Proof Required for Disability Insurance
J. Greene


Q: I was forced to take an early retirement because the doctor said I could not work more than six hours a day and not sit for more than an hour at a time. Social Security Disability says I’m fine — but do they try and live with the pain in my arm that goes numb, or the minor neuropathy in my feet from diabetes, or back pain caused by cervical damage? I cannot comb or curl my hair and I can’t carry a cup of tea to the living room. I feel like I am going crazy.

A: The program you’re asking about is a national insurance policy for long-term disability. Also known as SSDI, Social Security Disability Insurance is available to people who have rung up enough work credits in the Social Security system (working about five years usually does it) and have been certified as disabled.

      By the way, don't confuse SSDI with SSI, which stands for Supplemental Security Income. It's a separate program run by the Social Security Administration and it pays monthly benefits to the elderly, the blind and people with disabilities who have low incomes and limited assets.
      The toughest part about qualifying for these programs is proving that you're truly disabled and unable to work, as this reader has found. In fact, two out of three people who apply for disability benefits are turned down. But there's an appeals process that ultimately ends in a hearing before an administrative law judge. Lots of people end up going through this, given the huge number of initial applications that are rejected. Just watch television during the daytime, when all the lawyers who help people deal with disability appeals advertise their services, to get an idea of how big this issue is.
      Technically, you don't need a representative to file an appeal, but if you choose one remember that he doesn't have to be a lawyer — he just needs to be familiar with the Social Security regulations. Also, be aware that federal rules limit the amount he can charge you for representation. Most representatives charge you a fee only if you win your appeal, and that fee is limited to 25 percent of your past-due benefits, up to a maximum of $4,000. It might seem that he's accepting a paltry sum if the fee is based only on retroactive payments, until you consider that most appeals take 15 to 18 months to complete.
      So how does the government decide whether you're really disabled? According to a Social Security handbook, "disability under Social Security is based on your inability to work. You will be considered disabled if you are unable to do any kind of work for which you are suited and your disability is expected to last for at least a year or to result in death."
      The program has a list of diseases and conditions that automatically qualify you for disability benefits. Otherwise, you'll have to document your inability to work with a doctor, who must be able to show the severity of your problem with objective data such as lab reports or X-rays.
      But it doesn’t end there. Next, you have to deal with the type of work you can or cannot do. Social Security will determine whether you have "residual functional capacity" to perform the kind of work you've done in the past. That means a vocational expert may be called to determine whether, despite your severe impairment, you can still do certain types of work in your previous career. So if you worked in a bookstore and picked up heavy boxes of books to restock shelves, you could show that a severe back injury precludes you from doing that kind of work. But if the government shows you can still work in the bookstore doing something else, like being a cashier, you can lose.
      Let's say the bureaucrats find that you still can't stand all day at the cash register. They still have the chance to reject your disability claim if they can prove that you can do some other type of work that is more sedentary. The government considers that kind of light work to be the ability to sit for a total of six hours in an eight-hour day, the ability to walk short distances, have one arm working and be able to lift, push or pull five to 10 pounds.
      If you win benefits, there's a waiting period of five months between the onset of the disability and the date your payments can start. For more related information, see the next reader's question.

Q: If you have been approved for Social Security Disability, aren’t you also entitled to Medicare coverage if you have no other health plan?

A: Yes, you are eligible for Medicare if you are on Social Security Disability, but only after you’ve been receiving benefits for two years.

      You can get a lot of basic information from the Social Security Administration's Web site for disability. Scroll down the page until you find a listing for Publications, and check out the one called "Disability: SSA Publ. No. 05-10029." You can download this 22-page booklet which explains the program in simple language. This Web page also offers you the section of the Social Security Handbook on disability, which is more complete but also more technical.
      You can also try some of the Web sites for attorneys or other organizations that will represent you in a disability appeal, if you wade past all the self-promotion. One particularly helpful Web site is run by Allsup Inc., a national company that helps with appeals. Check out the disability FAQs.


Social Security Return
Social Security Return