Proof Required for Disability Insurance
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 Im 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 cant carry a cup of tea to the living room. I feel
like I am going crazy.
A: The program youre 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.
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
Q: If you have been approved for
Social Security Disability, arent 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 youve been
receiving benefits for two years.
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
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 doesnt 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.
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