Disability fraud

People on SSDI don’t only receive what they’ve paid into the system, so it’s very much public money - mine and yours and whoever isn’t collecting.

Wow. I feel stupid now. I’d always thought that the difference between SSDI and SSI was that one is public and one is not, and clearly I was wrong. SSI is a welfare program, though, based on need and not entitlement, while SSDI is based on prior earnings.

I stand corrected.

(My information about the ADA is accurate, though!)

Back in college, my pills stopped working. My GPA fell from a 3.85 to a 2.0 . It became impossible to get anything done. Unable to hold a job or stay in college, my folks recommended I go on disability. I, being deep in a long and chronic depression, didn’t much care what happened to me.

I was indeed turned down the first few times I applied. Currently, I’ve been a leech on the butt of society for about a decade. My current therapist thinks I am making some progress. I try and attend a day program for the insane five days a week. I’ve missed the last two days as I’ve been sleeping for 15 hour stretches. My caseworker is trying to get me to volunteer for a three hour shift at a local charity thrift store. The idea literally gives me panic attacks.

Though my skillset is now out of date, I retain a gift for working with computers. Given the right training, I could work in IT again- except that I cannot reliably wake up on schedule, get places on schedule, concentrate on a task, finish tasks on time, and I occasionally go to sleep and don’t wake up for a few days. These things make it hard to hold a job.

Re Fraud

I think some gaming the system is necessary. I can literally walk down to the Russian market and use my food stamps to buy a can of imported caviar. Foodstamps do not, however, cover toothpaste, or toilet paper. People on disability often come to view the system as a huge predatory adversary filled with disincentives to work. So you find few people committing outright fraud and laughing while they live off the public. You find plenty of folks working under the table in order to avoid being bumped into the next income bracket and losing their children’s health insurance.

If you don’t mind my asking, what does the acronym SSD stand for?
Thanks.

Off the top of my head- I receive both Social Security Disability and Social Security Supplimental Income or SSD and SSI

The criteria for permanent total disability are not limited to actual disability. They also include qualifications.

In other words, if all you know how to do is build roofs, and you can no longer build roofs, you may be permanently and totally disabled, even if you are physically capable of working as a nightclub DJ.

Explanation of SSD and SSI here.

My understanding is that Social Security administers benefits to disabled individuals in the form of DIB (Disability Insurance Benefits - Title 2 of the Social Security Act) and SSI (Supplemental Security Income - Title 16). DIB requires eligibility based on an earnings record. SSI does not. DIB benefits are higher than SSI. Folks can get SSI for reasons other than disability - such as age. I am not sure of how anyone would qualify to concurrently receive both SSI and DIB. I am not aware of ever hearing “Social Security Disability” (or the acronym SSD) as a meaningful term.

I suspect that you are receiving SSI benefits based on disability, and doubt that SSI and SSD refer to two different things. But I could certainly be mistaken.

Thank you. Am I correct, however, in observing that the distinction is between SSDI and SSI?

I’m curious how an individual could receive both DIB and SSI at the same time. Not saying it is impossible, just that I’m having difficulty imagining the criteria.

I believe SSD (or SSDI) refers to social security disability (insurance/income) and I have always heard that used as opposed to DBI, which may be the technical, “proper” acronym used internally and officially.

In cases where people receive both SSDI and SSI I was (am) under the impression that the SSD(I) does not raise their income level enough to preclude qualification for SSI, thus both benefits are granted (and entitled).

I am using http://www.socialsecurity.gov/d&s1.htm to check my facts, but it isn’t entirely clear from that page if or how one would receive both.

ETA: Here is the cite of how people could receive both. http://www.socialsecurity.gov/pubs/11000.html#part3

Can’t find my proof of income letters at the moment. But I did find a bank statement.

I see three payments per month

Comm of PA SSP DPWbenefit

US Treasury 310 Supp Sec

US Treasury 303 Soc Sec.

NOTE- Those two numbers are not payment amounts.

SSD(I) benefits are based on your pre-disability income. So if you were making minimum wage for your entire life, you’d still be pretty broke if you were receiving SSDI, especially if your disabling injury requires/required expensive medical care, for example.

My work nearly always has to do with eligibility, rather than benefits calculation - so while I know quite a bit about some things (related to SS), I am completely ignorant about many others (not restricted to SS! ;))

Just was curious as to what DC was referring about here, as the acronym SSD had no special meaning to me. IME, folks often refer to SS “disability benefits” without distinguishing between DIB and SSI.

DIB/SSDI (Disability Insurance) has to be tied to SOMEONE’s earnings record. SSI requires limited income and resources.

“Live and let live”, for me, Johnny.

I am currently on my second round of SSDI applications and have since moved from Stage III to Stage IV of AD.

http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp

Yes, I can still function on a day to day basis, and I’m mad as hell for having to do this, but I think they look for ANY reason to turn someone down if they can.

I expect to have to apply a third time, which is why I have enlisted the aid of my district’s US Senator/Representative.

Thanks

Q

Right - you also don’t have to have 40 quarters “paid in” in order to qualify for SSI, since it doesn’t come from SS payroll withholding but from the Treasury. Kids can qualify, for example.

I think we might have a chicken/egg situation here. So many people have (or have tried) to commit fraud that the SSA by necessity must be super-vigilant in preventing that, resulting in what seem to be nit-picky or unreasonable denials. But they make the standards and procedures so difficult that many people must resort to what might appear to be fraud (pseudofraud let’s say) in order to qualify even when it is warranted. Then the SSA finds those cases to be fraudulent or possibly so, so their standards and procedures become even stricter requiring legitimate candidates to jump through even more hoops and possibly resort to what might be considered fraud…

They’re rarely nit-picky denials. They’re often unreasonable.

The key here is that it’s virtually impossible for an unrepresented claimant to win an SSDI appeal without a self-evident claim (ie., paraplegia, paralysis, loss of higher brain function, etc.) They just don’t know which medical records to present and which questions to ask doctors and so on.

On the other hand, SSDI claims set the standard in other types of disability law. If you are pursuing a workers’ compensation permanent total disability claim and simultaneously pursing an SSDI claim, if the SSDI claim is approved, the workers’ compensation carrier will pretty much throw up its hands and approve that one too.

Even with those things it is often virtually impossible. My father was denied SSD (or DIB if that is what I am supposed to use) when he was in a coma, on a ventilator, with a poor prognosis and much medical documentation stating he would never function again in any capacity.

In his case it turned out okay (financially anyway) because he passed away a week or two after the denial, if he had survived much longer my mother and he would have been in a world of hurt without being able to pay bills or have a home to go back to. After he died (with plenty of life insurance) my mother was able to quit her job, pay off and remodel her house and is living the rest of her years comfortably on the insurance proceeds. If he had lived they would have been destitute. I always found that to be a ridiculous paradox.

I’m not sure that is the case. IME, the amount of outright fraud that occurs is pretty darned small. Certainly if you compare criminal prosecutions to benefits paid.

I think the biggest disjunct is that people do not realize that it is a complex regulatory program, with specific requirements for eligibility. Just because you cannot do your past work, and are not aware of any jobs you could do - or would get hired for - in your immediate vicinity, does not entitle you to benefits. And eligibility differs from individual to individual depending on their age, education, and work experience.

The vast majority of people who apply for SS disab bens are sympathetic in one respect or another. But the agency does not enjoy unlimited leeway to award benefits to everyone who is sympathetic, or who comes “close to” meeting the legal requirements.

Here’s a hypothetical situation - take a 40 year old HS graduate who worked as a construction laborer for 20 years. He severely injured his back, underwent multiple operations and physical therapy, and takes narcotics. His doctors say he cannot lift more than 5 pounds, cannot stand or walk for more than 10 minutes at a time, and must alternate between sitting and standing, and because of his meds he cannot drive or operate machinery, and must do only simple, repetitive work away from workplace hazards. He lives out in the country, in a region with crushing unemployment.

So tell me, is this guy entitled to SS disab benefits? He’s paid into the system for 20 years. If you believe he is not, do you consider it “fraud” for him to apply in the first place?

IME, the easy cases - whether paid or denied - tend to (not always) get resolved pretty quickly at an early stage. Quite often delay is related to a claimant’s failure to submit sufficient evidence of the type that would establish their eligibility. What a lot of people seem unwilling to acknowledge, tho, is that a whole bunch of applicatons are “close” cases. Very fact specific, which do not readily fit into any of the “award” or “deny” pigeonholes.

As an applicant, you really ought to figure out which of the man regulatory “pigeonholes” would result in you receiving a favorable decision, and then make sure that you submit sufficient evidence to convince someone familiar with the regulatory framework that you fit into those pigeonholes better than the other ones which might lead to denial.

DIB is a sort of “trade name” which makes it easier to differentiate between SSDI and SSI. SSDI is correct, though.

That’s pretty fucked up, by the way. I take it he was approved on appeal?

Criminal prosecution for disability fraud is (1) not worthwhile, and (2) not really in anyone’s interest.

Prosecuting people for SSDI fraud isn’t going to reduce the number of fraudulent SSDI claims, and in any case, it’s virtually impossible to prove that fraud has been committed. Most disability claims result from spinal injuries, and no two people respond the same way to effectively identical spinal injuries.

I don’t know the basis for your opinions, but they are different from the ones I have gained from 23 years of doing this work full time. But we are in IMHO, so I don’t care to exert the amount of effort it appears would be necessarily from these opinions you seem to hold so strongly.

You realize, don’t you, that it is not as tho there is a dearth of Plaintiff’s lawyers available (and eager) to handle cases on a contingent fee basis. Whether you like lawyers or not, the fact that no lawyer is willing to represent you may say something about the merits of your case.

The interplay between the various types of “disability” benefits available from various sources is - to put it mildly - somewhat more complex than you suggest.