COBRA extention for disability

[Guest SaraR]

We have a former employee who had to resign due to health reasons. He is age 67. He is trying to obtain the necessary documentation to receive the extended time under COBRA that is allowed for someone who is disabled. The catch seems to be that the COBRA requirements state you must have a letter from Social Security Adminsitration declaring you to be disabled. Social Security Admin. has told him that since he is over age 65 they will not review his claim of disability because he is already receiving full social security benefits. Therefore, he can not get the letter he needs in order to receive this extention of time under COBRA.

He has asked our COBRA administrator if a letter from his doctor would be sufficient, but they are sticking to the point that the regs state it is a letter from SSA that is needed.

Has anyone ever run into this before? Is anyone aware of any case law or interpretations out there about this issue? I really appreciate any information that anyone can provide.

[Sandra Pearce]

The COBRA regulations specifically state that the QB must be determined disabled by the SSA under Title II or Title XVI. Here is what I found on the SSA's own web site regarding claims for disability benefits:

Q. Who can get disability benefits under Social Security?

A. Under the Social Security disability insurance program (title II of the Act), there are three basic categories of individuals who can qualify for benefits on the basis of disability:

- A disabled insured worker under 65.

- A person disabled since childhood (before age 22) who is a dependent of a deceased insured parent or a parent entitled to title II disability or retirement benefits.

- A disabled widow or widower, age 50-60 if the deceased spouse was insured under Social Security.

Under title XVI, or SSI, there are two basic categories under which a financially needy person can get payments on the basis of disability:

- An adult age 18 or over who is disabled.

- A child (under age 18) who is disabled.

Since the former employee does not qualify by virtue of disability for a determination from the SSA, I would say he does not qualify for the extension. I doubt that any insurance company would reduce the requirement for disability detemrination by SSA.

[Guest SaraR]

Personally I agree and have tried to tell employee this. They feel somehow there is age discrimination tied up in this. I have suggested she contact The Department of Labor to ask them directly if they can give any guidance.

Thanks for the information. It was such an unusual situation, I wondered if anyone else had seen it before!

[Guest b2kates]

I agree with Sandra Pearce. The employee "aged" out of qualifying for SSA disability. therefore not eligible for COBRA extension.

[MGB]

I presume the same problem can occur at the opposite end.

If you are not disability insured, the SSA will not make a determination. And, if you are not financially needy, SSI will not cover.

For example, during the 1990s I left the real world and went back to school for a PhD. Because I went so long without SS covered earnings, I lost my SS disability coverage. For the first couple of years back to work, I still was not covered by SS disability. If I had become disabled during that time, I presume COBRA would not have recognized it.