Q: You recently wrote a column in which you said it is very difficult to qualify for Social Security disability benefits. I think just the opposite is true. It is so easy to get on the government disability dole. After all, you see so many commercials on TV from lawyers who tell people that they can get anyone on Social Security disability. They must somehow be in cahoots with the government. I'll bet they have their own doctors who automatically get people enrolled in the program. Isn't that a big scam?
A: No, it's not a big scam. And you are missing the point if you think the fact that many law firms specialize in Social Security disability law proves that I was wrong when I said that it is very difficult to qualify for disability benefits from Social Security. Just the opposite is true.
Why do you think an entire cottage industry of private legal specialists has grown up around the Social Security disability program? It's because the Social Security disability eligibility rules are so stringent. Or to put that another way, if it was easy to qualify for disability benefits, why would people need to hire lawyers to get those benefits?
In the world of disability benefit programs, including those from other government agencies and the private sector, Social Security is known for having the strictest definition of disability. Essentially, the law says you must have an impairment that prevents you from doing ANY kind of work for at least 12 months. Or you must have a condition that is terminal.
Despite this rather simple-sounding definition of "disability," it can be such a complicated and such a personal issue. As I always point out, one person's disabling condition may be another person's minor inconvenience. For example, I have a friend who is a paraplegic and must use a wheelchair. If you were to see him, you would say, "There is a disabled guy." Yet he works full time and gets upset when people refer to him as disabled. On the other hand, I've helped hundreds of people file for Social Security disability benefits because they had conditions as relatively minor as bad knees or a sore back.
That's one of the reasons why it is so difficult to administer a disability program. Here is another. Think of the hundreds of different kinds of possible disabling conditions: heart trouble, kidney disease, brain damage, cancer, nervous disorders, muscular and skeletal issues, mental health problems, etc. The list goes on and on. How do you decide how badly damaged a heart must be before someone can get disability? How dysfunctional must a kidney be to keep someone from working? How much pain must a person endure to make him or her unemployable and eligible for benefits? The Social Security Administration has established guidelines to help its disability claims evaluators make that decision for each potential condition. Yet no matter how much they try to objectify that process, the decision is still ultimately a subjective one.
And that's what leads to so much disagreement. And that's why sometimes lawyers get involved. But despite your allegations, the legal and other firms who specialize in disability law are definitely not "in cahoots" with the government. Instead, it is very much an adversarial relationship. And they certainly don't "automatically get people on the program."
Having said that, I will point out that they do have a high degree of success helping folks qualify for Social Security disability. Why is that? Remember those disability guidelines I mentioned earlier? The folks who work at these law firms have those guidelines memorized backwards and forwards. And when they are representing a disability claimant at a hearing before one of Social Security's "administrative law judges," they can "talk the talk" and "walk the walk." They know exactly how to present a case convincingly.
That is not to say that lawyers or other specialists are always needed to help a disability claimant get his or her Social Security benefits. Let me back up a few steps.
No one needs a lawyer to file his or her first claim for disability benefits. That's a relatively simple process of filling out a bunch of forms and then sitting back and waiting (usually about three months) for a decision. I have written past columns offering folks tips on filing for Social Security disability benefits.
About 35 percent of first-time claims are approved. Of course, that means 65 percent are denied. The reason a high percentage of first time claims are denied is because many folks file for disability benefits out of desperation. Most of them are simply unemployed and not really "disabled."
If your disability claim is denied, the first appeal is what SSA calls a reconsideration. And that is merely a matter of filling out a few more forms and waiting a couple more months for a decision. A reconsideration is just an internal review of the disability claim by SSA personnel. The last statistics I saw showed that between 10 and 20 percent of disability claims are approved at this level.
But if your claim is turned down again, then the next step in the appeals process is a hearing before the aforementioned SSA judge. You don't need legal help for this process. But many people feel more comfortable having an attorney represent them at the hearing. And if you use such help, you've got about a 70 percent chance of getting your disability claim approved. That's the good news. The bad news is it will cost you. Most of these firms will take 25 percent of any back pay benefits you receive.
