Tuesday, November 24, 2009

SSI versus SSD

Posted by Sylvius Von Saucken

How can I determine if client is receiving SSD as opposed to SSI?
Client injured in MVA. I have conditional payment info from MSPRC. Emergency room registration info lists “primary insurance” as “Medicare” and “secondary insurance” as “Medicaid,” (I don’t know if this information was given by client or already in computer from prior visits). Client is not reliable source as to what benefits he had been receiving. I want to make sure if and when case settles that only obligation is to reimburse MSPRC. I don’t want to make client ineligible for SSI (if he’s really getting those benefits) and I want to protect myself too from any issues if I distribute money to client.

Any help is appreciated. Would client’s Medicare card (or some other card) give the answer?

Ohio Attorney

This is a fact pattern we are seeing with greater regularity. The “dual-entitled” beneficiary whose settlement conjures up both a Medicaid lien under Rev. Code §5101.58 and a potential Medicare claim under 42 U.S.C. §1395y(b)(2) brings up additional considerations to settle. Typically, because Medicare does not pay for all of a disabled person’s (if not over age 65) medical expenses, if that person’s income and countable resources are less than threshold levels, he/she would also apply for Medicaid (to pay co-pays not covered by Medicare; to pay for long-term care after the first 100 days of hospitalization, etc.)

First, if your client has Medicare (red, white and blue card), and is under age 65, he/she could only use Medicare if he/she received SSDI for at least 24 consecutive months and had an established work history prior to becoming disabled. Medicaid, on the other hand, would be based on medical and financial need (rather than work history).

Second, the type of Medicaid program in which your client is enrolled will be relevant to crafting an appropriate benefit preservation plan, if needed.

Third, because SSI is based on financial need and there is a maximum benefit to be paid out, often once you know how much “Social Security” your client receives, and IF your client has a prior work history, you can better identify whether the benefit is SSI or SSDI.

The good news – our sister company has a government benefit preservation program: www.tglflaw.com. The process involves not taking your client’s word for it, as our paralegals verify actual benefits with your client’s case workers, and then provide a report, depending on the scope of our engagement. Our firm’s fees are always based on flat fees, and we offer consulting and full benefit preservation planning, with the understanding that our fee will always be commensurate with a client’s net recovery (so our services are truly value-added and education-oriented).

The really good news – with a formalized process to “verify and resolve” conditional payment reimbursement obligations to address “recovery” issues, you can have a better idea how much is left to preserve and then provide your client with information designed to help the client make informed decisions intended to integrate settlement goals with benefit preservation (to handle the “eligibility” side of the two-sided benefit coin).

Our best,
Sylvius von Saucken