The Social Security Act provides
financial benefits to qualified individuals who have suffered a physical or
mental disability. "Disability" is defined as the "inability to
engage in any substantially gainful activity by reason of any medically
determinable physical or mental impairment ... which has lasted or can be
expected to last for a continuous period of not less than 12 months" [42 U.S.C. Sec. 423(d)(1)(A)]. This comment
briefly outlines the process of obtaining Social Security disability benefits.
Always consult an experienced legal professional in Social Security disability
cases.
Successfully proving a disability
is the key barrier that claimants face. The U.S. Code states:
"An individual shall be
determined to be under a disability only if his physical or mental impairment
or impairments are of such severity that he is not only unable to do his
previous work but cannot, considering his age, education, and work experience,
engage in any other kind of substantial gainful work which exists in the
national economy, regardless of whether such work exists in the immediate area
in which he lives, or whether a specific job vacancy exists for him, or whether
he would be hired if he applied for work" [42 U.S.C. Sec.
423(d)(2)(A)].
There is a five step process for
determining if an individual is "disabled" as defined above:
1. The claimant must prove that she
is not currently engaged in substantial gainful activity.
2. The claimant must prove that she
has a severe mental or physical impairment(s) that significantly limits her
ability to perform basic work activities.
3. The claimant must meet the
definition of "disabled." Disability is presumed if one has certain
listed impairments. Otherwise, a residual functional capacity assessment is
conducted to determine the claimant's work environment limitations. This
concludes with a job exertion category classification.
4. The claimant must prove that her
impairment(s) prevent her from performing the physical and mental demands of
her previous work.
5. If the claimant has satisfied
all previous four steps, then to challenge the disability classification the
Social Security Commissioner must prove that the claimant is capable of
performing some other substantially gainful work that exists in significant job
numbers in the national economy. The claimant may rebut the Commissioner's
proof.
Procedurally, a Social Security
disability claim process begins with a filing either with an authorized state
agency or the Social Security Administration. A claimant may request a
reconsideration of a denial of benefits. Denial of benefits may be subsequently
appealed to an administrative law judge and beyond that step to the Appeals
Council of the Social Security Administration. After these steps, the
unsuccessful claimant may appeal to a federal District Court.
This court's review determines if
the Commissioner applied the proper legal standard and the Commissioner's
decision was supported by substantial evidence. Substantial evidence has been
defined to be relevant evidence that a reasonable mind might accept to support
a conclusion. The administrative law judge has broad discretion in determining
the merits of medical and other testimony. A treating physician's testimony is
not necessarily superior to that of a non-examining consultant.
In a January 9 decision, the
federal District Court for the Northern District of Illinois, Eastern Division,
in a sharply critical opinion, reversed and remanded an Administrative Law
Judge's denial of benefits for several reasons including using
"boilerplate" language that failed to link conclusions with evidence
in the record [Wilcox v. Colvin].
Additionally, the Court criticized the Administrative Law Judge's determination
of the claimant's credibility based solely upon medical evidence, the Judge's
failure to address limited concentration in the context of an unskilled job,
and a failure to adequately address the impact of the claimant's obesity.
The precise amount of benefits that
a successful disability claimant receives is calculated with a somewhat complex
formula. While private long-term disability insurance benefits typically do not
reduce Social Security disability benefits, government disability benefits such
as workers' compensation may reduce benefits in some circumstances.
Commentators have noted
inconsistencies between Social Security decision makers in our national legal
environment. This may be unavoidable, but further emphasizes the disability
claimant's frequent need for professional representation throughout the claim
process. This brief comment can only provide a brief educational outline of a
difficult topic. Consult the Social Security Administration and experienced
professionals in specific situations.
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