Edpna Exam Verified Solution 2023//2024

EDPNA Exam VERIFIED SOLUTION 2023//2024 Social Security Disability Insurance SSDI Citation - ANSWER CFR 20 Section 404 Good Cause for Late Filing (Citations: 404.911, 416.1411) - ANSWER If an appeal deadline is missed, and the claimant wants to appeal, he or she must show "good cause" for late filing. Examples of good cause are described in 404.911: - ANSWER • You were seriously ill and were prevented from contacting us in person, by phone, in writing, or through a friend, relative, or other person; • There was a death or serious illness in your immediate family; • Important records were destroyed or damaged by fire or other accidental cause; • You were making serious efforts to find necessary information to support the claim but had not been able to obtain it within the stated time periods; • You requested additional information from us explaining this action within the time limit. Within 60 days of receiving the explanation you requested reconsideration or a hearing, or within 30 days of receiving the explanation you requested Appeals Council review or filed a civil suit; • We gave you misleading, incorrect or incomplete information about when and how to request administrative review or to file a civil suit; • You did not receive notice of the determination or decision; • You sent the request to another government agency in good faith within the time limit and the request did not reach us until after the time period had expired; or • Unusual or unavoidable circumstances exist, which show that you could not have known of the need to file timely, or which prevented you from filing timely. SSA will consider the following for deciding whether a claimant had good cause - ANSWER • What circumstances kept the claimant from making the request on time; • Whether SSA's action mislead the claimant; • Whether the claimant did not understand the requirements; • Whether the claimant had any physical, mental, educational, or linguistic limitations which prevented them from making a timely request or from understanding or knowing about the need to file a timely request for review. Social Security Disability Insurance SSDI - ANSWER Title XVI SSDI Eligibility - ANSWER 1. Is the applicant under full retirement age (66)? 2. Is the applicant fully insured? 3. Is the applicant insured for disability? Auxiliary Benefits - ANSWER Benefits can be paid to the disabled worker's family in some cases. Benefits can be paid to dependent children under the age of 18 or a spouse (or divorced spouse if married for 10 years) under the age of 62 who has joint care of the children. Supplemental Security Insurance SSI - ANSWER Title II Supplemental Security Insurance SSI Citation - ANSWER CFR 20 Section 416 SSI - ANSWER No work requirement Children can qualify as disabled No retroactive benefits earlier than filing date Strict income and resource provisions Definition of Disability - ANSWER Citations: 404.1505, 416.905 The inability to do any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death, or which has lasted or can be expected to last for a continuous period of not less than 12 months. Insured Status - ANSWER 1. An individual must be fully insured 2. as a general rule they must meet to 20/40 requirement. (5 of last 10 years) Insured status - ANSWER Quarters of Coverage at least 6 Quarters One of Four For every year beginning with the year after attainment of age 21 up until the age you turn 62 or you die Rules of Disability Insured Status (SSDI Only) - ANSWER Citations: 404.130, 404.131, and 404.140 Rule 1 - 20/40:You have to have 20 quarters of coverage in the 40-quarter period ending with the quarter that you became disabled. This is called the 20/40 rule. Or essentially, you have worked five years out of the last ten years, before you became disabled. Rule 2 - Special Insured Status: Rule 3: You had a period of disability before age 31.You are insured in a quarter for purposes of establishing a period of disability or becoming entitled to disability insurance benefits if in that quarter- (1) You are disabled again at age 31 or later after having had a prior period of disability established which began before age 31 and for which you were only insured under paragraph (c) of this section; and (2) You are fully insured and have QCs in at least one-half the calendar quarters in the period beginning with the quarter after the quarter you became age 21 and through the quarter in which the later period of disability begins, up to a maximum of 20 QCs out of 40 calendar quarters; however- (i) If the number of quarters during this period is an odd number, we reduce the number by one; (ii) If the period has less than 12 quarters, you must have at least 6 QCs in the 12- quarter period ending with that quarter; and (iii) No monthly benefits may be paid or increased under Rule Ill before May 1983. Rule 4: You are statutorily blind. (1) You are disabled by blindness as defined in § 404.1581; and (2) You are fully insured. Special Insured Status (SSDI Only) - ANSWER Disable before the age of 31 20 CFR 404.130: You are insured in a quarter for purposes of establishing a period of disability or becoming entitled to disability insurance benefits if in that quarter- (1) You have not become (or would not become) age 31; (2) You are fully insured (next chapter); and (3) You have Quarters of Coverage (QCs) in at least one-half of the quarters during the period ending with that quarter after the quarter you became age 21; however- (i) If the number of quarters during this period is an odd number, we reduce the number by one; and (ii) If the period has less than 12 quarters, you must have at least 6 QCs in the 12- quarter period ending with that quarter. Insured Status - Statutorily Blind - ANSWER Citation: 404.130(e) Statutorily blind individuals must only meet the fully disability insured status. Statutorily Blindness - ANSWER Defined in the law as central visual acuity of 20/200 or less in the better eye with the use of correcting lens. An eye which has a limitation in the field of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees is considered to have a central acuity of 20/200 or less. (404.1581) Fully Insured Status (SSDI Only) - ANSWER 404.110 You need at least one QC (Quarter of Coverage) for each calendar year after you turned 21 and the earliest of the following: • The year before you attain age 62, • The year before you die, or • The year before you become disabled. The minimum number of QCs needed is 6. The maximum number needed is 40. Any year (all or part of a year) that was included in a period of disability is not included in determining the number of QCs you need. Waiting Period (SSDI Only) - ANSWER There is a 5-month period in which a claimant must have been disabled for 5 full consecutive months, beginning with the month that they were both insured and disabled, before cash benefits can begin. Your waiting period can begin no earlier than the 17th month before the month you apply-no matter how long you were disabled before then. Medicare Waiting Period - ANSWER Test Tip: Include the 5-month waiting period in your calculation and count 29 months forward from established onset date to get the date the Medicare eligibility would begin. To become eligible for Medicare a claimant has to have 24 months of disability eligibility, meaning they have been paid 24 months of cash benefits. 24 months after SSDI payments begin, the claimant will be automatically eligible for Medicare. Disabled Adult Child (DAC) (SSDI Only) - ANSWER An adult who was disabled before age 22 may be eligible for child's benefits if a parent is deceased, or receiving Social Security retirement, or receiving Social Security disability benefits. SSA considers this Disabled Adult Child claim a "child's" benefit because it is paid on the parent's earnings record. To meet requirements, the adult child -- including an adopted child, or, in some cases, a stepchild, grandchild, or step grandchild - must 1. be unmarried; 2. be age 18 or older; 3. have a disability that started before age 22; 4. meet the SSA definition of disability for adults, and 5. not have substantial earnings to be insured for Title 2 on their own record. Disabled Widow Benefits (DWB) - ANSWER Citation: 404.335 A widow or widower may be eligible for Disabled Widow(er)'s benefits if these requirements are met: 1. The widow(er) is between 50 and 60 years old; 2. The widow(er) meets the SSA definition of disability for adults; 3. The widow(er)'s disability began before or within seven years after the spouse's death. 4. The deceased spouse must have been on Title 2 disability or had Title 2 insured status at death