The Social Security Disability Insurance (SSDI) program pays benefits to adults who have a disability that began before they reached twenty-two years of age. The Social Security Administration (SSA) considers the SSDI benefit as a "child's" benefit because it is paid on a parent's Social Security earnings record. In order for a disabled adult to be entitled to this "child" benefit, one of his or her parents must be receiving Social Security retirement or disability benefits; or must have died and have worked long enough under Social Security. Disability benefits are also payable to an adult who received dependents benefits on a parent's Social Security earnings record prior to age 18, if he or she is disabled at age 18. The disability decision is made using the disability rules for adults.
In 2008, the SSA provided disability benefits to over 10.6 million people aged 18-64 and more than 61 percent (6.6 million) received benefits from the SSDI program alone. The breakdown of enrollment for SSDI is as follows: 6,115,214 people receiving benefits were workers, 82,100 were widowers, and 444,504 were adult children. The average monthly benefits received for workers was $1,149.80, 991.10 for widowers and 860.60 for adult children. The Social Security Administration will release an updated benefits report in July 2010.
Social Security pays benefits to people who cannot work because they have a medical condition that is expected to last at least one year or result in death. The very strict definition of disability is a requirement by the Federal government. While some programs give money to people with partial disability or short-term disability, Social Security does not. In general, to be eligible for disability benefits, you must meet two different earnings tests: a "recent work" test based on age at the time disability was acquired; and a "duration of work" test to show that person with disability worked long enough under Social Security. Certain blind workers have to meet only the "duration of work" test.
Listed below are the rules for how much work is needed for the "recent work" test based on age and onset of disability. First, if disability occurs in or before the quarter a person with disability turns age 24 then one and a half years of work during the three-year period ending the quarter the disability began is needed. Second, if disability occurs in the quarter after turning age 24 need to work during half the time for the period beginning with the quarter after the person with disability turned 21 and ending with the quarter when became disabled. For example, if disability occurs in the quarter when the person with disability turned age 27, then that person would need three years of work out of the six-year period ending with the quarter when disability was acquired. Finally, if disability occurs in the quarter when turning age 31 or later then need to work during five years out of the ten year period ending with the quarter disability was acquired. The rules are based on the calendar quarter in which the person with disability turned or will turn a certain age. Provided are a few examples of work needed for the "duration of work" test if acquiring a disability at various ages: Disability before age 28 generally need 1.5 years of work, disability at age 34 then generally need 3 years of work, etc. An exhaustive list can be found on the Social Security Administration website. The calendar quarters are as follows: First Quarter: January 1 through March 31; Second Quarter: April 1 through June 30; Third Quarter: July 1 through September 30; Fourth Quarter: October 1 through December 31.
After receiving disability benefits for twenty-four months, Medicare eligibility is available. Persons with disabilities will get information about Medicare several months before coverage starts. However, if diagnosed permanent kidney failure requiring regular dialysis or a transplant or diagnosed with amyotrophic lateral sclerosis (Lou Gehrig's disease), may qualify for Medicare almost immediately. If the person receives Medicare and has low income and few resources, the state may pay Medicare premiums and, in some cases, other "out-of-pocket" medical expenses such as deductibles and coinsurance. Only the person with a disability's state can decide if they qualify. To find out if an individual qualifies, contact the particular state or local welfare office or Medicaid agency. Food stamps are available to people with disabilities and an application and information can be found at any Social Security office. Another option is to contact the SSA and ask for food stamps and other nutrition programs or food stamp facts. Medicaid is a health care program for people with low incomes and limited resources. In most states, children who get SSI payments qualify for Medicaid. In many states, Medicaid comes automatically with SSI eligibility. In other states, it is required to sign up. Also, some children can get Medicaid coverage even if they do not qualify for SSI. The individual should check with the local Social Security office, state Medicaid agency, or state or county social services office for further information regarding this subject.
An administrative law judge is comparable to a trial judge; consequently they can take oaths, hear testimony, and make decisions regarding an individual's entitlement to disability, whether from the social security disability or Supplemental Security Income (SSI) disability program. If a person with a disability makes it as far as the hearings level of the Social Security disability process, then an administrative law judge will be the one to determine if they are considered disabled under the rules and guidelines of the Social Security Administration.
The administrative law judge reviews all the evidence in the file, an average of around 400 pages, and many of them administrative pages, then requests the staff obtain such additional medical evidence as may be needed. When fully developed the judge then needs to determine whether a favorable decision can be made on the record presented, without a hearing. In most cases a hearing is required and the judge then determines what expert witnesses will be required for the hearing. After this review, the staff secures the expert witnesses and schedules the case for hearing. Once the hearing is scheduled, the judge continues to be involved with the case to review newly submitted evidence and to consider and resolve prehearing motions and issues. Typically, a day or two before the hearing, the judge will conduct another review of the file to insure familiarity with the facts and issues for the hearing. When the hearing is concluded the judge must prepare thorough decisional instructions for the writing staff, review and edit the draft decision and sign the decision. (Bernoski, 2009).
A pressure that is faced as an administrative law judge is the issue of back logging. According to Merriam-Webster online, back log occurs when there is "an accumulation of tasks unperformed or materials not processed". This has become an imperative issue within the Social Security Administration specifically regarding SSDI. In recent years, SSA's backlog of claims for SSDI and SSI disability benefits has reached unprecedented levels, with more than 1.3 million Americans currently awaiting a decision on their case. The problem is particularly severe at the hearings level, where the backlog has more than doubled since 2000-from about 310,000 to more than 765,000-and the average waiting time is now almost 500 days. These backlogs have resulted from years of underfunding as SSA's workload increased due to the aging of the population and additional responsibilities given to the agency. Resource shortages have also led to service delivery declines in other areas. SSA has significantly cut back on program integrity activities such as continuing disability reviews and SSI redeterminations, even though these activities have been demonstrated to generate considerable savings, as much as $10 in program costs for every $1 in administrative expenditures. In addition, service to the public has declined in SSA's field offices, as noted in a January 2009 report from the Government Accountability Office (GAO), and the backlog problem is of such severity that GAO included it in its biennial ''high risk'' list of federal programs. In the past two years, Congress has provided additional funding to begin to address these problems, and SSA has begun to implement a plan to eliminate the hearings level backlog by 2013. However, the agency continues to face new challenges. Disability and retirement claims are increasing due to the economic downturn in combination with demographic changes. From fiscal year 2008 to fiscal year 2009, initial disability claims are projected to increase by more than 12 percent and retirement claims by more than 8 percent, and both are expected to increase even further in fiscal year 2010 and fiscal year 2011 (http://www.docstoc.com/docs/20111687/ELIMINATING-THE-SOCIAL-SECURITY-DISABILITY-BACKLOG----House-Congressional-Report-111th-Congress-2009). The SSA has made decreasing the backlog problem the highest priority. In fiscal year 2009, SSA reduced the pending level nine consecutive months and ended the year with nearly 38,000 fewer pending dispositions. Also, all of the oldest cases were virtually eliminated and the average time it took to process a request for hearing was reduced (http://www.socialsecurity.gov/appeals/congressional-booklets.html). Finally, to continue fighting the back log issue the SSA has used teleconferences and other innovations to speed things up. Furthermore, Congress came through with money to hire 7,000 employees.
One individual that has been affected by the back log problem directly is David Richards. Last year, Richards had routine blood work done and he was told to go to the hospital as there was a serious problem with the results. "I needed a blood transfusion," he says. "Between June 13th and probably around June 16th, I had around eight of them." With all of these health issues and bills to pay for Richards speaks of elevated blood pressure and decreased mood. Due to his diagnosis of Stage 3 colon cancer he has been receiving treatment and has not worked in over a year. To add to the stress, Richards has been awaiting disability benefits that would pay him approximately $1,000 a month. The wait that one can endure during the disability benefits process can take a year or more and by that time some may have lost homes, or even passed away. When Richards applied for benefits a year ago, he was denied and he appealed which was also denied. "Everything was over the phone," he says. "I just filed the paperwork and mailed it back to them. I never once [saw] anybody in person." Richards finally decided to hire a lawyer who requested a hearing in front of a judge. To get a hearing in front of a judge in Pennsylvania, where Richards is from, could take approximately 437 days. Without disability benefits, Richards survives on $400 a month in welfare and food stamps. He is also months behind on his rent. The Social Security office where Richards lives recently hired five new judges. Richards finally got a hearing with one of the new judges on Oct. 1, 15 months after he stopped working (http://www.npr.org/templates/story/story.php?storyId=112397747).
The backlog issue can cause many struggles for people dealing with it. As Richards mentioned it let him to worry and have elevated blood pressed which can lead to an overall poorer quality of life while waiting to receive SSDI benefits. Rosenhack and colleagues (2000) conducted a study examining the relationship between receiving disability payments and changes in health status, community adjustment, and subjective quality of life. Results showed that three months after the initial approval of SSDI, beneficiaries had significantly higher total incomes and reported a higher quality of life. Improved quality of life in these people led them to feel more satisfied with their lives and spent money on necessities such as housing, food, and transportation. Though this is just one study and may not be able to be generalized across all disability populations it shows the importance that the people who need SSDI receive it.
Though many people have not received the SSDI they need, the SSA is working towards eliminating the back log problem and preventing its reoccurrence through a four-pronged plan, (1) compassionate allowances; (2) improving performance; (3) increasing adjudicatory capacity; and, (4) increasing efficiency with automation and business processes. The most aggressive timeline for eliminating the backlog is 2012, and the agency is committed to allocating as many of its resources as possible to achieve this goal. At the moment, the agency has approximately 1,082 administrative law judges at SSA leaving the backlog at almost 350,000 cases. Though the SSA is working as hard as they can to eliminate this issue, if the budget does not permit to do more than attrition hiring of both administrative law judges and certain staff, the pending workload will approach one million cases by 2013 (http://www.ssa.gov/legislation/testimony_052307_addendum.htm). Thus, leaving more and more people like Dale Richards with only piles of unpaid bills and an increased amount of worry.
