Since it was established in the 1950s, the Social Security Disability Insurance program has provided benefits to ever-increasing numbers of people unable to work because of a disability. Even though millions of Americans now receive SSDI benefits, most initial claims for benefits are denied. Therefore, the assistance of a knowledgeable social security disability attorney is invaluable when seeking SSDI benefits.
Social Security Disability Insurance Benefits
Social Security Disability Insurance (SSDI) was introduced in 1956 as an expansion of the Social Security program. It was created to provide cash benefits to people with disabilities so severe that they are prevented them from working.
According to The Economist, original estimates put the number of expected SSDI benefit recipients at about 250,000 people. However, at the end of 1974, almost 4 million people were receiving SSDI benefits, and by August 2011, the number reached almost 10.5 million people.
People who have contributed sufficient amounts to the Social Security program through payroll taxes may be eligible for SSDI benefits if they become disabled and are unable to continue to work. Applicants must meet the Social Security Administration’s (SSA) definition of disability, which generally states that an individual is disabled if:
- The individual cannot do the work he or she previously did because of a disability
- The individual’s medical condition, as well as age, education and work history prevents him or her from adjusting to other work
- The individual’s disability has lasted one year, is expected to last one year or is expected to result in death
The SSA follows a five-step process when evaluating applicants’ claims for SSDI benefits:
- Step 1: Is the individual working? The threshold question is whether the individual is engaged in “substantial gainful activity,” which the SSA defines as average earnings of more than $1,000 a month in 2011. If so, his or her claim will be denied.
- Step 2: Is the individual’s medical condition severe? The individual’s disability must interfere with basic work-related activities for the SSA to continue its evaluation.
- Step 3: Does the individual’s medical condition meet or equal a listing of impairments? Social Security compares each condition to its own list of impairments. If any claimed medical condition meets, or is equal to the description of the impairment in the listing, an individual is considered disabled, if that person has also been out of work, or is expected to be out of work, at least one year
- Step 4: Can the individual do the work previously done? Some medical conditions are severe but do not prevent an individual from doing the same work he or she previously did. If the individual is capable of doing the same work as before, despite the disability, his or her claim will be denied.
- Step 5: Can the individual do any other work? Considering the applicant’s age, education, work experience and job skills, if the individual is capable of doing a different type of work, his or her claim will be denied.
Medical Evaluation
Central to the SSA’s determination of qualifying disability is a review of the individual’s medical records and an examination by a doctor. Many SSDI applicants see doctors called independent medical examiners who work for companies under contract with the government. Put simply, the independent medical examiner’s job is to provide an objective evaluation of whether an applicant is disabled.
In a story printed in Guernica magazine, a former SSDI independent medical examiner recounted her experience in the position and the special challenges she faced. Such doctors generally have 40 minutes to interview and examine SSDI applicants and then determine just how disabled they are.
These types of evaluations are particularly difficult for patients with disabling conditions such as mental illness, fibromyalgia and back pain that cannot be confirmed through concrete measures like lab tests or x-rays. In addition, the SSA is interested in knowing an applicant’s “residual functional capacity,” meaning the length of time he or she is capable doing activities like standing and reaching. However, such measures are difficult to extrapolate from a 40-minute meeting.
Statistics from Guernica show that, in 2005, about 64 percent of initial SSDI applications were denied. But, denials can be appealed, and many are reversed. An attorney can help SSDI applicants present the best case possible and can help ensure that examining doctors have the information they need to make accurate and informed evaluations, increasing the likelihood of a successful application.
If you are no longer able to work because of a serious medical condition, contact an attorney to discuss your options.
