Social Security Disability News

July 2010

Online Medicare Claims

The services available online at www.ssa.gov now includes Medicare applications.

A formal retirement claim remains a cross-application for Medicare, but workers with a full retirement age that is over 65 now must contact Social Security to enroll separately in Medicare if they wish to begin coverage as early as age 65. The new online application makes that process easier.

Enrolling in Medicare before retirement benefits begin also requires direct payment of the Part B premium. Medicare will either send a bill every three months or the worker can use Medicare Easy Pay as an electronic payment option: Medicare premiums are automatically deducted from either a savings or checking account, with no extra charge for the service. A Medicare-only application may be filed up to three months before attaining age 65.

Progress on Hearing Backlog

Pending cases at ODAR (Office of Disability Adjudication and Review) as of March 2010 totaled about 697,000, the lowest level since June 2005. Backlog reduction initiatives have caused a monthly drop since December 2008. The average processing time from hearing request to hearing decision has decreased to 442 days, down from a high of 514 days.

As noted in an agency press release: "Social Security has actively addressed the hearings backlog and increased the capacity to hold more hearings. The agency hired 147 Administrative Law Judges (ALJs) and over 1,000 support staff in FY 2009, and has plans to hire an additional 226 ALJs this year. The agency now has four National Hearing Centers to help process hearings by video conference for the most hard-hit areas of the country. The agency also has aggressive plans to open 14 new hearing offices and three satellite offices by the end of the year. The first of these offices was opened in Anchorage, Alaska on February 19, 2010."

Compassionate Allowance List Expanded

The Social Security Compassionate Allowance (CAL) initiative expedites disability decisions for specific medical conditions. While aimed primarily at the state agency disability determination services, the initiative applies at all levels of adjudication: a claim is to be fast-tracked whenever a designated condition is diagnosed.

The Social Security Administration recently added 38 new impairments to the initial list of 50 conditions warranting an expedited disability award. The most notable addition to the list is early onset Alzheimer's disease. If this condition is first diagnosed at the hearing level, for example, advocates can move for an immediate compassionate allowance on the record.

The agency CAL home page is www.ssa.gov/compassionateallowances.

Social Security Outlays Exceed Revenue

For the first time since the 1980s, Social Security benefits paid in 2010 will exceed payroll tax receipts. The economic downturn invalidated estimates that this tipping point would not be reached until 2016, prompting renewed interest in program changes to strengthen solvency.

The Social Security trust fund still shows a positive balance of some $2.5 trillion, measuring the difference between total tax receipts and total benefits paid since the program began. This surplus, invested in Treasury securities, would not be depleted until about 2037, even without the upcoming adjustments that are sure to be made. Those adjustments boil down to only three choices: raise taxes, lower benefits, or the highly unpopular "welfare" option of tapping general revenues for a bail out.

Migraine Headache Guidance

Migraine headache is usually a "rule out" diagnosis because there is a dearth of objective evidence and assessment is based primarily on subjective symptoms. The Social Security Administration has recently acknowledged that despite significant changes in the diagnosis and treatment of migraine headaches since that time, there is little change in the guidance provided.

Once other possible causes have been ruled out by laboratory findings, migraines can be established as a "medically determinable impairment" based on "signs" reported by a physician if accompanied by detailed descriptions of the headache event, which is defined as an "intense headache with more than moderate pain and with associated migraine characteristics and phenomena.".