EDPNA EXAM QUESTIONS Flashcards
What is a “severe” impairment?
An impairment or combination of impairments is only severe is the impairment significantly impacts at least one basic work activity.
You are representing your client at a hearing. A vocational expert (VE) is present. The ALJ asks if the VE has reviewed Exhibit 15F, which is a consultative psychological examination report, in which the psychologist opines that you client is capable of performing simple, repetitive, unskilled tasks that do not require ongoing contact with the public or coworkers. The VE states that he has reviewed this report. The ALJ asks if he agrees with the limitations that have been assessed, and the VE says that he does agree with the limitations contained in the report.
What do you say about the ALJ’s questioning of the VE?
Improper, because the VE is offering his opinionb about the relationship of the limitations to the clinical signs and findings, thus rendering an opinion on medical issues.
Mark Baum arrives at your office with a dismissal order dated three weeks ago. The order states that his request for a hearing on his Supplemental Security Income claim was not timely filed and the claimant’s reasons for missing the deadline did not constitute good cause for late filing. He believes he did have good cause and askes you what he should do next.
What would you advise Mr. Baum to do?
File a rerquest for Appeals Council review of the Dismissal Order pursuant to 20 CFR 416.1467.
An ALJ authorizes a representative to charge and collect $2,000 for his representational services for a claim for disability insurance benefits. SSA directly pays the representative $2,000. Six months later, SSA erroneously paid the representative an additional $2,000 based upon the same claim. One year after issuing the erroneous payment, SSA sends a letter to the representative informing his of the excess fee payment and requesting a refund within 30 days.
What should the representative do?
Refund the $2,000 excess payment to SSA within 30 days, as requested.
When a disabled individual receives Social Security disability insurance benefits, their spouse and/or minor children may also be eligible to receive Social Security benefits. These benefits paid to the spouse or minor child are called what?
Auxiliary Benefits. Auxiliary Benefits can be paid to:
1. Children under 18
2. Spouse
3. Divorced spouse (if married 10 years)
4. Somebody under age 62 who has custody of children.
Refers to each 3-month period of employment during which an employee contributes to the retirement income program under the Social Security Act of 1935.
Quarter of Coverage. You have to have a minimum of 6 credits and maximum of 40.
What is the appeal deadline?
The appeal deadline is 60 days + 5 mailing days.
How is a person Medicare Eligible?
Disabled for 24 months (29 months total from onset)
Disabled Adult Children Benefits (DAC) 404.350?
You have to be found disabled before age 22 and IF
1. a parent is deceased
2. Parent is on SS Retirement
3. Parent is on SSDI benefits
You must Be:
- Unmarried
- 18 or older
- Have a disability that started before age 22
- Cannot have substantial earnings to be insured for T2 on their own record
404.350
What does “T2” mean?
T2 means Title II of the Social Security Act
Disabled Widow(er) Benefits (DWB or DIWW) 404.335
The disability benefits are available to disabled widows and widower of insured workers, with benefits first payable to the widow(er) at an age between age 50 and 60.
- Disability began within 7 years after the spouse’s death
- Deceased spouse must have been on T2 (Title II) benefits or had T2 insured status before death.
Substitution of Party POMS 23510.035?
Rule is not in CFR (hallex 1-2-1-50)
SSA - 539 Form
T16 - limited to surviving spouse who was living with claimant within the past 6 months or parent/parents of disabled or blind child.
Order of Sub for T2:
- Surviving Spouse
2 Children entitled to monthly benefits - Parents of claimant who are entitled
- Surviving Spouse (not living with claimant)
- Children of claimant
- Parents of claimant
- Legal Rep of estate
What is Hallex 1-2-1-50?
I-2-1-50.
Death of Claimant
Last Update: 12/29/14 (Transmittal I-2-129)
A.General
For information on when an administrative law judge (ALJ) may dismiss a request for hearing due to the death of a claimant, see Hearings, Appeals and Litigation Law (HALLEX) manual I-2-4-35.
Under title II, if there is any person who qualifies as a substitute party under 20 CFR 404.503(b) and wishes to pursue the request for hearing, the ALJ will not dismiss the request for hearing because a substitute party is a person who may be adversely affected by a dismissal. See also Program Operations Manual System (POMS) GN 02301.030.
Under title XVI, if there is any survivor who may be paid benefits under section 1631(b) of the Social Security Act (see also 20 CFR 416.542(b)) and who wishes to pursue the request for hearing, the ALJ will not dismiss the request for hearing because a qualified survivor is a person who may be adversely affected by a dismissal. See also POMS SI 02101.003.
NOTE:
If the primary issue being appealed is revision of the wage earner’s earnings record and a survivor establishes potential entitlement based on that earnings record, the hearing office (HO) will make the survivor a substitute party upon request. It is not necessary for the survivor to establish that he or she may be adversely affected by the ALJ’s decision. For more information, see HALLEX I-2-4-35.
What is Hallex?
HALLEX (Hearings, Appeals and Litigation Law Manual) is a publication from the Social Security Administration’s Office of Disability Adjudication and Review (ODAR). ODAR administers hearings and appeals for people seeking reviews of their applications for disability benefits. HALLEX contains policy statements from the SSA’s Appeals Council, as well as procedures directed to lower levels of the SSA for carrying out the SSA’s guiding principles.
What is SSA - 539 Form? (Form HA-539)
Form HA-539 | Notice Regarding Substitution of Party Upon Death of Claimant
If a claimant dies before the Administrative Law Judge (ALJ) completes his or her action on a request for hearing, an eligible individual may ask to substitute for the deceased and pursue the claim for benefits. You use this form to notify us that you want to pursue the deceased’s claim.
What happens if a claimant dies before the hearing is held?
POMS 23510.035
Claimant Dies Before the Hearing Is Held
If a claimant dies before an ALJ holds a hearing and there are no other parties to the hearing (see HALLEX I-2-1-45), the designated HO (Hearing Office) staff must determine whether there is a substitute party or qualified survivor, as described in subsection A above. When the record shows there may be such an individual, HO staff will:
Contact the individual directly when the record includes contact information to determine whether the person qualifies and intends to pursue the matter; or
Use the document template in the Document Generation System to request that the servicing field office (FO) obtain the individual’s contact information and a statement of the individual’s intentions.
NOTE:
The FO will notify the HO when it becomes aware that a party awaiting a hearing has died. The FO will also contact any eligible party, substitute party, or qualified survivor to obtain the necessary information regarding pursuing the claim and forward the information to the HO. See POMS DI 12045.045.
Special Insured Status 404.130
Disabled before age 31.
- Must be fully insured
- You have QCs in at least one-half of the quarters during the period ending with that quarter and beginning with the 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.
What is CFR 404.130 ?
How we determine disability insured status
(a) General. We have four different rules for determining if you are insured for purposes of establishing a period of disability or becoming entitled to disability insurance benefits. To have disability insured status, you must meet one of these rules and you must be fully insured (see § 404.132 which tells when the period ends for determining the number of quarters of coverage (QCs) you need to be fully insured).
What is CFR 404.130 (How we determine disability insured status) Rule 1.
CFR 404.130 - How we determine disability insured status
(b) Rule I - You must meet the 20/40 requirement. 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 fully insured; and
(2) You have at least 20 QCs in the 40-quarter period (see paragraph (f) of this section) ending with that quarter.
What is CFR 404.130 (How we determine disability insured status)
Rule 2?
CFR 404.130
(C) Rule II - You become disabled 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 have not become (or would not become) age 31;
(2) You are fully insured; and
(3) You have QCs in at least one-half of the quarters during the period ending with that quarter and beginning with the 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.
What is CFR 404.130 (How we determine disability insured status)
Rule 3?
CFR 404.130
(D) Rule III - 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 III before May 1983.
(e) Rule IV - You are statutorily blind. 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 by blindness as defined in § 404.1581; and
(2) You are fully insured.
(f) How we determine the 40-quarter or other period. In determining the 40-quarter period or other period in paragraph (b), (c), or (d) of this section, we do not count any quarter all or part of which is in a prior period of disability established for you, unless the quarter is the first or last quarter of this period and the quarter is a QC. However, we will count all the quarters in the prior period of disability established for you if by doing so you would be entitled to benefits or the amount of the benefit would be larger.
Continuing Disability Reviews - CFR 404.1589 / 416.989
Reviews post receiving SSDI
Two Types of reviews:
1. Medical (3 years)
- Work (Trial Work Period)
Trial Work Period (TWP) 404.1592
SSA incentive to provide a person with SSA money for up to nine months in a five year period when they have earned more than the SSA income limit
- the 9 months does NOT have to be consecutive
_ If they make under $900/month, this month does not count.
In-Kind Income Definition?
Non-cash payments received in exchange for services rendered or in lieu of cash contribution.
How We count Earned Income - CFR 416.1111
(a) Wages
§ 416.1111 How we count earned income.
(a) Wages. We count wages at the earliest of the following points: when you receive them or when they are credited to your account or set aside for your use. We determine wages for each month. We count wages for services performed as a member of a uniformed service (as defined in § 404.1330 of this chapter) as received in the month in which they are earned.
How we count earned income - CFR 416.1111
(b) Net Earning From Self-employment
CFR 416.1111
(b)Net earnings from self-employment. We count net earnings from self-employment on a taxable year basis. However, we divide the total of these earnings equally among the months in the taxable year to get your earnings for each month. For example, if your net earnings for a taxable year are $2,400, we consider that you received $200 in each month. If you have net losses from self-employment, we divide them over the taxable year in the same way, and we deduct them only from your other earned income.
How we count earned income - CFR 416.1111
(c) Payments for services in a sheltered workshop or activities center
CFR 416.1111
(c) Payments for services in a sheltered workshop or activities center. We count payments you receive for services performed in a sheltered workshop or work activities center when you receive them or when they are set aside for your use. We determine the amount of the payments for each calendar quarter.
How we count earned income - CFR 416.1111
(d) In-Kind earned income
CFR 416.1111
(d) In-kind earned income. We use the current market value of in-kind earned income for SSI purposes. (See § 416.1101 for a definition of current market value.) If you receive an item that is not fully paid for and are responsible for the unpaid balance, only the paid-up value is income to you. (See the example in § 416.1123(c).
How we count earned income - CFR 416.1111
(e) Royalties and honoraria
CFR 416.1111
(e) Royalties and honoraria. We count payments of royalties to you in connection with any publication of your work, and honoraria, to the extent received for services rendered, at the earliest of the following points: when you receive them, when they are credited to your account, or when they are set aside for your use. (See § 416.1111(b) if you receive royalties as part of your trade or business.)
What is unearned income - CFR § 416.1120
What is unearned income - CFR § 416.1120
CFR § 416.1120 What is unearned income.
Unearned income is all income that is not earned income. We describe some of the types of unearned income in § 416.1121. We consider all of these items as unearned income, whether you receive them in cash or in kind.
Unearned income - 416.1121 / 416.1124
Unearned Income - 416.1121 / 416.1124
Income received from sources other than employment.
Examples: Cash, Pensions, Annuities, SSDI benefits, Rental income, inheritance, prizes/awards/gifts, alimony, child support.
One-Third Reduction Rule - CFR 416.1131
One-Third Reduction Rule- CFR 416.1131
If receiving food and shelter, SSI benefits are reduced by 1/3.
Example: If they are getting max amount, $841, the payment would be $561.
Presumed Maximum Value (PMV) - CFR 416.1140
Presumed Maximum Value (PMV) - CFR 416.1140
Allows you to show that your in-kind support and maintenance is not equal to the presumed value. We will not use the presumed value if you show us that -
(i) The current market value of any food or shelter you receive, minus any payment you make for them, is lower than the presumed value; or
(ii) The actual amount someone else pays for your food or shelter is lower than the presumed value.
