Establishing Medical Disability in Boston SSDI Cases

Establishing a medical disability with the U.S. Social Security Administration (SSA) is a lot harder for most than it should be.  This is mainly due to SSA lacking the budget to cover benefits to all valid claimants.  Congress continually forces SSA to operate on the verge of a fiscal cliff. SSA in turn denies many valid claims in a thinly-veiled attempt to get claimants to give up.  The situation has gotten so bad, it’s almost unheard of for an initial application to be approved. The exceptions are those who present evidence of one of a few terminal illnesses on the fast-track list. Even then, initial approvals are not a given.

Boston SSDI LawyerThe SSA also denies credible applications by issuing a very narrow definition of what it means to be disabled and finding anyone able to engage in substantial gainful activity not disabled.  Cost-conscious lawmakers have established “substantial gainful activity” to mean the ability to make a little more than $1100 in a any given month. This figure is not precise and it does fluctuate to reflect current economic realities. However, it is generally  far from what a disabled claimant in Boston needs to support his or her family.

Problems with How SSA Determines a Medical Disability

A recent article from the National Academies of Sciences, Engineering, and Medicine,  examines the process by which SSA determines whether someone is disabled. The first thing to note is it tends to be far more exclusionary than what claimant’s treating medical professionals assert in their “opinion of disability” letter submitted to the SSA with claimant’s initial application.

As our Boston Social Security Disability Insurance SSDI attorneys can explain, these dependencies in the SSA version of what it means to be disabled and what the medical community thinks it means to be disabled are creating a real problem. As noted in this recent report, the guidelines SSA uses have very little correlation to the following factors:

  • The need for inpatient admission to a hospital
  • The need for readmission to a hospital
  • Medical findings of disease severity
  • Medical opinion of a claimant’s ability to engage in substantial gainful activity

If this seems somewhat absurd, that these factors are not considered very relevant, or even relevant all to SSA, this is because the situation is absurd.  If a person is sick enough to be admitted to a hospital once they are seen by a doctor in the emergency department, there is a likelihood of severe illness. This is also true if a patient is released from medical care and then their respective condition worsens to the point where they must be readmitted to a hospital. With the cost of medical care these days, and problems with insurance, hospitals do not take admission decisions lightly.  There is a problem less people being admitted than actually have a medical need for admission due to financial constraints in the hospital industry not less.

This report was based upon what is known as a surveillance study.  This means researchers look at records and other data rather than speaking with patients directly during the course of their treatment in real time.  Essentially, they looked at medical records collected since 1965 and then compared them to records of those where were determined not to be disabled or determined to be disabled by SSA.

What they found is no correlation between these above-listed factors a decision made by SSA.  What we have is people who have been repeatedly hospitalized due to very serious medical conditions a long with doctor’s opinions they could work, followed by a finding of a non-medical professional at SSA determining claimant was able to work.

The way SSA makes its findings is normally by having an employee who has been trained as a vocational expert (VE), look at very old and not practical set of guidelines from the Dictionary of Occupational Titles (DOT) and see if there is a job in this guidebook claimant can work somewhere in the country.  They do not even talk about actual claimants since they are not qualified to do so they can only answer hypothetical questions about hypothetical claimants posed by an administrative law judge (ALJ).

Things Claimants Can Do To Increase Chances of SSDI or SSI Benefits Award in Boston

While we know the reason this problem exists, what we need to discuss is what a potential claimant can do to help increase the chances they will be found to be disabled and awarded Social Security Disability Insurance benefits. Not only are these claimants looking for a finding of disability, they would also like such a finding as early in the process as possible given that it takes over a year in most cases to be awarded benefits.

The most important thing a claimant can do is take make sure they retain an experienced Boston Social Security disability attorney as early in the process as possible.  This is true whether they are applying for Social Security Disability Insurance benefits or Supplemental Security Income (SSI).  SSDI is a program for disabled workers with an employment history who can no longer engage in substantial gainful activity and SSI is a program for disabled children and adults living in a low income household, and those who are blind and elderly who do not qualify for Social Security Old Age and Retirement benefits.

It is a sad reality many claimants do not retain an attorney and try to go it alone.  They mainly do this because they feel since they can’t work, they cannot afford an an experienced Boston SSI or SSDI lawyer.  This is not a concern they should have as claimants will not have to pay any costs or legal fees unless and until they receive a benefits award.

If you or a loved one is seeking Social Security Disability Insurance in Boston, call for a free and confidential appointment at (617) 777-7777.

Additional Resources:

Social security’s process for determining disability in adults, March 1, 2018, National Academies of Sciences, Engineering, and Medicine

More Blog Entries:

Boston SSDI Lawyers: In Defense of Social Security Disability Benefits, Feb. 24, 2018, Boston SSDI Lawyer Blog

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