Preserving Benefits Critical to the Smith Family

Like many families of children with autism, the "Smiths" are struggling because their health insurance does not cover the cost of their child’s specialized therapy. The father is the sole income provider for the family of five, and he earns just $500 a week working at a Boston hotel.

His income is stretched to cover basic necessities like food, rent, utilities, transportation, and medical expenses. There is rarely anything left to pay for the therapy needed to treat their 10 year-old son, "John", who lives with autism and seizures. In order to pay for the treatment along with their basic necessities, the family had been receiving Supplemental Security Income (SSI) benefits for several years. The therapy had proven successful, as there had been notable progress in the development of John’s communication skills.

Unfortunately, in fall 2007, the Smiths received the first in a series of letters from the Social Security Administration (SSA) notifying them that they had received an overpayment of more than $13,000. They were shocked and confused. They stopped receiving their critical SSI check. As one might guess, that winter was very difficult for them. They fell behind on their rent and bills, and they could no longer afford the therapy that had proved so instrumental to John’s progress.

The Smiths were referred to GBLS through the Legal Advocacy and Resource Center. The GBLS Children’s Disability Project staff helped them file a waiver of overpayment. The staff discovered that SSA never properly processed the waiver. They then engaged in a persistent series of phone calls. Finally, GBLS advocates were able to schedule a meeting with the SSA claims representative.

With all the necessary documentation in hand, GBLS was able to demonstrate that the Smiths had complied with every regulation and that the overpayment was caused by a clerical error at SSA. GBLS staff discovered that the mistake dated back to 2003, and in fact the family was owed $1500 because they had been underpaid!

The Smiths family is now back on its feet. Once they started receiving SSI benefits again in May 2008, John resumed his crucial therapy. He is doing well and is involved in his school community.