SSDI Changes Complicate the Disability Benefits Maze

With the addition of reconsideration in 10 states, already understaffed SSA offices will have to spend more time managing applications and appeals through a process they haven’t experienced in nearly 20 years. In these states, the SSA has said it will hire and train Disability Determination Services (DDS) staff, another change that takes up even more precious time.

The SSA now also requires that applicants provide every piece of medical information that “relates to” their disability. The average person going through the SSDI process for the first time generally doesn’t know what health record information is or is not important to Social Security, so the majority play it safe and send in far more information, often duplicating and including irrelevant records. Not only is it expensive for applicants to gather all this information — it can potentially cost hundreds of dollars — it’s also time consuming.

If applicants opt not to initially submit everything and end up getting denied, they have the chance to submit additional evidence before their hearing. The good news is that the SSA now alerts SSDI applicants of their hearing date 75 days in advance compared to the previous 20 days. The bad news is that the SSA now requires all supplemental information to be shared five days before their hearing, preventing claimants from being able to present information on the day of their hearing. Though 75 days may sound like ample time to prepare, applicants can’t control how quickly medical providers respond to requests for information and might still miss that deadline.

Unfortunately, even if applicants possess the crucial piece of evidence they need the judge to see on the day of their hearing, this new “five-day rule” may prevent the evidence from being considered. Even worse, if a recent SSA policy proposal is approved, applicants soon may no longer get the chance to have their case heard in person with an administrative law judge. Instead, they will be required to attend a video hearing, and applicants often suffer from this low-quality interaction: with 6% fewer people receiving SSDI approval with video hearings. Once again, an applicant may be wrongfully denied and see delays in coordination of their LTD income with SSDI benefits.

A final SSA change has to do with how appeals decision-makers and administrative law judges consider disability claims. Instead of giving priority or “controlling weight” to medical information provided by a person’s treating physician, a state agency’s examiner or medical consultant is to be considered equally — even though these outside examiners are not as familiar with the applicant’s medical history as is their treating physician. A Tennessean article reveals that one agency doctor spent only 12 minutes per Social Security disability case.

In spite of what may have been good intentions, each of the SSA’s new regulatory measures has the potential to make it more difficult for individuals to access the disability assistance they’ve paid for and to complicate the marketplace for LTD carriers, who’ve designed their programs to coordinate with the federal insurance program that 155 million workers annually fund through their FICA taxes.

On the face of it, no one can afford to have longer SSDI wait times. In addition, American workers and the LTD carriers who provide vital disability insurance coverage should be concerned that this federal insurance program — created to save workers from financial devastation — is being devastated through regulatory reforms that are creating more barriers and hardship for workers.

— Read Jim Allsup Publishes Guide to the SSDI Claim Determination Maze, on ThinkAdvisor.

Steve Perrigo is the Vice President of National Accounts and Consulting for Allsup.