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Account Services Training Module 5: Awards Deep Dive

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Courtney Scott

on 18 June 2018

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Transcript of Account Services Training Module 5: Awards Deep Dive

Spousal Benefits
Evaluating Survivor vs. SSDI Benefits
Toll free number: (877) 261-1947
Facsimile: (877) 899-1345
Website: www.advocator.com

Warm Transfer Overview

A warm transfer is a three-way call between the RSL claims examiner, The Advocator Group, and the claimant.


The purpose of a warm transfer is to provide claimants with a smooth introduction to The Advocator Group’s SSDI representation services.

How long:

The average warm transfer takes less than 2 minutes to complete.

Awards by Level
Initial awards

Reconsideration awards

Hearing (Administrative Law Judge) awards
Awards Process:
Overview of events
1. Notification of Award
2. Initial Awards Call
3. Obtain Notice of Award
4. Summarize Award
5. Collect Payment Info
6. Dependent Filing
7. Offset Correction
8. Reimbursement Facilitation
Notification of Award
Notice of Decision (NOD) - Partially or Fully Favorable

Notice of Award

Attorney Fee
Entitlement date
Past-due benefits (PDBs) & related information
SSDI benefit amount(s), payment histories, and schedules of payment
Attorney fee information
Tax information
Appeal information
Time frame for when a client will be reviewed
Medicare (depending on entitlement)

What is on the Notice of Award?
Sample NOA:
Ongoing benefits
Closed Period vs. Ongoing Benefits
Closed period

There is a start date and end date to the disability and, as a result, payable benefits only for that time period.
Benefits are paid from when the client becomes entitled and going forward.
Must be validly married to the claimant.

Must be at least age 62 (permanent reduction before Full Retirement Age).

May not be entitled to a benefit on their own record which equals or exceeds 50% of the wage earner’s full benefit.

Benefit payment for Spousal benefits is typically 50% of the wage earner’s full benefit.

Benefit may be less if the family composition reaches the family maximum.

Dependent Interview
Dependents are listed on a claimant’s Initial Application.
After primary award is received, claimant must do a phone or in-person interview with the local SSA office (15-20 minutes).
Providing proof of relationship, schooling, etc.
Must be with the dependent’s primary caregiver or with the dependent themselves if they are age 18 or older.

Must meet the definition of a child by SSA regulations:
Natural, adopted, or legitimate child
Stepchildren and grandchildren may also be eligible

Must be under the age of 18, age 18-19 and still in high school, or disabled
Disabled children must meet Social Security disability standards
If approved, the benefits will continue for as long as the child is considered disabled (regardless of age)

The benefit payment for children:
Life Case: 50% of the wage earner’s full benefit
Death Case: 75% of the wage earner’s full benefit
Benefit may be less if the family composition reaches the family maximum

Dependent & Surviving
Child Benefits
Additional Benefits Available
Widow & Disabled Widow Benefits
Surviving Divorced Spouse Benefits
Mother & Father Benefits
Surviving Parent Benefits

Social Security will determine all benefits to which a claimant may be entitled.

It is imperative that SSA is aware of any marriages, divorces, etc., to accurately research all records.

It is often advantageous for the individual to file for whichever benefit is higher.

SSA representatives are required to determine the most advantageous benefit, as benefits such as Medicare become a factor.

Other Offsets
Workers’ Compensation
State Disability Insurance (CA, HI, IL, MN, NJ, NY, PR, RI)
Pension not covered by Social Security
Other Social Security benefits (SSI, SSER, SSR, Widows/Survivors, etc.)

2015 Reimbursement Facilitation Strategies
First half 2015 results:

EFT Sign Up Rate: 89%
Reimbursement Dollars Successfully Facilitated: 84%
Total Overpayment Dollars Successfully Facilitated: $3.8M
Average Overpayment Size: $14K

Reimbursement Facilitation
1. Maintain compliance with POMS
2. Focus on claimant education
3. Leveraging data and technology
4. Manage customer touch points and use common language
Reimbursement agreements
Client letters & calculation summaries
Account Services Executive

Account Services Associate

Contact Information
Sample RSL Data - Can be customized for each carrier.
Awards Overview
Closed vs. Open Period Benefits
Spousal & Dependent Benefits
Other Offsets
Reimbursement Facilitation Initiatives
Reimbursement Metrics
Three Key Takeaways
Sample RSL Data - Can be customized for each carrier.
1. The awards process can be complex!

2. SSA works to determine the most appropriate benefits for claimants and dependents based on their individual records.

3. The Advocator Group works with claimants to ensure that they understand their reimbursement obligation, then facilitates the transfer of those funds back to [CARRIER NAME].
Reimbursement Facilitation
Awards Deep Dive
Full transcript