Qualifying for Social Security disability benefits.
Most people begin the claim process with doubts and trepidation about the outcome. There are numerous media reports that decry the programs failure to pay benefits to thousands of people in need. It is very important to understand that the disability program was designed to be a liberal program that is intended to provide benefits to people to disabled to work full-time.
SSA’s definition of disability only requires that the individual demonstrate an inability to perform full-time work (full-time work is referred to as “substantial gainful activity” in the definition). The individual only needs to show that the medical condition that prevents full-time work will do so for at least 12 months. The definition does not require permanent disability.
The problem with the program is not that the regulations are strict. The regulations and the courts support an individual right to benefits. (see http://www.examiner.com/examiner/x-13746-Tampa-Social-Security-Disability-Examiner~y2009m7d17-Regulations-and-the-Courts-Support-Social-Security-Disability-Eligibilty) The main obstacle to qualifying for benefits is the unwillingness of the decision-makers to give credence to the individual’s symptoms and limitations.
The strongest evidence of the impact of symptoms and limitations is provided by the claimant. The way this evidence is provided to SSA is primarily on forms completed by the individual. The other way this information get on record is through oral testimony by the claimant at a hearing. Review of the award rate on claims at the application level (the decision is based on written statements only) vs. at the hearing level (the decision includes consideration of oral testimony) shows that almost twice the number of cases get approved after an oral appearance.
It can be established by reviewing SSA’s statistics on the number of cases approved at the application and reconsideration levels. These statistics reveal only 38% are granted at the application level. Only 18% are approved on the Request for Reconsideration (Annual Statistical Report on the Social Security Disability Insurance Program). This same report establishes that over75% of the claims that were decided by an Administrative Law Judge were granted. Those individuals who pursue the claim to the hearing level by filing a Request for Hearing stand twice the chance of being approved for benefits than they did on the application. The reason for this may be very simple. The Administrative Law Judge is given the opportunity to see and speak to the claimant.
Most disability claims require that the decision-maker determine whether the medical condition can reasonably cause the symptoms that disable the individual. After all, it’s not the diagnosis that results in disability but the symptoms caused by the diagnosed condition. Everyone experiences symptoms differently. Some people have a higher tolerance for pain than others. The same x-ray evidence of damage may result in disability in one person and not another because of the individuals tolerance for pain. This requires that the decision-maker determine the symptoms that result from a medical condition as well as the severity of the symptoms. Since the decision-maker on the application and reconsideration do not have the benefit of personal observation, the decision may not be accurate.
The decision-maker on a claim for disability at the application and reconsideration level is a doctor employed by the Disability Determination Service. This doctor is charged with reviewing the medical records to determine if the claimant has a medical condition that would result in disabling symptoms and limitations. The fact of the matter is that the decision requires a judgment call by the doctor. The doctor, however, has not ever examined the claimant. The doctor never even met the claimant. The fact that twice the numbers of cases are approved after an oral hearing compared to written applications, shows the value of face-to-face disability determinations.
It may take up to 2 years to receive a hearing date on a Social Security disability claim. Regardless, the fact a hearing provides the best opportunity to state your case. Entitlement to benefits does not require total or permanent disability. It does require determination, patience and ,perhaps, a persuasive oral argument.