Disability Services & Legal Center Basic Orientation for Benefits Counseling

Disability Programs SECTION 2

Disability Programs: 5 types

Private employer based disability programs, such as Unum or Matrix. Grandfathered Programs: Prior to 1983 Federal employees DID NOT pay into Social Security All fed employees hired after 1983 pay into Social Security Railroad Retirement (AMTRAK) DOES NOT pay into Social Security Workers Compensation for job related injuries. State of California State Disability Insurance (SDI) – temporary. Social Security Disability Programs:  Social Security Disability Insurance (SSDI)  Supplemental Security Income (SSI)

Grandfathered Disability Programs Since 1983, almost all groups in the United States contribute to the Social Security system. Before 1983, members of Congress, the President and Vice President, the Supreme Court and all federal employees were exempt from Social Security taxes and benefits. Currently, the only prominent groups that do not participate in the Social Security system are: Railroad workers (AMTRAK), covered by the Railroad Retirement Board, an independent agency of the U.S. government Religious personnel in some faith based organizations. Police & Firefighters State and local government employees with their own retirement and disability systems.

Grandfathered Disability Programs Federal Employee Although all federal employees hired since Jan. 1, 1984, pay into the Social Security system, those hired before that date can still be covered by the Civil Service Retirement System, created in 1920, before the current Social Security system existed. The 1983 law mandating Social Security coverage for federal employees allowed this group to make a one-time choice to stay in the Civil Service Retirement System or move to Social Security. The law also mandated that those federal employees originally hired before Jan. 1, 1984 and left government service and were later rehired must participate in the Social Security system.

Grandfathered Disability Programs Railroad (AMTRAK) Employee Created in 1935, as was Social Security, the Railroad Retirement Board is dedicated only to serving U.S. railroad employees for social insurance programs. Along with retirement benefits, the Railroad Retirement Board offers survivor benefits, unemployment, sickness and disability payments for railroad employees and their families. Although an independent federal agency, the Railroad Retirement Board does have some administrative duties within the Social Security Act for some benefit money and interfaces with Social Security to administer retired railroad employees' Medicare insurance.

Grandfathered Disability Programs State & Local Employee Many state and local government employees still do not pay into Social Security. These groups are covered by other retirement plans. For example, teachers and educators in Texas are covered by the Texas Retirement System, but can also access some Social Security benefits. They are subject to the Government Pension Offset, which reduces some Social Security benefits they otherwise could collect. Spousal and widow or widower benefits are also restricted. Almost one-quarter of the nation's state and local government employees remain exempt from Social Security.

Grandfathered Disability Programs Police & Firefighters Some state or local police personnel and firefighters are exempt from Social Security, having retirement pensions funded -- sometimes insufficiently funded -- by the states, cities, towns or counties for which they work. Some states, such as Rhode Island, have encountered financial problems with their self-insured retirement systems because of unfunded liabilities and pension fund losses. Those states that have funding problems cannot easily join the Social Security system. Making lump sum payments for new Social Security members is a challenge some local governments cannot meet.

Grandfathered Disability Programs Clergy & Religious Orders Members of the clergy and religious orders not taking a vow of poverty can elect to participate or not participate in Social Security benefits. Even after the 1984 regulations were enacted, churches and church-related organizations can still elect not to include their employees in Social Security coverage.

Where does disability check come from? Consumers do not know - Most of the time, consumers do not know the source of their disability payments. Clues - Checking bank statements or the disability check stub can give clues about the type of disability program. Frequency - Some programs give one check per month and other programs pay every 2 weeks. Adding the clues up - Knowing the monthly payment amount, how many payments/month, & when they are paid can give clues about the type of program.

Why is it SO important to know about all these disability programs?

Why it’s important to know which Disability Program(s) Eligibility Criteria - Each of these disability programs has different medical and non-medical eligibility criteria that the client must meet. Rules - Each program has rules detailing how going back to work will affect disability benefits. Dual eligible - Occasionally, clients can be receiving benefits from two or more programs. Work & disability - There is often a delay between going back to work and having your disability benefits reduced. Sometimes it can be years, which can result in large overpayments.

Private Employer Based Programs

Coverage - Private Employer based disability programs can cover temporary disability, permanent disability, or both. Proprietary Information - Only the company that purchases and provides this disability benefit program has access to program information, including medical eligibility & appeals process information. The person receiving the disability benefit does not have access to program information. NO DSLC Assistance – Sadly, DSLC is rarely able to assist individuals in these programs as there is no access to information on the benefit package or appeal process.

Workers Compensation (WC)

 WC is a moving picture – it is is constantly being modified.  Some changes apply to all claims while other changes only apply to new claims with older claims being grandfathered.  3 Groups - Typically there are three groupings.  1 st group – Returning to the same job (broken leg, pregnancy).  2 nd group – Not returning to the same job and will need a rehabilitation program to retrain for another job.  3 rd group – Never returning to work and will receive a settlement.  WC payments - Clients can be offered monthly maintenance payments, medical insurance coverage payments, and/or lump sum settlements.

Worker Compensation WARNING: Workers Comp AFFECTS SDI, SSDI & SSI!

WARNING: Workers Comp AFFECTS SDI, SSDI & SSI!  NO Double Dipping - Any WC monthly payments or lump sums that cover the the same disability time period will affect a person’s SDI, SSDI, or SSI. ♦ Example: Lazarus gets $300.00/month from WC. His SSDI amount is reduced by $ each month.  WC = NO Change! Some WC settlements do not affect SDI, SSDI, or SSI! ♦ Example: medical insurance coverage does not affect SDI. It does affect SSDI or SSI in that the WC medical coverage is primary and Medicare or Medi-Cal is secondary.