THE REAL STORY ON SOCIAL SECURITY DISABILITY

"Background"

Unlike Social Security for those who can work but do not do so, Social Security Disability is for those who cannot work due to medical conditions. The primary difference between the two programs is that disability income is based upon a fraction of what the person's earnings were before they became disabled. Over the past decade, the standards for Social Security Disability have been made substantially more stringent. But because it pays more, the government fights like any litigant in a law suit - and then some.

"The figures on wrongful disallowance"

Sixty-four percent (64%) of Social Security claims are initially rejected by the Social Security Administration. Of the 64% who are denied, when it was still available 45% of applicants appeal. When there was Reconsideration 85% were still denied. However, of the 85% of claims which are denied at reconsideration, 61% go on to again appeal to an Administrative Law Judge for a trial and 55% of that 61% are held to be VALID disability claims! That trial with a lawyer in front of an independent law judge is the last good chance for a disabled person with a difficult case to win his/her case if the claim is valid.

"How does Social Security reject so many valid claim"

FIRST, the Social Security Administration as a matter of routine turns down legal Social Security Disability calims. Don't blame the employees, as the boss - the U. S. Government - requires them to apply a different set of evaluation standards than are required by the Law! As incredible as this sounds, this is uniformly done throughout the country in an effort to hold down costs. First, a high proportion of people who would qualify under the law do not qualify under the handbook which is distributed to Social Security Admnistration employees. Second, as the figures show, a substantial percentage of those people who qualify under the C.F.R. (the actual standards) do not bother to appeal due to lack of education, discouragement and the like.

SECOND, the Social Security Administration hires "professionals" to review the file - usually without seeing the injured worker - and who will usually "profess" what good shape the claimant is in. Often times, these doctors do not practice medicine or carry malpractice insurance as their sole source of income depends on their "independent consultant fees" which range from $500.00 to $1000.00 per hour. Personally, when we have to use outside professional medical or vocational help for claimants, I look for people who the law judges know to be honorable or consultants who the Compensation carriers or Social Security Administration no longer hire because they would not pull punches evn when their income was on the line.

The Real Standards

The process of Social Security evaluation is sequential. Your disability must have existed for one year or be reasonably expected to continue for in excess of one year and must prohibit you from doing any job in the national economy. Then you must qualify in one of three ways:

First way: There are certain defined illnesses that automatically will result in Social Security being granted at the law judge hearing level. Your lawyer can provide the doctor with the definitions and list of tests that are needed to support the doctor's opinion. As regards loss of the musculoskeletal system for the spine, for example, pain is certainly an important factor to consider but it must be associated with 28 different relevant abnormal signs and any relevant laboratory findings. For many conditions, lab tests must be ordered whether your doctor thinks they are necessary or not in order to substantiate his or her findings; this is not unreasonable if such tests exist. A simple statement that the patient is totally disabled because of damage to the spine, for example, won't do. All this is serious business and guessing games don't work. You need a doctor who takes time with the forms, believes in disability, and who doesn't try to show how well his or her surgery went when in fact you are suffering; someone has to read your doctor's reports to be sure they are sufficient. The most frequent problem I see is with estimates of lifting capability rather than nerve conduction studies to actually document the severity of the problem.

The second way to qualify: If you do not have a listed illness (many are not), you may still be eligible because your residual capacity to do work is impaired - you medically might not be able to perform a job in the national economy because of education, physical ability and the like. The test to determine whether or not this secondary type of analysis must be undertaken is called the "residual functional capacity" test or "grids" for short. Basically the grids are a series of employability tables. At age 51, for example, a person is in the "closely approaching advanced age" catagory. In that catagory a person would be disabled only if the claimant is a high school graduate without transferable education and without transferable skills and limited to a sedentary job. Each term has legal definitions. For example, sedentary work involves lifting no more than ten pounds at a time and occasionally lifting or carrying articles like files, ledgers, and small tools. In addition to being able to sit for several hours at a time, a sedentary job requires only an occasional amount of walking and standing. On the other hand, if it were the advanced age catagory such a person would be disabled if he or she were limited to "light work". Light work involves jobs which can be taught after a short period of demonstration or within 30 days. They do not require special skills or experience. Light work involves lifting no more than twenty pounds at a time with frequent lifting or carrying of objects up to ten pounds. At this stage of establishing your case, in addition to your doctor, your lawyer may have to turn to a vocational rehabilitation counselor to deal with issues your doctor is not comfortable with or qualified to answer. The grids are not substitute for professional evaluation of your individual case - my experience is that claimaints who fill out their own application often leave out critical information because they know that their doctor has said they are disabled; so the lawyer and rehab specialist are needed to go back and pick up the pieces and to be sure that the doctors rehabiltation expectations are not out ot line with the job market.

The Third Way: If the illness is not "listed" or the "grids" do not help, one has to examine "Actual Limitations" Sometimes there are certain environmental, manipulative, or other limitations - usually caused by multiple disorders - which could render a person disabled for Social Security Disability purposes even if he or she does not meet the "listing" or the "grids". If the doctor can show that grids do not apply because of "manipulative" or "posture limitations" which prevents the person from engaging in any substantial employment activity and prohibits them from engaging in any vocationally relevant past work, the person may be disqualified on that basis alone. I must warn you, however, that this last - fall back - analysis must be very clearly proved to be accepted. Hiring a vocational rehabilitation specialist is usually essential.

CONCLUSION

Do not become discouraged when you are initially turned down. Consider hiring a lawyer who practices this type of law. Be sure your doctor is not only willing and able to help you but will take the time to work with the lawyer to be sure that the legal requirements are addressed or referred to the vocationsl specialist. And remember that everything from the first application to the final decision must be carefully documented.

Conrad F. Cropsey, Briggs Bldg., Albion, NY