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 . Or at the firm web site of www.smithdickey.com .
Copyright © 2002 Pitt Dickey - Used with permission