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Medical disabilities have a way of becoming financial disasters. American rules and regulations are especially complex. Here is a brief guide for navigating the arcane process of getting on disability retirement in the USA.
Many people go through a very long process to get approved for disability. Rejection is common at every step of the process. The statistics are not encouraging.
- Every year over two million American workers apply for SSDI. In 2013, there were 2,327,840 applicants. The following numbers are from the 2013 statistics.
- Nearly one-third of applications (31 percent, or 714,778 of the 2,327,840 total) were rejected as incomplete before they were even considered by an examiner. This could be because medical records were missing, someone other than the disabled person filed the application without documented authority, the applicant had not worked long enough or paid enough quarters, the applicant had earned too much money during the application period and was found to have engaged in "substantial gainful employment," or there were simply errors in the application that the applicant did not correct after being asked.
- More than two-thirds of applications survive the first round of review and go to the "initial application stage." At this point an examiner looks at the record to determine whether the applicant can (or does) still work, how serious the disability is, whether the impairment meets the criteria of the Social Security Administration's List of Impairments, whether the applicant can still do his or her old job, and whether the applicant is, at the time the application is being examined, able to do a new job. Any one of these five factors can be disqualifying. Only 37.9 percent of applications are approved by Social Security Administration examiners. Of the rejected applicants, 48.2 percent request an appeal.
- The next step of appeal is to the applicant's state disability determination service. At this point, the only new information that can be presented is medical. State disability examiners only approve about 9 percent of applications on the basis of new medical evidence. They reject 91 percent.
- Only 18 percent of remaining applicants, just 77,359 disability seekers in 2013, take the next step and ask for a hearing before an administrative law judge (ALJ). The judge looks at the totality of the file and determines whether the law has been followed. A few judges notoriously accept 90 percent of claims. Others reject 90 percent of claims. Nationwide, about 35 percent of applicants are successful before the ALJ, usually when the Social Security Administration has made a series of legal errors or there is overwhelming medical evidence in the case. However, it is possible simply to get a "bad judge." In that case, the next step, by now usually two to four years after the initial application, is to file with the Appeals Council, a panel of judges who look at the whole case but usually only reverse a decision if the ALJ has made an error in interpreting the law.
- Only about 20 percent of cases reviewed by the Appeals Council, in a process that takes up to a year, are sent back to the ALJ with instructions to reverse an error, to grant disability payments. However, these claimants can go to the US Court of Appeals, if a matter of an error in the application of the law is not corrected by the Appeals Council. At this point, if there has been no error in the judge's understanding of the law, stated in terms of the law, the case will not even be heard. However, when the problem is a "bad judge" and the applicant has a lawyer and appeals to the Court of Appeals, the applicant wins about 80 perdent of the time. In 2013 just 62,986 people out of over two million initial applicants persisted this long.
Social Security benefits are not awarded at all if you die while your case is being decided. If it takes years to get a favorable decision, you still only get two years in back pay, and you don't get your SSI back pay all at once because the check would put your over the assets limit. SSI has to be spent within nine months or future payments are canceled on the grounds that you are too wealthy to receive them. There are no exceptions because the process is unfair.
However, if you are prepared, if you retain an attorney for a complicated case, you somehow survive long enough, and you persist with your claim, Social Security is there for you. It is simply very hard to collect.
- David A, Morton, III, M.D. The Nolo Guide to Getting and Keeping Your Social Security Disability Benefits. Nolo Press. 2014
- Photo courtesy of me and the sysop via Flickr: www.flickr.com/photos/pyxopotamus/2150043533
- Photo courtesy of AFGE via Flickr: www.flickr.com/photos/afge/15236306437
- Photo courtesy of Joe Gratz via Flickr: www.flickr.com/photos/joegratz/117048243
- Infographic by Steadyhealth
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