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Jenae Belmas, EBS in Marathon County, helped a client obtain Medicare Part B benefits. Earlier this summer, the client was released from incarceration and immediately went to SSA to restart his Social Security retirement payments and his Medicare Part B. The SSA worker, however, told him he had to wait until the GEP in January, 2024. The client assumed he was receiving correct information from SSA, and did not seek Jenae's assistance until he was having problems getting a Medicare Advantage Plan in place. Jenae helped the client point out to SSA that it should have used the new Special Enrollment Period for recently incarcerated individuals. SSA kept telling the client it was in the process of reinstating his Part B, but each time Jenae checked in, his status had not changed. Finally, the client had a medical emergency and would not get treatment because he feared his lack of health coverage. Jenae contacted her supervising attorney, who escalated the issue to the highest levels at SSA. It ultimately took six months and vigorous advocacy, but the client finally got the benefits he was entitled to so he could receive the care he needed.
11/30/2023
Story #129
Lindsey Holden, EBS in Portage County, assisted a client in obtaining QMB. The client's spouse received an inheritance that caused her to lose SSI, Medicaid, and QMB. However, the main portion of the inheritance was real property in the spouse's name, only. This meant that the client could be eligible for MAPP, but because she did not qualify for premium-free Part A, she would be responsible for Part A and Part B premiums without QMB. The client's spouse intended to sell the property eventually, but was hesitant to do so that quickly. When Lindsey explained that she could become QMB eligible if the property was listed for sale, they contacted a realtor (a relative) who listed the property for them. Lindsey was able to show IM that the property was unavailable under MEH 16.2.2 , and with assertive follow-through, the client's QMB was processed.
11/30/2023
Story #128
Leanne Grover, EBS for Barron County, worked with a client who had received a letter from Social Security in March requesting verification of employment for the previous three years. Leanne helped the client submit all of her wage documentation within a week after receiving the letter but, in August, the client received another letter saying she was ineligible for SSDI payments for several months during the review time frame. Leanne submitted the relevant paystubs again, only to receive an overpayment notice in September totaling more than $19,000. Leanne helped the client submit a reconsideration request and included sections from the POMS clarifying that vacation and sick time should not be counted toward earned wages. Upon reconsideration, SSA determined that there was no overpayment and that SSDI payments would be reinstated.
Monetary Impact = $19,000
10/31/2023
Story #123
Mary Velcich, EBS in Green County, helped a client successfully appeal part of an overpayment of over $5600. The client retired mid-year and began receiving early Social Security Retirement benefits that month. In addition to her final paycheck, the client received a large payout for her unused sick days. Mary determined that SSA used the yearly earnings test to determine that the client had been overpaid for the entire year. However, because the client was only retired for part of the year, SSA should have used the monthly earnings test, which meant that the client was only overpaid in the month she retired. Mary helped the client obtain records from her employer about her last paycheck and unused sick days and submitted a reconsideration to SSA. SSA agreed, and the client was relieved that she didn't have to repay the entire overpayment amount.
Monetary Impact = $5,600
9/29/2023
Story #115
Ellen Venne, EBS of Adams County, helped a client get an SSI Overpayment waived. The client, who suffered from mental health issues and confusion related to medication side effects, did not understand when SSA called him and told him he needed to start paying $200 per month. SSA had made a mistake when paying him SSI benefits (they failed to consider his wife's Social Security Retirement Income), and then assessed an overpayment of nearly $14,000. Ellen helped the client request a waiver, and in less than two months, the entire overpayment was waived.
Monetary Impact = $14,000
9/29/2023
Story #111
Mindy Shrader, EBS in Sauk County, showed incredible patience in getting two cases resolved successfully. In the first case, Mindy helped a client request a waiver of a nearly $7,000 Social Security overpayment in early September 2020. Despite the fact that Mindy regularly checked in on the case, SSA apparently lost the waiver request until June of this year, when they sent a letter to the client requesting updated financial information. Mindy helped the client provide updated information about her income and expenses and attached that to a copy of the original waiver request, and SSA finally approved the waiver request!
Monetary Impact = $7,000
8/31/2023
Story #106
Terri Esselman, EBS of Clark County, helped a client negotiate a $10 per month repayment plan with SSA for an SSI overpayment. The client was incarcerated, and had incurred an SSI overpayment totaling over $2,000. The client did not deny that he was overpaid, and did not want to request a reconsideration or waiver. Instead, he just wanted to reduce his monthly repayment amount so SSA would not take his full checks. At first, SSA told the client the lowest amount they could accept was what could be repaid over 12 months, then they said 36 months. However, Terri was able to use the POMS rule that a person receiving LIS (Part D Low Income Subsidy) qualifies for a repayment amount as low as $10 per month. After educating SSA about this policy, he was granted this repayment amount and can now pay it off slowly over time as he re-enters the community post-incarceration.
8/31/2023
Story #104
Gail Sauerman also achieved a favorable result for a client with an SSI overpayment that went all the way to an ALJ hearing. The client had a large SSI overpayment that was mainly due to real property that she shared with her ex-husband. We were able to prove that because he refused to sell the property, then it should not be counted as an available resource. However, SSA still assessed an overpayment for three months due to being over resources from multiple vehicles. Gail worked meticulously with the client to provide a timeline of when the vehicles were owned, sold, inoperable, and junked. She obtained pictures of the vehicles and ledgers from the scrap dealer. The ALJ accepted the additional information Gail gathered and issued a favorable decision, which eliminated the remaining $1,119 of the overpayment.
Monetary Impact = $1,119
8/30/2023
Story #103
Jessica Flores, EBS in Door County, helped a gentleman who was brought from the other side of the state and dropped off in Door County with a few bags of possessions and nowhere to go. Jessica worked with the I&A staff at her ADRC to get him find employment and a place to stay. She also helped get him all the benefits for which he qualified, and she helped him get set up with a new representative payee for his SSDI benefit. However, his SSDI benefit was reduced one month which left him without enough money to pay his rent. Jessica worked with the Veteran Outreach and Recovery Program and hosted the VA staff to come meet the client in her office. They were able to get him funding so he was not kicked out of his short-term residence. The VA was also able to help him move to one of their Housing & Recovery transitional houses where they will work to get him into HUD-VASH for stable ongoing housing, transportation to doctor appointments, meals, and recovery support (which they predicted would cost him $0). They will also work to get him a non-service-related pension so he will see a good increase to his income.
7/27/2023
Story #94
Kenton Zink, EBS for Dane County, helped a client reduce an SSI overpayment of more than $12,000 to around $900 by demonstrating to the Social Security Administration (SSA) that the client was over the SSI asset limit due to COVID-19 stimulus payments. He then helped the client understand options for spending down assets and provided SSA with updated bank statements and a receipt showing that she had used her remaining assets to prepay rent. He got the issue resolved within a week, and the client's benefit payments resumed without missing a month. With SSI being her only source of income, the client was greatly relieved to have that problem resolved so quickly.
Monetary Impact = $11,100
6/29/2023
Story #93
Kris Schiek, EBS in Oneida County, helped a client successfully appeal an SSI overpayment of over $14,000. Kris helped the client obtain bank statements dating back to 2020 to show that SSA incorrectly counted his COVID-19 stimulus payments as available resources. Kris's supervising attorney created a table to show how the stimulus checks kept accumulating and, because they are excluded resources, he should not have been assessed an overpayment for not spending them down. SSA agreed, and issued a favorable decision in less than two months.
Monetary Impact = $14,000
6/29/2023
Story #91
Mindy Shrader, EBS in Sauk County, helped a client do a significant amount of detective work to prove that she was eligible for receiving benefits related to her ex-spouse. The client initially came to see Mindy because she was worried that she couldn't afford her increased rent. After talking to the client, Mindy learned that the client might be eligible for benefits on her ex-husband's record. Unfortunately, the client had been married in another country before moving to the United States, and the divorce had taken place in another state. The client provided all the records she had about her marriage, which were not in English, and Mindy helped her bring those to SSA. In addition, Mindy helped the client request a copy of her divorce judgment from the other state to send to SSA. Unfortunately, SSA was unable to accept the marriage documents because the agency is prohibited from accepting documents from that country. However, the client was able to connect Mindy with an old friend who had witnessed the wedding and was willing to write a letter to SSA verifying when the wedding had taken place. SSA finally approved the client's application for benefits, which increased the client's total monthly benefit amount by over $1,200 and got her over $17,000 in back pay!
Monetary Impact = $17,000
6/29/2023
Story #90
Pam Fuchs, EBS in Sauk County, helped a client successfully appeal an SSDI overpayment in a case that took nearly two years to resolve. The client was injured while working in another state many years ago and received worker's compensation (WC) after that. She later moved to Wisconsin and applied for SSDI benefits after her WC payments had ended. SSA sent a letter to her representative payee asking for information about the WC payments, but the representative payee had significant medical issues and was unable to respond to that letter. As a result, SSA assumed the client was receiving WC payments and SSDI benefits at the same time without any offset calculated. Because the overpayment notice was so vague, Pam helped the client request reconsideration because SSA had not provided enough information for us to evaluate whether an overpayment had actually occurred. SSA responded by asking for records of the client's WC payments. Pam tried to track down the records, but the client's former employer, medical providers, and WC attorney no longer had any records. She was finally able to obtain records from the state where the work injury occurred, which showed that the client had not been receiving any WC payments at the time she applied for SSDI. SSA agreed, and not only did the client no longer have an overpayment issue, but SSA actually owed her some money!
6/29/2023
Story #89
Tiffany also assisted a 66-year-old client who was referred in May because she was terminated from her job and was unable to afford the high cost of Trulicity, a new drug her doctor prescribed for her diabetes. The client was enrolled in SeniorCare Level 2B but did not have funds to pay the $850 deductible. Because of her loss of income, Tiffany helped her successfully apply for the Qualified Medicare Beneficiary (QMB) Program in May, and her benefits became effective June 1st. Meanwhile, Tiffany also assisted her with an application for Social Security retirement benefits. Due to this new source of income, her QMB enrollment will only last for one month. However, as a result of having been enrolled in the QMB program, she will have full Extra Help/Low-Income Subsidy (LIS) for the rest of the year. The client was finally able to fill her prescription and she paid the $10.35 co-pay under LIS. Fortunately, she was offered a job which starts next month. The client is very pleased with the assistance she received from Tiffany during a very stressful time in her life.
Monetary Impact = $850
6/1/2023
Story #88
Tiffany Scully, EBS in Dane County, was successful in assisting a 75-year-old client with enrollment in Medicare Part B without a late enrollment penalty (LEP), using the Special Enrollment Period (SEP) related to loss of employer group health plan (EGHP) coverage. The client was covered under her spouse's EGHP since she turned 65. After her spouse retired in September 2022, she applied for Part B, but her application was denied by SSA because they said she did not show proof of active employer coverage from March 2013 to the present. The client sent SSA a completed Request for Employment Information form, but the employer's representative indicated that their records only went back to 2017. The original business the spouse worked for had changed names several times and was purchased by a larger company in 2017. When Tiffany and the client contacted the insurance company for the EGHP, they also could not provide proof of coverage prior to 2017. According to SSA POMS HI 00805.295 (Evidence of GHP or LGHP Coverage Based on Current Employment Status), when the employer, GHP or LGHP cannot provide all evidence of coverage based on employment status, the applicant can submit other documentation. Based on this, Tiffany helped the client submit a new Medicare Part B application along with a statement of claimant (Form SSA 795) explaining the situation as well as the additional evidence the client was able to locate, which included W2s, paystubs showing deductions for health insurance with a spousal surcharge, and tax forms 1095-C (Employer-Provided Health Insurance Offer and Coverage). This was all faxed to the Madison SSA Field Office on one of the last days of the client's 8-month SEP. She had just become aware of the EBS Program, after months of trying to address this issue on her own. She cried tears of joy when she found out that her Part B enrollment was processed and there was no LEP!
6/29/2023
Story #87
Melissa Chase, EBS in Fond du Lac County, recently helped a 72-year-old client with an SSI termination and pending overpayment. SSA continued to count this client's COVID-19 stimulus payments as a resource, and they also counted an extra vehicle that the client did not actually own. Melissa worked with the client and SSA for months to try to get this issue resolved. Finally, Melissa helped the client appeal and send in a statement regarding these issues. One week later, the client received backpay of almost $3,500 and her SSI payments resumed.
Monetary Impact = $3,500
6/29/2023
Story #86
Amanda Runge, EBS in Winnebago County, recently received a fully favorable decision for a client with an SSDI overpayment of over $114,000. The client, a 61-year-old man, had worked for many years for a friend. SSA alleged that this client had gone over the monthly substantial gainful activity (SGA) amount with his earnings for several years. However, this client's friend/boss had provided him with a lot of extra accommodations and even paid him for days in which he did not work. Amanda helped the client gather evidence of this, along with paystubs and a letter from his former boss, to send in with the appeal. The appeal was fully favorable, and the client no longer owes an SSDI overpayment.
Monetary Impact = $114,000
6/29/2023
Story #85
Jennifer Trasser, EBS in Outagamie County, recently helped a 64-year-old client get an SSI overpayment waived. The client had received annual rental payments in January every year, and he used this income to pay his property taxes. He thought that SSA understood that this was a recurring payment every January, so he didn't need to report it each year. However, he was still issued SSI benefits and was determined to have had an overpayment for the month of January spanning four years. Jennifer helped the client submit a waiver request. She then attended the personal conference with the client to provide support and assistance. A few weeks later, the client received notice that his overpayment was waived.
6/29/2023
Story #81
Pam Fuchs, EBS in Sauk County, recently helped a client with an administrative waiver of an SSI overpayment. SSA had actually stopped the client's benefits because they believed she was over the resource limit, but Pam helped the client send up-to-date bank statements to SSA showing that she was under the resource limit, and SSA reinstated her benefits. Although the client had overpayments waived in the past, her medical conditions made it difficult for her to manage her finances, and she no longer had the same support network helping her as she had in the past. Pam helped the client fill out the paperwork to request a waiver, and SSA agreed to waive the overpayment.
5/31/2023
Story #76
Mindy Shrader, EBS in Sauk County, helped a client with a successful reconsideration of an SSI overpayment. The client received an overpayment notice in April 2023 alleging that she had been overpaid in an earlier month and in May 2023, which stopped her benefits as of May 1. Mindy determined that the earlier month's overpayment was due to the fact that the client's MCO had not deducted that month's CBRF room and board payment from her account. Mindy obtained a letter explaining the situation from the MCO and argued to SSA that this was similar to a situation where a beneficiary is only over the resource limit because the landlord did not cash a rent check before the first of the following month. SSA agreed with this and determined the client had not been overpaid in that month. Mindy also provided bank statements to show that the client had remained under the resource limit but was obviously unable to obtain a May bank statement in April when the reconsideration was filed. Unfortunately, SSA continued to insist that the client was ineligible for benefits in May. Thankfully, Mindy was able to obtain a bank statement with the client's May 1 balance after May 1, and SSA finally agreed to reinstate the client's benefits.
5/3/2023
Story #75
Emily Reuter, EBS in Grant County, recently helped a client with a successful reconsideration of an SSI overpayment. SSA believed that the client was over the SSI resource limit because she and her spouse owned a number of tools that had previously been exempt business assets when the spouse was working. Emily worked with the client to figure out an approximate resale value for the tools, which turned out to be less than SSA's estimate of the value. More importantly, Emily argued that the tools should be considered household goods, as the client and her spouse planned to use them to make repairs to their home in the near future. SSA agreed, and the client was thrilled!
5/31/2023
Story #73
Jamie Ausloos, EBS in Forest County, helped a client eliminate an SSI overpayment totaling over $13,000. SSA incorrectly counted the client's income for more than five years. Jamie helped the client submit a Request for Reconsideration form and bank statements for the months at issue. SSA not only eliminated the entire overpayment, but it also determined the client was due back payment of over $500. Most impressively, SSA made its decision in just three weeks (reconsiderations often take years!)
Monetary Impact = $13,500
4/28/2023
Story #66
Amanda Higgins, EBS in Dodge County, helped a client clear up an issue related to the amount she was contributing to her household's food and shelter expenses. The client was living with her daughter's family, and when she applied for SSI, she told SSA that she was unsure how much she contributed to household expenses. Instead of explaining to the client why this information was needed and giving her an opportunity to follow up with the agency, SSA assumed that she was not paying for her own food and shelter expenses and reduced her SSI benefit amount by 1/3. Amanda helped the client submit information showing that the client was paying her fair share of household expenses in July 2022, but SSA did not act on that information for many months. After a number of unsuccessful attempts to work with the local field office, Amanda and the client were finally able to speak with someone at SSA in January of 2023. That worker was able to update SSA's records showing that the client had been paying for her food and shelter expenses, and the client is now receiving the full federal SSI benefit amount. In addition, the client will be receiving a significant amount of backpay for the months her benefits were incorrectly reduced!
1/31/2023
Story #54
Pam Fuchs, EBS in Sauk County, helped two clients successfully appeal their Income-Related Monthly Adjustment Amounts (IRMAAs). The clients had sold businesses when they retired, which resulted in significant capital gains income in 2021. Pam helped the clients explain that they had stopped working and that their current income was much lower than reflected by their 2021 tax returns. SSA agreed and removed the IRMAAs!
2/28/2023
Story #53
Amanda Higgins, EBS in Dodge County, received a favorable decision from SSA after spending a year and a half helping a client with a complicated overpayment situation. The client had been receiving widows benefits for several years when SSA inappropriately reduced those benefits after her late husband's first wife applied for benefits on his record. The client tried to resolve this with SSA at the time, but the agency told her there was nothing they could do about it. As a result of the reduction in benefits, the client applied for retirement benefits on her own record. She withdrew the application for retirement benefits the following month when she thought the issue with her widows benefits had been resolved. However, SSA took nearly nine months to process the client's request, and eventually sent her an overpayment notice saying that she owed over $16,000. Amanda reviewed the client's records and discovered that the client had been both overpaid and underpaid between the retirement benefits and widows benefits. Amanda helped the client request reconsideration, but SSA did not issue a decision until over a year later, after the client contacted Senator Baldwin's office for assistance. In that decision, SSA agreed that the client had been overpaid and underpaid and recalculated the overpayment, which reduced it to a little over $900. Amanda then helped the client request an administrative waiver because the overpayment was the result of SSA's errors. Even though there was a pending waiver request, SSA sent a notice to the client saying that the overpayment would be withheld from the client's monthly benefits. After several frustrating attempts to check the status of the waiver, Amanda followed the SSA case escalation process and finally learned that the waiver was granted, and the overpayment was removed from the client's record.
Monetary Impact = $15,000
1/25/2023
Story #49
Pam Fuchs, EBS in Sauk County, helped a client withdraw her application for Social Security Retirement benefits. The client applied for SSR in April 2020, thinking that she would be working fewer hours. When that didn't happen, she submitted paperwork to withdraw her application for benefits in May 2020. However, that paperwork was not processed until June 2021, and the client continued to receive benefits until July 2021. The client tried to pay back these benefits several times, but one check was returned, and the replacement check she sent was never cashed. She called her local SSA field office several times to try to resolve this, but each time, she was told to wait 30 days for a resolution. Unfortunately, the client couldn't file a new application for SSR until the withdrawal of her first application was completed. The client sought Pam's help in January 2022. Pam followed the case escalation protocol with SSA, but the payment center stopped responding to the field office manager's requests. Pam then helped the client request a congressional inquiry with Sen. Baldwin's office. Finally, over two years after the client first attempted to withdraw her application for benefits, she received confirmation that her application had been successfully withdrawn. At that point, the client was able to repay the benefits she had received in error and reapply for SSR.
11/30/2022
Story #44
In July, Megan Girardy, EBS in Jackson County, met with a man who had recently entered into home hospice after surviving four years with stage four prostate cancer. They discussed the process of applying for disability benefits and began filing for early retirement benefits. The local SSA field office representative proved very helpful and began the process of filing for survivor benefits and designating the client's wife as representative payee for their two children. Megan helped the client complete a compassionate allowance request in August. At each visit along the way, they spent time discussing family, going through old photos, sharing hunting stories, and learning about his family's history. When the client passed away in late October, Megan was invited by the family to come to their home to assist with the notification process. After she arrived, his wife showed Megan that she had received notice that benefits were approved with a back payment award of more than $18,000, which the family later used to cover funeral expenses. Megan received a hand-written thank you note with the client's signature, an invitation to his celebration of life, and an open pass to his hunting cabin to continue sharing stories with his family.
Monetary Impact = $18,000
10/31/2022
Story #43
Ashley Greene, EBS in Crawford County, recently helped a client regain access to her online bank account so that the client could continue to receive her SSI benefits. The client lost her debit card several months before, and when she tried to request a replacement card online, she accidentally created a second account. Thinking that this could be fraud, the bank put a hold on her account and asked her to send copies of a state ID card and Social Security card so they could verify her identity. Unfortunately, the client had also lost her Social Security card. To make matters worse, SSA sent the client a letter saying that they stopped her SSI benefits because her most recent benefit check had been returned. This left her with no income and no access to any of the money in her bank account. The client set up a new account at a local bank, but SSA could not change her direct deposit information without confirmation of her old bank account routing number. Ashley helped the client set up a MySSA account so that she could request a new Social Security card. That card arrived within a week, and Ashley helped the client send a copy to the online bank. Although customer service said they would reset her account, that still wasn't resolved a month later. Ashley helped the client send additional documentation to prove her identity, and after meeting with the client four times in one week in order to work on this, the client finally regained access to her account. This meant that the client could change her direct deposit information with SSA, and SSA deposited over $3,000 in SSI backpay the following week. Ashley also helped the client file complaints about the online bank with the Consumer Financial Protection Bureau and the Wisconsin Department of Financial Institutions.
Monetary Impact = $3,000
11/30/2022
Story #40
Tiffany Scully, EBS in Dane County, also assisted a 63-year-old client with a good cause late appeal for an SSDI appeal. (Note: EBS typically do not help with SSDI appeals, but Tiffany got permission from her BSSA to assist in this narrow circumstance). The client was referred to the EBS Program by a nurse practitioner at a local cancer treatment clinic who tried to assist him with a phone appointment to apply for disability, but they were unable to get through to the claims rep due to phone issues and missed their scheduled appointment. When Tiffany and the client contacted the Madison SSA FO to reschedule, the claims rep informed them that the record showed the client already applied for SSDI in August 2021, based on a history of seizures. His claim was denied in March 2022. The client did not recall ever applying for SSDI, even though the forms had been signed by him, and he never received the denial notice. Tiffany explained that while the original claim was still pending, in November 2021, the client had been diagnosed with metastatic melanoma. During the call with SSA, the claims rep consulted with the FO manager who recommended submitting a good cause late appeal rather than a new disability application. With the client's permission, Tiffany consulted with the nurse practitioner at the cancer clinic who confirmed that the client met and exceeded the criteria under the compassionate allowance listing for skin malignant melanoma with metastases. After consulting with her program attorney, Tiffany met with the client and completed the necessary forms to request the good cause appeal, then faxed everything to the Madison FO and indicated that it was a TERI case. After making numerous calls to the FO over the course of two months requesting an update on when the claim would be sent to the DDB, Tiffany utilized the escalation process, and the area work incentives coordinator ensured that this process was completed. Within a few days of receiving the claim, the DDB issued a favorable decision which the area work incentives coordinator communicated to the EBS. The client is very pleased as his monthly Social Security benefit increased significantly under SSDI. Prior to the appeal, he had been receiving early retirement benefits, and, after paying his rent each month, he had less than $200 remaining for his other living expenses, making it difficult to make ends meet.
10/30/2022
Story #38
Mindy Shrader, EBS in Sauk County, helped a client get reenrolled in Part B after she was somehow disenrolled during the process of switching from Railroad Retirement Medicare on her late husband's record to Medicare via the Social Security Administration based on her own work record. The client didn't realize that her Part B coverage ended until she was at the pharmacy trying to fill prescriptions and learned that her Advantage plan disenrolled her. Mindy helped the client request equitable relief, and when the case stalled in the processing center, Mindy reached out to Elida Elizondo at SSA to see if she could move the case along. After that, SSA granted the equitable relief request, and the client's Part B was reinstated.
10/30/2022
Story #35
Leilani Amundson, EBS in Dane County, recently helped a client get her Medicare Part B retroactively reinstated. The client turned 65 and signed up for Medicare. She had thought that her financial planner set up the automatic withdrawal for her premium payments, however they did not. She received a notice dated April 2022 that her Medicare would be ending, and she wouldn't be able to reenroll until the general enrollment period (GEP). However, she didn't see this notice until several months later due to illness. She immediately went to the local SSA office and paid the balance of over $4,000 (including IRMAA), but there was still an issue. Leilani called the SHIP hotline who noted that her payment did not reflect the additional 40 cents on the bill and confirmed her check didn't correctly spell out the cents even though it was written in the numeric box. This was the only issue anyone could pinpoint. Leilani was able to reach an SSA representative who agreed to an appeal for equitable relief, took her telephonic signature, and got a screenshot of her payment of .40 The SSA worker then submitted his approval and recommendation for expedited reinstatement for Medicare to restart as of June of 2022.
9/30/2022
Story #34
Tiffany also successfully assisted a 63-year-old client with a request for expedited reinstatement (EXR) of SSDI benefits. The client started receiving disability in 2012, however, his benefits ended in 2021 due to work activity. Unfortunately, the client's health worsened, and in the fall of 2021, he was no longer able to earn above SGA. Tiffany assisted the client with completing the forms required for the EXR and made sure he received provisional benefits while his claim was pending. In June, he was found eligible for benefits starting in January 2022. Since his daughter was a full-time high school senior from January - May, she was also found eligible for benefits under his record.
9/30/2022
Story #32
Tiffany Scully, EBS in Dane County, helped a client get almost two years' of Social Security backpay totaling over $22,000. The client receives a government pension based upon her own work and a government pension based upon her spouse's work, which was higher. SSA was counting the higher pension amount when calculating the government pension offset (GPO) but should have been using the pension based upon the client's own work. Tiffany helped the client file a request for reconsideration but had not heard back for over a year, despite numerous contacts with SSA. Tiffany finally decided to try the new SSA case escalation process and that worked to resolve the issue and get the client the back pay she was entitled to.
Monetary Impact = $22,000
9/30/2022
Story #31
Kathy Schultz, EBS in Langlade County, helped a client get an over $21,000 SSDI overpayment waived. The client was receiving SSDI and remained under Substantial Gainful Activity (SGA). When her employer had a worker shortage, the client offered to take on extra hours on a temporary basis, even though it was not good for her disabling condition to do so. Before taking on the extra hours, the client called SSA to ask how the work would affect her SSDI. The SSA worker said “there are no limits on your work for three years." In fact, the client had already used her Trial Work Period (TWP), and when a person enters their Extended Period of Eligibility (EPE) they stop receiving benefits, although remain eligible to reenroll in SSDI without a new application. The worker, however, misunderstood the client's TWP and EPE and made it sound like the client could work any amount of hours during her EPE and receive her full benefits the entire time. The client relied on the SSA worker's advice, however, and took on the extra hours. The client submitted a waiver on her own, and after a denial, Kathy helped the client call SSA to determine how they came up with their figures, and to reevaluate the denial based on the client's lack of fault in the overpayment. In an unheard of turn of events, based on this phone conference SSA reversed its denial and waived the entire overpayment. The client had been so fearful that the overpayment was going to cause her to lose her house. She was so thankful for Kathy's assistance that she sent her flowers as a gesture of appreciation.
Monetary Impact = $21,000
9/30/2022
Story #30
Mindy Shrader, EBS in Sauk County, recently helped a client successfully request reconsideration of an SSDI overpayment of more than $60,000. The client is a farmer and had received a crop insurance payment one spring when it was too wet to plant. Because the crop insurance payment was taxable income, he reported it on his taxes, which made his adjusted gross income look very high for the year. SSA assumed that the income was from work and determined that he was no longer eligible for SSDI. In addition, SSA terminated his Medicare enrollment. Mindy helped the client submit a copy of his tax return to SSA to show that the income was not from substantial gainful activity. She also requested that SSA provide critical payments while the reconsideration was pending so that the client could afford his living expenses. Not only was the reconsideration successful, but the client received more than $10,000 in backpay, and his Medicare was reinstated.
Monetary Impact = $60,000
9/30/2022
Story #27
Mary Velcich, EBS in Green County, recently helped a client correct her date of birth with SSA. The client turned 65 in 2019, but because her DOB was incorrect in SSA's records, Medicare denied every claim. It turned out that her DOB was entered incorrectly when she changed her last name after her wedding in the 1970s. She was able to call 1-800-Medicare and have them manually correct information for each individual claim so that they could be processed and paid, but her efforts to resolve this with the Janesville office were unsuccessful. The client came to the Mary at the end of July, and Mary helped her call the Janesville office. When they couldn't resolve the issue that way, Mary followed the SSA case escalation guidelines and emailed the Field Office mailbox. Mary finally able to resolve the issue with the Field Office Manager, and she confirmed with Medicare that everything is corrected now.
8/31/2022
Story #25
Leda Judd successfully helped a consumer receive SSI and SSRE with a backdate.
The consumer called our office because he hasto pay $1.35 per med and wants to go back
to using his Foward card since he had $0 co-pays. A referral was made to me on June 2, 2022.
I checked Cares prior to calling him and he had no income. He is 66 years old and turning
67 in the fall. During our conversation, he said he lived with his sister and in return
for rent he helped with their mother who had Alzheimer's. I asked him why he did not have
any income and he said he wanted to maximize his social security retirement benefit and
wait until his full retirement age to take SSRE. He said, according to SSA letters he
received, if he took it now it would be $337/m . If he waited until he was 70, it
would be $537. He had wanted to decline Medicare and stay on Medicaid only. I explained
he could not do that because he is entitled to Medicare at age 65. He was auto-enrolled in
to an LIS Part D plan because he had been on BC+. He said he can't ask his sister for any
more money, not even $1.35 for medications. I felt if he had income, he would be able to pay
for his medications and help out with household expenses. He agreed. We then discussed calling
the Social Security office to schedule an appointment to collect his SSRE AND apply for SSI so
he could receive his maximum benefit. When I did the math, I felt he would receive a total of
$861, which includes SSRE of $337 + $524 SSI. Plus the SSI state supp of $83.78. He would need
to claim shelter costs to get the state supp of $83.78. He said he would pay his sister rent if
he had money to pay her. We called SSA on 6/2/2022 and scheduled his appointment to apply for
SSRE and SSI. A phone apt was scheduled for June 24, 2022. I received an email from the
consumer that he was approved for SSI on July 5, 2022. "Great news! My SSI application was
accepted. I received payment already of $3400 today." He also stated that he will get his
SSRE and there will be a backpay but he was not given an amount.
Since this time, he has received several letters which are confusing and have conflicting
information. We called SSA to help us with understanding the letters. I explained he received a
letter reducing his SSI amount to $64/m for September. The rep at SSA assured us it will be all
straightned out by October. He then received a letter dated August 23, which states he has an
overpayment for SSI in the amount of $531. He did not want to file for a waiver or appeal due
to his mental health issues. I will continue to monitor this case and help him if he changes
his mind and wants to request a waiver or appeal.
I feel this story was important to point out because of the impact our program has. A person
may call for one issue and after we ask a few questions, realize there is a larger issue that
we can help with. Monetary impact is confusing because of the recent overpayment. I should
record $861 x 12 = $10,332 x 4 (years) = $41,328. If he had not called our office, he would
have most likely waited until he was 70 to draw on his SSRE benefit of $537. This is one of
the largest monetary impacts I have recorded. I have not closed this case because of the
overpayment but the person was approved for SSRE and SSI with backdates on 7/5/22.
Leda
Monetary Impact = $41,328
7/5/2022
Story #23
Kayli Williamson, EBS in Polk County, helped a client successfully appeal a $5,500 SSI overpayment notice which occurred between 2019 - 2021. The client had been alleged to have been over the $2,000 resource limit due to having too much money in his bank accounts and for owning a camper. Kayli wasted no time in digging into this case, and upon investigation discovered that the camper had recently been assessed by a professional who worked in the camper buying and selling industry. This professional had estimated the camper to be worth $0 due to its extensive roof and structural damage, bad tires, and irreparable fifth wheel due. The estimate indicated that at best the camper would only be worth money for metal scrapping if brought into a recycling center. Furthermore, the EBS found out that the camper was supposed to be an asset owned by his ex-wife given that the terms of their divorce judgment said the camper would belong solely to the ex-wife after the divorce was final in 2006. Therefore, the client had no legal right to sell or transfer the camper as doing so would be in violation of the divorce court order. Finally, Kayli discovered that the reason that the client's bank account was over the limit was due to stimulus money he had recently received. The stimulus money should have been an exempt resource for SSI for 12 months after the date it was received. Shortly after sending in the appeal, Kayli and the client were informed that their reconsideration request had been fully successful. The client was thrilled.
Monetary Impact = $5,500
6/30/2022
Story #17
Pam Fuchs, EBS in Sauk County, recently helped a client reinstate her SSDI benefits. For some reason, SSA had stopped this client's benefits in the middle of a work review because she had worked over the SGA limit in two months during her extended period of eligibility (EPE). However, the client's EPE had not ended. The client tried for several months to get an explanation from SSA, but the agency would only tell her that she had to request an ALJ hearing. Pam helped the client request an ALJ hearing, and shortly after that, SSA reopened the work review. The client soon received a check for the benefits she was owed for the months her benefits were stopped, and her regular monthly benefits started up again. The client was thrilled that this was all resolved without having to wait for an ALJ hearing.
6/30/2022
Story #16
Joanne Welsh, EBS in Richland County, helped a client successfully appeal an SSI overpayment. The client had received an inheritance many years ago, which caused her to lose SSI eligibility at that time. Over time, the client gradually spent the inheritance on her living expenses. When that money was gone, she reapplied for SSI. Although she began receiving benefits, SSA later decided that she still had the money from the inheritance, which put her over the asset limit. Joanne helped the client prepare a summary of how she had spent the money over several years and request reconsideration. SSA agreed that the client had not been over the asset limit when she reapplied for SSI, reinstated her benefits, and determined that she was owed over $1,600 in backpay for the months her benefits were stopped after she received the overpayment notice.
Monetary Impact = $1,600
6/30/2022
Story #15