The Disability Benefits Process

The process of applying for disability benefits can be long and arduous. Each state’s Disability Determination Service (DDS) is charged with conducting the initial review and referral. The standards for determination vary from state to state. This lack of uniformity presents some significant problems for both agency employees and citizens. Obtaining disability benefits is subject to certain basic qualification requirements. First, the worker must have an established work history with a minimum number of employment periods based on age. Second, the length of the disability itself must be expected to last a minimum of twelve months. In some states, the DDS erroneously referred pregnant workers for Social Security Disability, despite the fact that the length of pregnancy would not meet the minimum time required. These flawed referrals, however, may be an attempt by a state to pass along its funding burden to the federal government. Third, and perhaps most important, the disability must be so severe as to eliminate employment in any occupation. Disability is not allowed if a worker can engage in any activity that can generate another source of income. For example, an airline pilot may no longer be able to fly a plane, but he/she may be able to obtain employment as a flight teacher. If this is the case, the ex-pilot does not meet the qualification for disability benefit approval.


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After meeting the initial criteria, an applicant is then referred to the federal Social Security Administration. Here the input from field workers becomes crucial. Observational data and any documentation of disability must accompany the application. The majority of SSA workers are conscientious in assisting in the completion of an application. They are unbiased in their assessment of the situation and attempt to present a fair and accurate statement of the disability. In certain cases, a physician’s input is required as well. These observations may influence the decision to allow or deny benefits. Mental illness presents perhaps the most challenging disability decision. Whereas physical disability may be temporary and treatable, in psychiatric cases, the expectation of improvement may be less certain. Moreover, the system is not exempt from fraud. In some cases, unscrupulous citizens have been known to collect undeserved benefits. Here the caseworker must balance the citizens’ service needs against other agency goals, including stewardship and fiscal responsibility.


An issue with the process becomes apparent after the initial application for benefits. Until recently, the only time review of decisions was allowed was after benefits were awarded. There was virtually no review for cases that resulted in denial of benefits. Given the constrained budget and political pressures, denial was therefore quite common for initial decisions, with the exception of the most obvious and compelling cases. Only recently has some review of the denial of benefits become a part of the decision-making process and even then on a sporadic basis.


When denial occurs, it is the function of the caseworker to inform the applicant. Not surprisingly, the denial is met with emotions such as anger, sorrow, frustration, confusion, and often feelings of being insulted. Caseworkers attempt to diffuse the denial message by informing the applicant of his/her right to appeal and providing educational material on the appeals process. However, the multistep appeals process is exhausting and frequently can take years for claims to be decided. In a few instances, appeals have even reached the U.S. Supreme Court. Unfortunately, applicants have sometimes died waiting for their claim to be decided.


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