1) Introduction
The United States is a country which rests on a foundation of ideals. At the core of the nation’s foundation are very specific ideals such as freedom, independence, and morality. The government’s domestic policies are supposedly based on and designed to support such ideals. Unfortunately, what policies are designed to accomplish and what they actually accomplish are sometimes vastly different.
Americans regard themselves as a moral society. Part of this sense of morality is derived from the belief that our government assists in the care of those who are unable to care for themselves, including children, the elderly, and the disabled. But do our policies, which are funded directly by our taxes, really accomplish their goals? In the case of Social Security Disability Insurance (SSDI), the answer is a profound and categorical “No.”
2) History : What is Social Security Disability Insurance?
The Social Security Act of 1935 was originally written by President Roosevelt as part of his administration’s economic response to the Great Depression. As part of their plan to prevent another depression in the U.S., the plan included the use of payroll taxes to provide a kind of social insurance, providing citizens who found themselves unable to provide for their basic needs with a small source of income. In 1956, the Social Security program was deemed inadequate to respond to the needs of U.S. citizens, and congress added Disability benefits to the program.
Disability and other Social Security benefits, such as retirement income, are fully paid for by automatic payroll taxes. As anyone who has ever earned a U.S. paycheck knows, working citizens who earn a wage are required to submit a certain amount of their income to the U.S. government. A certain portion of those taxes go directly to providing Social Security benefits, including Disability benefits. The program, known as Social Security Disability Insurance, is designed to prevent workers who become medically disabled from falling into poverty. Workers are not able to “opt out” of the SSDI program; in other words, workers cannot refuse to pay that portion of their payroll taxes in return for waiving the disability insurance. Theoretically, all American workers who have paid enough into the Social Security system are enrolled in the SSDI program automatically, and are therefore covered in the event that they should become disabled.
3) SSDI Today: Theory versus Reality
As covered in the previous section, in theory all American workers who pay taxes are automatically insured against losing all income if they become disabled by Social Security Disability Insurance, an automatic deduction from every paycheck.
However, the reality of SSDI today is far removed from the theory behind its inception. Although all American workers who pay taxes pay into the SSDI system, many workers who become medically disabled find it nearly impossible to receive the benefits to which they are entitled. Citizens who have not worked, or have not paid taxes, are automatically disqualified from the program. Unfortunately, and often tragically, most workers who HAVE paid into the program and subsequently become disabled are also unable to receive benefits. Wherever those automatic taxes coming out of payroll checks are going, they do not seem to be going to the Social Security Disability Insurance program as advertised.
In theory, anyone who has become disabled after working and cannot maintain a 40-hour work week due to a medical disability is supposed to be eligible for Social Security Disability benefits. However, the reality is that most people who file for such benefits are denied, even if they meet the established criteria.
4) Why Receiving SSDI Benefits Is Difficult or Impossible
The current SSDI system is not a system of inclusion; it is full of obstacles and barriers which are designed to weed as many people as possible out of the disability system. If these obstacles were only to serve to prevent fraud, they would be understandable. The sad fact, however, is that they generally serve the greater purpose of providing benefits to as few applicants as possible. With the social security system somehow going bankrupt, the government is invested in denying benefits to as many people as it can.
Here are just some of the ways the system works against the disabled:
· Waiting periods – The process of submitting a claim for SSDI takes most people several years at minimum. In fact, a claim cannot even be submitted until the disabled person has been so ill or injured as to be unable to work for a minimum of one year – that means the earliest anyone ever sees a dime is nearly a year and a half… and to be honest, I’ve never personally known anyone to get approved that quickly. Many claims continue into multiple years – as many as 8 or more.
· No really, the waiting periods – Most claims admitted for SSDI (approximately 75%) are denied the first time through. No questions, no debates, denied the first time as a matter of (unofficial) policy. This occurs for two reasons. First, a large number of people will not have the knowledge or capacity to fight the denial, and will drop the claim all together. The second, and more insidious reason for the waiting periods, is that many claimants will die while their claim is in process, and therefore the claim will never have to be paid. This tells you what disabled claimants are truly up against. If they survive and persist, they can request a court hearing to challenge the denial. This process takes a minimum of another year, more likely up to two years depending on the region. When the court date finally arrives the claimant’s chances of approval vary greatly depending on which judge hears the case. While some judges seem reasonable, even compassionate, most do not; they are simply looking for any excuse to deny the claim. And with a stack of paperwork inches thick and years of history, they can usually find one reason, however small, which is all they need. Then the claimant can appeal the decision. This process has NO time limit. The appellate court can hold the claim in limbo for as many years as they see fit. Most claims take upwards of 3 – 5 years to reach a final decision, sometimes many more, regardless of how ill the claimant may be. (Remember that these claimants are experiencing debilitating illness or injuries the whole time – but they are supposed to stick with the red tape and claim process for YEARS on end, with no assistance whatsoever during the process). The sad fact is, most claimants cannot stick with the process, so most claims never have to be paid.
· Paperwork – The average amount of paperwork which a disabled person is required to fill out in order to process a claim (which can take up to five or more years) is so outrageous as to effectively exclude anyone who cannot routinely understand, organize, keep track of, and fill out multiple versions of governmental forms, which are in no way simplified for the disabled population. A typical disability file can be the thickness of an unedited dictionary. Keeping up with the file is the equivalent of a part-time job…and if the claimants could do that, they wouldn’t be applying in the first place.
· Due dates – People hoping to claim disability benefits must not only keep track of all the paperwork, but must be sure not to turn in any paperwork later than the date requested by the SSDI system. Any late paperwork is grounds for a denial. This includes paperwork from doctors, who are often too busy to complete one patient’s paperwork by the requested date. Due dates are also set for visits to caseworkers,phone calls, and SSDI doctor visits (more on that later).
· Transportation - Many people who are disabled face significant transportation barriers. Often they cannot drive themselves, so unless they can arrange and/or pay for transportation to the multiple required doctor and caseworker visits, they are out of luck. Some cities have special transportation programs for the disabled; the catch-22 is that one must already receive disability benefits to qualify. This puts the transportation burden entirely on the disabled person, or friends/family if there are any available to assist. Missing any of the required appointments is grounds for denial.
· Finances – Obviously, becoming disabled wreaks havoc on the wallet. Nevertheless, claimants are personally responsible for all medical costs involving their own doctors, fees for copying paperwork, costs of transportation to required appointments, etc. This is on top of what are often extensive medical fees for diagnosis and treatment.
· Medical care – the SSDI system is entirely financial. It does not in any way assist applicants with obtaining either medical care, or the medical documentation required to “win” a claim, which can also be extensive and expensive. It is in the applicant’s best interest to be under the close, detailed care of physicians and specialists. The less often an applicant is seen by a physician, the less likely the claim will be approved. However, the SSDI system does not acknowledge this bias and provides no assistance for obtaining the medical care and documentation needed to successfully process the claim.
· SSDI doctors – As part of the claim process, many claimants are required to be seen by doctors who work for the SSDI system. Not surprisingly, these doctors will almost always report that the patient is well enough to work. The appointments take about 5 minutes, and are all the SSDI system needs to deny a claim. Although the law states that judges must give the reports of treating physicians (who see the patient regularly and long-term) greater weight, the reality is that this rarely happens. SSDI essentially pays doctors to report that claimants are not disabled enough for benefits.
· Restrictions to activity – Engagement in any work (even occasional or part-time) is grounds for immediate dismissal of any SSDI claim. So despite the fact that a disabled applicant has an extra financial burden with the claim, even occasional work for a family member to help make ends meet can be enough to deny benefits. Although claimants can sometimes bypass this rule with what is known as an RTW, the fact is that any work activity puts applicants at risk for dismissal, and it is the SSDI system, not the applicant, who makes the final decision as to whether the work was acceptable or not. As with work, enrollment in any classes is grounds for dismissal. The result is that people who have lost work due to a disability cannot be re-trained, or take even basic classes (such as a writing or cooking class) to improve their quality of life, or find a potentially suitable occupation or new occasional work. The restrictions apply for the duration of the claim process, and are permanent for any person “fortunate” enough to have his or her claim approved.
· Lawyers can hurt as much as they help - Claimants may choose to have their claims represented by an attorney, but this in no way guarantees that they will be approved. While it is true that disability attorneys sometimes know how to sidestep the pitfalls of the process, they are only allowed to recover a finite amount of money with each claim. This means that the longer the claim goes on, the less percentage the attorney will recover. Disability attorneys are invested in accepting clients whose claims are most likely to be approved “quickly,” longer claims are less likely to be approved and provide financial compensation for the attorneys. The practical implication is that attorneys will actually pay less attention to more complicated claims – claims which most need their assistance.
· Systemic bias – Although the SSDI system does not acknowledge any bias, the reality is that systemic bias against certain categories of patients is a huge factor in the processing of any claim. First is age – it is a matter of formal policy that applicants over age 50 find some weight added to their claims. However, the simple truth is that the younger the claimant, the more difficult to get approved, despite the claimant’s medical condition. This might be fine if illness and injury only affected the elderly, but they do not. Become disabled at a younger age, you’re up a certain creek without a paddle. Also, women with children at home face sever bias in the SSDI system, as there is an unspoken belief that all female applicants with children are somehow going through this suffering and claim process just to afford to stay home. Believe me when I say, there are much easier ways to do that. The insinuation is ridiculous, but it affects applicants nevertheless, and there is nothing they can do about it. Perhaps counter-intuitively, applicants also face stronger bias the better educated they are. There seems to be a belief that people who are more well-educated shouldn’t need disability benefits, even though one has little to do with the other. Ironically (since the system is designed to prevent payouts) the one thing that SSDI does not consider is income. It is not supposed to be a financially based decision; theoretically, anyone fitting the definition of “disabled” should be able to claim benefits despite other income. But the reality is that even patients who have income from family members or elsewhere often find themselves drowning in debt due to the medical bills and other financial burdens resulting from the disability…and sadly, they often take their loved ones down with them. Despite how the system seems to work, disability is not a game, and most of the bankruptcies in the U.S. are caused by a family member’s medical debt. Now you know why.
Read more about the challenges of SSDI claims
