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Windfall Offset Provision

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Westlaw Citation Schena V. Sec'y

It was a mistake for ALJ to equate claimant's expressions of willingness to try to work with capacity to work. Claimant's decision not to have spinal surgery did not bar him from receiving SSDI benefits given surgery's uncertain and sometimes adverse consequences. Denial of social security disability benefits because of claimant's alleged willful refusal to follow "recommended" course of treatment erroneously disregarded language of regulation speaking in terms of willful failure to follow "prescribed" treatment. Assessment as to whether social security disability benefits claimant's refusal to undergo treatment is reasonable should be made in light of such variables as risks involved, likelihood of success, consequences of failure and availability of alternative treatment; and reasonable fear of painful or dangerous surgery may justify refusal of treatment. It was mistake on part of administrative law judge to equate claimant's expressions of willingness to try to work with capacity to work.

1/1/1980
Westlaw Citation Splude V. Apfel

Court will not recharacterize retroactive SSI as SSD in order to undo recoupment of state aid from retro SSI. Policies in favor of recoupment of state aid from SSI and recoupment of overpaid SSI from SSD are stronger than policy to protect SSD from assignments under §407(a) of the Social Security Act. Anomalous situation - where state aid is recouped if SSI retro is paid before SSD retro, but state aid is not recouped if SSD retro is paid first - does not render statutory scheme unconstitutional because it's rational. Social Security benefits, like SSDI, have been regarded in some contexts as "property" for constitutional purposes. But, Windfall Offset Provision (42 U.S.C. § 1320a-6(a)) does not violate anti-assignment clause and is not unconstitutional because it's rational. Anomalous situation - where state aid is recouped if retroactive SSI is paid before retroactive SSDI, but state aid is not recouped if SSDretro is paid first - does not render statutory scheme unconstitutional. There's no statutory or constitutional violation in provision allowing deduction from SSD retro to recoup overpayment of SSI retro. Provision should be read as an internal computation of how much SSI and SSD a person is due - whereby a prior overpayment of one benefit reduces the amount of the other benefit paid for the same time period.

1/1/1999
Westlaw Citation Tremblay V. Sec'y HHS

Although views of medical advisor are not always by themselves substantial evidence when medical advisor does not examine claimant, this rule is of limited value in a case involving a condition alleged to have existed many years before, and where claimant's proof of disability is slight. Conflict between evidence provided by the medical advisor and the treating physician is for Secretary to resolve. The principle enunciated in Browne is by no means an absolute rule. Findings of a non-testifying, non-examining physician by themselves, may constitute substantial evidence, in the face of a treating physician's conclusory statement of disability.

1/1/1982
Westlaw Citation Tremblay V. Sec'y HHS

Social Security benefits of claimant may be reduced upon receipt by claimant of disability pension under Civil Service Retirement System.

1/1/1996
Westlaw Citation Ward V. Comm'r of Soc. Sec.

Remand for legal error not required where there is independent legal ground for the decision (application of correct legal standard would lead to the same result). Where claimant received both Social Security retirement benefits and civil service pension, Windfall Elimination Provision 42 U.S.C. §415(a)(7), formula applied to reduce Social Security benefits. Applies to those eligible for periodic pension payments after 1985. Eligible means satisfies all the prerequisites for payment of pension.

1/1/2000


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