As of March 17, 2020, all the Social Security Administration (SSA) field offices have been closed to the public in response to the growing COVID-19 pandemic according to its website.
Despite the field office closures, the SSA remains functional. Per the SSA’s website, these closures will have varying degrees of impact on the SSA’s activities, including the curtailment of processing of third-party requests to determine social security disability insurance (SSDI) status, which may impact certain cases workers’ compensation cases.
Regarding the SSDI aspect, as noted, the SSA is not currently providing social security disability insurance (SSDI) statuses to third parties, which has traditionally been a method used by parties to evaluate whether an individual has a reasonable expectation of Medicare enrollment within 30 months of a workers’ compensation settlement to determine if the settlement meets one of CMS’s Workers’ Compensation Medicare Set-Aside (WCMSA) review thresholds.[1]
While the SSA is not currently providing this information to third parties, there are other possible ways a claimant’s SSDI status could be noted. For example, the claimant can obtain a “Social Security Benefit Verification Letter” online through the SSA website and provide it to the workers’ compensation carrier. This letter provides information regarding the claimant’s SSDI, SSI, and Medicare benefits statuses. To access this information, a claimant simply needs to set up an account, log in, and download the information from the SSA. If verifying SSDI status is a key step in your WCMSA analysis or general Medicare secondary payer (MSP) compliance activities, this may be an option for the parties to use when trying to bring the claim to resolution at present.
Outside of the SSDI issue, these closures do not appear, at this time, to be significantly impacting the other SSA functions. For example, Social Security Benefits and Supplemental Security Income payments will continue to be paid monthly, and beneficiaries can still receive assistance with issues and questions via phone and online services.[2] Furthermore, to accommodate for travel restrictions and other issues caused by COVID-19, the SSA is extending deadlines whenever possible through their good cause policy.[3]
That’s not to say all services are available. According to its website, the SSA has triaged out certain aspects of its workload in favor of focusing on processing and providing needed benefits.[4] It is further indicated that the SSA has currently suspended medical continuing disability reviews, collection of overpayments, processing of Freedom of Information Act requests, conducting organization or individual representative payee accounting, and processing of non-appointed representative or representative payee third party information requests.[5]
As workers’ compensation claims handling continues to adjust to the issues created by the impact of COVID-19, ISO Claims Partners will continue to monitor developments impacting MSP compliance and provide relevant strategies to help keep claims moving.
If you have any questions, please contact the author at swong@verisk.com or 978-825-8262.
[1] Under CMS’s WCMSA review process, CMS recommends that a WCMSA arrangement be created and submitted for its review and approval when “[t]he claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability or lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.00.” WCMSA reference guide v. 3.0 October 10,2019 8.1 Review Thresholds.
In terms of “reasonable expectation,” CMS states that “[a] claimant has a reasonable expectation of Medicare enrollment within 30 months if any of the following apply: the claimant has applied for Social Security Disability Benefits; the claimant has been denied Social Security Disability Benefits but anticipates appealing that decision; the claimant is in the process of appealing and/or re-filing for Social Security Disability benefits; the claimant is 62 years and 6 months old, or the claimant has an End-Stage Renal Disease (ESRD) condition but does not yet qualify for Medicare based upon ESRD.” WCMSA reference guide v. 3.0 October 10,2019 8.1 Review Thresholds. To assist in determining a claimant’s social security disability (SSD) status, it is a common practice for workers’ compensation claims payers to have third parties, such as WCMSA vendor companies, request the claimant’s SSD status from the social security administration. As noted, the SSA has currently suspended responding to third-party requests for this information at present. However, as noted above, the claimant may obtain this information directly through the SSA website.
[2] https://www.ssa.gov/coronavirus/
[3] https://www.ssa.gov/coronavirus/
