Social Security Administration Disability Benefits
The Social Security Administration test of disability is An inability to perform any substantial gainful activity because of a medically determinable physical or mental impairment which can be expected to last for a continuous period of not less than 12 months. (1) In Social Security terms, substantial gainful activity means work that (a) involves doing significant and productive physical or mental duties; and (b) is done (or intended) for pay or profit. (1) A person is ineligible to receive Social Security disability benefits if he or she: Is working (except in a sheltered setting), even though chronically ill, At present has the statutory ability and capacity to work, Recovered within 12 months of the onset of a disabling illness, Has no medically determinable impairment (except for one of the somatoform disorders, which are considered under a separate set of rules) (2).
Physicians should advise every patient of the option to file for Social Security disability benefits when that patient has not been able to work because of illness for 12 consecutive months. Indeed, an application may be filed as soon as it appears that the duration of disability will exceed 12 consecutive months. Often such a prognosis may be made within 6 months of disease onset, and at that time the filing process for Social Security disability benefits should commence. A person who has worked and paid Social Security taxes applies for Social Security Disability Insurance (Title II), and a person of limited income and resources receives disability benefits through Supplemental Security Income (Title XVI). Claims for Social Security disability benefits are made at the local Social Security District Office, either in person or by telephone (800-772-1213). Initial filing - which asks about the nature of the disease, name of the physician, and vocational background - is made by the claimant; physicians and attorneys are not involved at this time. It is the filing of a claim that alerts the government to a person's inability to work.
Once the initial claim is filed, the Social Security Administration gathers by separate inquiry three types of information: Medical - initial description of medical condition, including capacity for lifting, walking, sitting, and standing (3), Vocational - description of past work; date last worked, Administrative - proof of citizenship and, possibly, insurance status, A response by the Social Security Administration may take as long as 6 to 8 months. The application will be analyzed by both a nonphysician and a physician who review medical and vocational issues for the Social Security Disability Determination Services, a state agency that works under a contract to the Social Security Administration. (4) The physician-reviewer is usually not a practicing clinician and may have had no training or experience in the medical field under discussion.
Initial applications for disability benefits are routinely denied, and your patient should be prepared for initial denial. The language used by the Social Security Administration is consistent regardless of the details of the particular case, with no flexibility for individual situations. The denial usually observes that the claimant appears to be able to move hands and arms and to stand, but leaves open the possibility of reapplication if the patient's condition worsens.