Nancy A. Berryhill, acting commissioner of Social Security, announced Tues., Sept. 5, that three new Compassionate Allowances conditions: CACH–Vanishing White Matter Disease-Infantile and Childhood Onset Forms, Congenital Myotonic Dystrophy, and Kleefstra Syndrome. Compassionate Allowances are a way to quickly identify serious diseases and other medical conditions that meet Social Security’s standards for disability benefits.
“Social Security is committed – now and in the future – to continue to identify and fast-track diseases that are certain or near-certain to be approved for disability benefits,” said Acting Commissioner Berryhill.
The Compassionate Allowances program identifies claims where the applicant’s disease or condition clearly meets Social Security’s statutory standard for disability. Many of these claims are allowed based on medical confirmation of the diagnosis alone, for example pancreatic cancer, amyotrophic lateral sclerosis (ALS), and acute leukemia. To date, almost 500,000 people with severe disabilities have been approved through this fast-track policy-compliant disability process, which has grown to a total of 228 conditions.
By incorporating cutting-edge technology, the agency can easily identify potential Compassionate Allowances and quickly make decisions. For other disability cases not covered by the Compassionate Allowances program, Social Security’s Health IT program brings the speed and efficiency of electronic medical records to the disability determination process. When a person applies for disability benefits, Social Security must obtain medical records in order to make an accurate determination. It may take weeks for health care organizations to provide records for the applicant’s case. With electronic records transmission, Social Security is able to quickly obtain a claimant’s medical information, review it, and make a determination faster than ever before.
“The Compassionate Allowances and Health IT programs are making a real difference by ensuring that Americans with disabilities quickly receive the benefits they need,” added Ms. Berryhill.
About 600 Long Island Rail Road retirees will lose their disability benefits after a federal agency voted last week to halt the payments, amid a sweeping investigation into what prosecutors have called a major disability fraud scheme, according to agency documents and officials.
The agency, the United States Railroad Retirement Board, which over more than a decade granted disability benefits to hundreds of railroad retirees based on fraudulent medical evidence with little scrutiny, took the action on Thursday during a five-minute meeting at its headquarters in Chicago. The vote approved procedures under which the board will cut off the benefits, which, officials said, are costing the agency $2 million a month.
Railroad workers should be aware that in addition to retirement annuities based on age and service, the Railroad Retirement Act also provides disability annuities for workers who become totally or occupationally disabled. Medicare coverage before age 65 is also available for totally disabled employees and those suffering from chronic kidney disease, according to the Railroad Retirement Board (RRB).
The following questions and answers describe the disability benefits available from the Railroad Retirement Board (RRB), their requirements and how to apply for them.
1. I’ve been working for a railroad for over 30 years. I’m only 52 but my health has been deteriorating and I don’t think I can work until I’m 60 and eligible for a retirement annuity based on age. What benefits could I be eligible for?
You may be eligible for benefits based either on total disability or occupational disability.
A total disability annuity is based on permanent disability for all employment and is payable at any age to employees with at least 10 years of railroad service, and under certain conditions to employees with 5 years of service after 1995.
An occupational disability annuity is based on disability for the employee’s regular railroad occupation and is payable at age 60 if the employee has 10 years of service, or at any age if the employee has at least 20 years of service. A “current connection with the railroad industry” is also required for an occupational disability annuity. The current connection requirement is normally met if the employee worked for a railroad in at least 12 of the last 30 consecutive months immediately preceding the annuity beginning date.
2. How do I apply for disability benefits?
To receive disability benefits you must file an application at one of the RRB’s field offices. You can be in compensated service while filing a disability application as long as the compensated service terminates within 90 days from the date of filing and the compensated service is not active service.
To expedite filing for a disability annuity, you or a family member should call or write an RRB field office to schedule an appointment. For the appointment, bring in any medical evidence in your possession and any medical records you can secure from your treating physicians. If you are receiving workers’ compensation or public disability benefits, notice of such payments must be submitted. In addition, proof of your age and proof of any military service credit claimed and a description of your past work activity will also be required.
If you are unable to personally visit an RRB office or meet an agency representative at a customer outreach program service location, you may request special assistance, such as having an RRB representative come to a hospital or your home.
3. I understand there are companies that will help me with the disability benefit application process, usually for a fee. Should I take advantage of these services?
We can’t advise you whether or not to hire any company or individual to help you file a disability application, however, there is certainly no requirement that you do so and there is usually no need to. There are RRB field offices located throughout the country trained to assist you in filing for a disability application at no cost to you. RRB personnel are the best resource available to assist disabled employees with their applications and advise them on how to obtain any additional medical evidence required or any other necessary documents or records. In fact, any time you need information or assistance, you should contact an RRB field office. In addition to the personal attention you will receive, special booklets and other printed materials are available. If you have a question about your benefits, you can speak to an RRB representative by calling the agency toll-free at (877) 772-5772 from 9:00 a.m. to 3:30 p.m., Monday through Friday. If you leave a message, your call will generally be returned within the next two business days.
4. Am I required to tell my employer that I am filing for disability benefits?
No, you are not required to inform your employer that you are filing for disability benefits. This is a private matter between you and the RRB. However, when a railroad employee files for an occupational disability annuity, a letter is sent to the employer seeking information about your jobs with that employer. Also, monthly summaries of benefits awarded are routinely sent to those employers who have requested them.
5. How do the standards for total disability and occupational disability differ?
An employee is considered to be totally disabled if medical evidence shows a permanent physical and/or mental impairment preventing the performance of any regular and gainful work. A condition is considered to be permanent if it has lasted or may be expected to last for at least 12 months or result in death.
An employee is considered to be occupationally disabled if a physical and/or mental impairment prevents the employee from performing the duties of his or her regular railroad occupation, even though the employee may be able to perform other kinds of work. An employee’s regular occupation is generally that particular work he or she has performed for hire in more calendar months than any other work during the last 5 years, or that work which was performed for hire in at least one-half of all the months in which the employee worked for hire during the last 15 years.
6. What medical evidence will I be required to submit if I file for a railroad retirement disability annuity?
If you file for a disability annuity, you will be required to submit medical evidence supporting your claim. You may furnish medical evidence in three ways:
You will be given a report form for your personal physician to complete. In this way the RRB can get information about your condition from the medical source that knows you best.
You will be asked to sign an authorization to release to the RRB any hospital, clinic, or employer medical records about your condition.
The RRB may ask you to be examined at the agency’s expense if more evidence is needed to:
Obtain more detailed or specialized medical findings about your condition, or
Resolve conflicts or differences in the evidence already on file.
7. What are acceptable sources of medical evidence?
The following are acceptable sources of medical evidence:
Licensed or certified psychologists
Persons authorized to send copies or summaries of the medical records of hospitals, clinics, sanitariums, medical institutions, or health care facilities.
Also, information from other sources can sometimes be important to a decision about your ability to work, such as:
Public and private social welfare agencies
Observations by non-medical sources (for instance, a vocational consultant)
Other practitioners (naturopaths, chiropractors, audiologists, etc.)
Sometimes the RRB will not be able to make a decision on your application without obtaining additional information. If so, an RRB representative will contact you by telephone or mail. You may be asked to send in the additional forms, proofs, or statements that are needed. You may also be asked to report for a medical examination.
It is in your best interest to fully cooperate if medical or other evidence is needed so that the decision on your claim is made as quickly as possible and based on the best information available.
If you fail to submit medical evidence that is needed and requested, a decision will be made on the evidence available. Also, if you fail or refuse to report without good cause for an examination scheduled and paid for by the RRB, it may be decided that you are not disabled.
8. Are copies of my disability application and medical evidence provided to my employer?
No. Federal law prohibits the release of this information to your employer without your written authorization. Your application for disability benefits and any medical evidence submitted in support of your claim are handled and maintained with strict attention to confidence and privacy by RRB personnel.
9. What happens after the RRB receives my application and medical evidence?
After the RRB receives your completed application and all the needed evidence, the agency will decide if you are entitled to disability benefits.
If you are not entitled to disability benefits, the RRB will send you a notice explaining:
Why you cannot receive disability benefits, and
What you can do if you disagree with the reason you cannot receive them.
If you are entitled to disability benefits, you will receive a notice that shows the amount of your monthly payments and other information about your benefits.
10. How soon after filing my application can I expect a decision?
Under the RRB’s Customer Service Plan standards, the agency will make a decision on your application within 100 days of the date you filed your application.
It should be noted that processing applications for disability benefits is more complex than other benefits due to the need to develop medical evidence. When you file an application for disability benefits, RRB field office staff will provide you with additional information on processing times for decisions and payments.
11. If the RRB decides that I am eligible for disability benefits, can my employer contest that decision?
No, employers cannot contest the RRB’s decision to award disability benefits to an individual.
12. Could early Medicare coverage be available to me if I’m rated disabled by the RRB?
Medicare coverage before age 65 may begin after a totally disabled employee has been entitled to a disability annuity for at least 24 months. There is no 24-month waiting period for those who have ALS, also known as Lou Gehrig’s disease. Many employees who are disabled for all employment but are otherwise qualified for an occupational disability annuity are initially awarded occupational disability annuities in order to expedite payment. The fact that you are initially awarded an occupational disability annuity does not preclude early Medicare coverage, if your physical and/or mental condition is such that you are totally and permanently disabled.
Over 70 percent of all employees awarded disability annuities will meet the medical criteria for what is called a disability freeze determination. The standards for freeze determinations follow social security law and are comparable to the criteria for granting total and permanent disability. Also, if you are granted a disability freeze you may qualify for early Medicare coverage and lower Federal income taxes on your annuity.
It should also be noted that Medicare coverage on the basis of kidney disease requiring dialysis or a kidney transplant is available not only to employee annuitants, but also to employees who have not retired but meet certain minimum service requirements, as well as spouses and dependent children. For those suffering from chronic kidney disease, coverage may begin with the third month after dialysis treatment begins, or earlier under certain conditions. However, applications by rail employees for early Medicare coverage on the basis of kidney disease must be filed with an office of the Social Security Administration, rather than the Railroad Retirement Board.