Injured At Work? We’ve Fought for Arizona’s Workers Since 1975

• Update claimant on current location of file and any needed information. Discuss timelines. See Overview of Case Procedural History in this manual.

Encourage claimant to apply for AHCCCS or appeal any AHCCCS denials. Refer claimant to free or sliding scale clinics. Encourage claimant to continue with WC supportive care.

Inquire if claimant has another provider that can be asked to complete the form. If no other provider exists, consider evaluations that may be available in a WC record. The claimant may need to request the provider make a referral for a functional capacity or psychological exam.

• If a claimant has not worked enough quarters to fulfill the 20/40 rule, the claimant is eligible for SSI only. SSI is financial based program, a “welfare” program. The benefit is approximately $967 and qualifies for AHCCCS. Any earnings while on SSI are offset.

• While a claimant is working, SSA is reaching into the paychecks and taking out money. This is purchasing long term disability insurance from the government. Just like you pay for car insurance in January and your coverage is good through June, with continued work and paying in, you buy insurance coverage for SSD into the future. This coverage expires at your Date Last Insured (DLI). If you are found disable before the DLI, you qualify for SSD benefits. These benefits, your PIA, is based on the money paid in. Any earnings, less than SGA, are NOT offset.

• SSI recipients are eligible for AHCCC insurance immediately. SSD recipients become eligible for Medicare on their 25^th month of benefit receipt.

• Claimants are eligible for SSI benefits from the date of application. Any benefits due to the claimant from the date of application to the award are retroactive benefits. SSA pays back benefits in excess of $2901 in three installments. These installments are six months apart, and the claimant has nine months to spend the money before it counts as a resource for SSI monthly reporting. The first two payments cannot exceed $2,901 (three times the monthly amount). The third payment is the remainder.

• Claimants are eligible for SSD benefits up to 12 months prior to the application or from the date of onset if it is less than 12 months. Retroactive payments for SSD are a one lump sum. SSA requires a 5-month wait before SSD benefits begin. During these 5 months, the claimant may be eligible for SSI benefits.

• SSA can request food stamps or general assistance funds be repaid by the claimant from the retroactive benefits.

• SSA can deduct $330 a month from the SSI benefits if shelter is provided as a gift to the claimant. Claimants need to clearly communicate to the SSA DO personnel conducting the financial interview that all food and shelter is a debt and the claimant owes people for the food and shelter received.

• An incorrect calculation can be appealed with a letter requesting correction sent to the DO.

• SSI and SSD allow a trial work period that allows the claimant to return to work for a period of up to 9 months within a 60 month period and can continue to receive benefits. This allows the claimant to be free to try to return to work without a loss of benefits.

• SSI recipient’s earnings from work are offset from the SSI monthly benefits of $674. The claimant must keep SSA apprised of the monthly earnings.

• SSD recipient can perform work that is less than SGA and continue receiving SSD benefits. Work that is less than SGA must be less than SGA because of physical or mental limitations. If these earnings are self limited, SSA can determine the claimant is no longer disabled and benefits will be stopped.

• Going to school is not considered a return to work so long as this activity does not mimic work, such as sitting in class 8 hours a day for 5 days a week.

• Encourage the claimant to consult with the attorney about return to work.

• Enrolling in college or technical courses is not work so long as it does not mimic work, ie: attend classes 5 days a week for 8 hours a day.

• Refer to an attorney from T&A referral list. Refer to the free legal aid in their appropriate county.

• The deceased spouse must have worked the required credits (based on age) and died within 7 years of widow’s finding of disability. The widow must be 50 years old for DIB or 60 years old for retirement benefits. Younger widows can get benefits if caring for the deceased’s child. If the widow remarries before 50 years old or the marriage did not last more than nine months, the widow is not eligible for benefits under the deceased spouse.

• You need to know:

  • Date of deceased’s death

  • Length of marriage

  • Has widow remarried

  • Age of widow

  • Is widow disabled or requesting retirement

  • Is widow caring for deceased’s children

• Widow application is basically the same as other applications.

• The child must have a medically determinable diagnosis that impairs the child markedly in two domains.

• The parent must then qualify for SSI under the financial rules.

• Ask the parent how this child differs from other children of the same age, performance or discipline in school, and therapies the child uses (physical, occupational, speech, psychiatric, IEP, etc).

• Domains include:

  • Acquiring and using information;

  • Attending and completing tasks;

  • Interacting and relating with others;

  • Moving about and manipulating objects;

  • Caring for yourself; and,

  • Health and physical well-being.

    • (20 C.F.R. 416.926a)

• SGA can be either the ability to work 40 hours a week OR perform activities that earn at or above the SGA monthly limit.

• A claimant can work a lower paying job at part time, example 20 hours a week, and earn less than the SGA amount and still be found disabled if this less than 40 hour work week is the result of physical or mental limitations rather than a choice to work less than full time to collect benefits.

• A claimant may own a business and only work part time but the business is lucrative and the earnings are more than the SGA amount. In this case, the claimant is not working full time but because the earning are at or above SGA, the claimant will not be found disabled.

• A claimant may file for early retirement at age 62 while a disability case is pending in SSA system. When the claimant is found disabled, SSA will adjust the amounts and pay the claimant the difference. The claimant can get disability benefits until retirement age (65 or 67 years old).

• An individual already getting retirement benefits cannot apply for disability.

• Often a claimant that is disabled and therefore not able to work will be delinquent on child support payments. Often the ex-spouse owed the payments will threaten the claimant with incarceration for “deadbeat” payments. Encourage the ex-spouse to not press charges because if a claimant has an outstanding warrant, Social Security will not pay the claimant. The ex-spouse will not get any money in this catch-22 situation.

• Generally, if you enter a nursing home or hospital (or other medical facility) where Medicaid pays for more than half of the cost of your care, your SSI benefit is limited to $30 a month. Some States supplement this $30 benefit. We may lower the SSI benefit by any income you have.

• A special rule applies if you will be in the facility for 90 days or less. If you give us certain information, you may continue to receive your regular SSI benefit.

  • A doctor must state in writing that you will be in the facility for 90 consecutive days or less.

  • We also need a statement from you or someone knowledgeable about your circumstances that you need your SSI benefits to maintain your home or living arrangement while you are in the facility.

• We need these statements as soon as possible after you enter the facility. They must be submitted before you leave or by the 90th day you are there, whichever is earlier.