Who Gets Disability Benefits?
There is no secret formula about who gets benefits, but here are some myths exploded.
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From my perspective (a former Disability-Medicaid caseworker and a former disability claims examiner for the Social Security Administration), I don't find it surprising that individuals who file for disability are unsure as to who qualifies for disability and are a bit jaded about the Social Security. Here are three rumors that swirl around SSDI and SSI that don't help clarify things.
1) No one is approved for disability on the first application.
2) Good disability cases are denied.
3) People who probably shouldn't be awarded disability benefits are routinely approved.
Are these "myths" correct? I'll address them one by one.
1) In actuality, about three out of ten applicants for Social Security Disability or SSI disability benefits are approved on the first application, so the first part is not correct. (Of course, the flip-side to that equation is that 70% of all cases are initially denied, which is a discouraging statistic.)
2) There is no doubt that good cases are denied. As a disability examiner, I routinely saw solid disability claims get denied by agency supervisors who were obviously intent on controlling the number of approvals made by their subordinates (sad, but true, this really happens in the state agencies that render medical determinations for the Social Security Administration). In fact, as I've said for quite some time, the mere fact that so many claimant who are denied at the initial claim and reconsideration levels are are later approved at disability hearings substantiates the notion that the Social Security disability system is a little rotten at the core.
2) Regarding the third part, I can't really say that, as an examiner, I saw "bad cases" getting approved. In fact, it was usually quite the opposite. At the hearing level, however, that may be a bit different. Many disability representatives will be quite frank in admitting that when it comes to the differences in decisions made by one group of administrative law judges (within a single hearing office), there sometimes seems to be little rhyme nor reason. To some extent, that may also be a factor of subjectivity. Because the truth is, ten different individuals reading the same set of medical records may potentially come to ten different conclusions. Decision-making within the SSD and SSI programs is simply not as objective as the Social Security Administration would have us believe; rather, instead, the process is quite subjective.
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By: Tim Moore, former Social Security disability claims examiner