Social Security Disability Insurance (SSDI), which provides benefits for disabled workers, has seen a sharp increase in claims in recent years. In fact, there has been extraordinary growth of federal disability insurance, which is now estimated to cost $260 billion per year.
According to the Social Security Administration, the agency charged with determining whether or not a person qualifies for disability benefits, there are now approximately 8.9 million disabled American workers receiving SSDI benefits. This number has doubled since 1995.
There are two commonly offered explanations for this dramatic rise in disability numbers. One theory is that the downturn in the economy has played a large part in the substantial growth of SSDI benefit payments. This argument, however, is quite cynical and presents a rather unflattering view of disabled American workers and their health-care providers.
The theory assumes that because of the recession, workers are unable to find jobs and, as a result, simply choose to go on disability. This is demeaning to those applying for disability, as most of these claimants have worked hard and have simply reached the point where their injuries or physical/mental conditions make it impossible to continue.
This theory also implies that workers are simply substituting disability payments for unemployment benefits. This “conspiracy” would require that health-care providers be complicit in this scheme, because order to qualify for SSDI benefits, a person must have medial proof that a physical or mental disability has prohibited him or her from working for at least one year.
A more logical explanation for the increasing claims is simple demographics. As the Baby Boomer generation ages, they become prone to injury, especially those working in positions that require manual labor. Older people tend to get injured more easily and, as a result, many become disabled and file disability claims.
The bad news is that the system is currently at its peak in terms of the number of aging Baby Boomers in the system, but the good news is that many of these current beneficiaries will age into Social Security and Medicare and these numbers should shrink.
In spite of the fact that the number of claims received by the Social Security Administration has risen, the Social Security Administration has also been denying a record number of these disability claims at almost every stage of the process.
At the initial claim level, 67 percent of applications are rejected.
Rejected applicants at the initial level may request reconsideration, and of those reconsideration requests, 88 percent are denied. This is a crushing blow to those truly in need of this assistance for their survival.
If reconsideration is denied, a claimant may request a hearing before an Administrative Law Judge (ALJ). The national statistics for ALJs’ dispositions reflect that 52 percent of appeals are allowed, while 16 percent are dismissed and 32 percent are denied.
According www.disabilityjudges.com, the nine ALJs in the local Wilkes-Barre office deny benefits to an average of 61 percent of applicants whose cases they hear.
If the ALJ denies a claim, an applicant may appeal to the Appeals Council of the Social Security Administration, headquartered in Falls Church, Va.
Statistics from the Appeals Council are not promising to claimants. In 2012, there were 134,335 appeals from ALJ decisions filed nationally and 77 percent, or approximately 103,500, of those 2012 appeals were denied.
If the Appeals Council denies an appeal, a claimant has 60 day to file an appeal in a federal court.
Unfortunately, only 14 percent of cases denied by the Appeals Counsel filed an appeal to the federal courts last year. Appealing to the federal court typically yields a more favorable result for applicants, as about 45 percent of all cases appealed to federal court were reversed or remanded.
What remains to be seen is whether the number of claims drop with the uptick of the economy, as some suggest, or whether this is a demographic issue that will resolve with time.
Whatever the cause, it is critical that workers with legitimate claims properly document their injuries and ensure that their health-care providers do the same.
If you are one of the increasing numbers of claimants being denied Social Security Disability benefits, you should make every effort to exhaust the appeals process. Do not make the mistake of thinking that the Social Security Administration was correct to deny your claim and simply give up.