18 months suspension, his otherwise
eligible dependant children or spouse would be eligible for
disability benefits.
It is important to note that the
penalty period does not effect the eligibility of the person who
makes false statements for either Medicare or Medicaid. If Joe was
eligible for Medicare benefits before his false statements were
discovered, he will still be eligible for Medicare during his
period of 18 months suspension of the monthly cash benefits.
In addition to the loss of
disability benefits for the fixed periods described above, a
person making false statements can also be subjected to civil or
criminal penalties under prosecution by the U.S. Attorney’s
Office. These civil fines or criminal penalties are in addition to
the loss of the periods of disability payments.
A person who is accused of making
false statements by the SSA can appeal the loss of his period of
eligibility through an administrative process which includes a
case review, informal conference, formal conference within the SSA
leading up to a hearing before an Administrative Law Judge within
the SSA system itself. The Administrative Law Judge’s decision
is also subject to being reviewed by the Appeals Council and
ultimately the U.S. Courts.
In all dealings with the Federal
Government it is naturally very important to tell the truth. In
dealing with the Social Security Administration it is equally
important to deal fairly and accurately with that agency. The
system has teeth in it which can be quite sharp if individuals
attempt to defraud the disability programs offered under Social
Security.
Notice: Since Social
Security Disability is directed under Federal law, the information
in this column will apply anywhere in the United States.
However each Office of Hearings and Appeals and District Office
have their own ways of doing things as does the various Federal
District and Circuit Courts. I have kept this column
primarily dealing the the mechanics of how the Social Security
District Offices and Office of Hearings and Appeals evaluates
disability claims.
- Pitt Dickey
Pitt Dickey has practiced law
in Fayetteville since 1978. He has handled SSA disability claims
for over twenty years. He practices with the firm of Smith,
Dickey, Smith, Hasty & Dempster, P.A. at 555 Executive Place
and can be reached at 910-485-8020 or at pitt@smithdickey.com
. Or at the firm web site of www.smithdickey.com
.
Copyright © 2002 Pitt Dickey -
Used with permission
