Social Security Disability Insurance: Worth Fighting For

People know that money is deducted from their paychecks and sent to the federal government for Social Security, and most assume this means they will receive monthly retirement benefits in their golden years.

What many are not aware of is that the Social Security program is even a broader safety net than that cast by retirement benefits. The law provides for monthly disability insurance benefits for workers if they become disabled from working before retirement age. According to the Social Security Administration, or SSA, the chances of becoming disabled before retirement for a typical worker at the age of 20 are a surprising three in 10.

Eligibility

Social Security Disability Insurance - SSDI for short - will pay a monthly benefit to a disabled worker who meets its financial, work history and disability eligibility criteria. Regarding work history, basically a worker must have been employed relatively recently and over a certain number of historical calendar quarters. His or her condition must also fit within the SSA's legal definition of "disability." Some dependent family members of an eligible claimant may also qualify for payments through his or her SSDI account.

To be eligible for SSDI, an applicant must be disabled from working because of a "medical condition that is expected to last at least one year or result in death." While this sounds straightforward, the agency has had a fairly dismal record since the 1980s when it comes to accurately determining at the application stage whether people are indeed disabled according to the official definition.

Thankfully, several levels of appeal exist for review of an improper SSDI denial and the law provides for the payment of attorneys fees from past-due benefits in a successful case, or sometimes directly from the federal government if the agency took an unjustified position in the claim.

It is not unusual to be wrongly denied on the initial application, and a skilled attorney with specific SSDI experience can assist such a claimant. It can even be a good idea to have a lawyer for the initial application process.

Expedited Processing and Compassionate Allowances

The agency is also well known for slow processing, which is especially difficult for very sick claimants who have been without paychecks for a while. To help speed up the applications of those whose medical conditions are so serious they are obviously disabled from working, the agency has a couple of special procedures designed to speed up the approval process.

One of these is the Compassionate Allowance program, known as CAL, in which the agency targets applicants with particular medical conditions that can be objectively proven and that automatically qualify as disabling. Currently, the list of 113 CAL conditions includes a variety of diseases in categories like cancer, dementia, certain heart and brain conditions, and other rare, debilitating diseases.

On August 11, 2012, 52 more medical conditions will be added to the compassionate allowance list, mostly immune system and neurological problems, and additional cancers.

The Regular Track

For an applicant who does not qualify for expedited processing, the normal procedure is for his or her claim to be sent to the local Disability Determination Service, or DDS, the state agency with which SSA contracts to process applications. SSA and DDS have the duty to take all of an applicant's medical conditions into account in combination and to see that the medical record is sufficiently developed to make an informed decision.

This means that the DDS must gather the applicant's medical records and, if necessary, send him or her for further medical assessment if the medical evidence is insufficient. For example, a claimant may share with the agency that he or she not only has a debilitating physical impairment, but also suffers from significant depression and anxiety. If no medical evidence exists of the mental impairments, the agency should develop the record by referring that claimant to a mental health professional for evaluation.

This is another good reason for an applicant to have a knowledgeable lawyer working for him or her on an SSDI claim - to push for full development of the medical evidence so an accurate assessment of disability is possible from a complete evidentiary record.

The Five Steps

To decide if a claimant is disabled according to Social Security's definition, a five-step analysis is normally used by the agency:

  • First, is the claimant working and earning enough money to disqualify him or herself? If yes, the application is denied.
  • Second, is the claimant's medical condition severe, or does it "significantly limit the ability to do basic work activities" like "walking, sitting and remembering" for a year or more? If not, the application is denied.
  • Third, does the claimant's medical condition or combination of conditions meet or equal one on the SSA's List of Impairments that are so serious that they automatically qualify the applicant? If yes, then the application is approved.
  • Fourth, can the claimant return to his or her previous work? If yes, the application is denied.
  • Fifth, is there any other kind of available work the claimant can realistically do, considering his or her impairments, age, education, work experience and skills? If yes, the application may be denied.

If the SSDI application is turned down, several levels of review and appeal exist:

  • Reconsideration of the decision by the DDS
  • Hearing before an SSA administrative law judge
  • Review by the SSA Appeals Council
  • Appeal to the claimant's local U.S. district court
  • Appeal to the appropriate U.S. Court of Appeals
  • Appeal to the U.S. Supreme Court

The bottom line is that these claims are worth fighting for. The agency makes mistakes. Some disabling conditions can be hard to prove, but it is worth the time to do so. If you face an uphill battle in your SSDI claim, talk to an accomplished SSDI attorney early in the process.