A PRIMER ON SOCIAL SECURITY DISABILITY LAW

Abstract

If you receive a paycheck, you are likely paying into the Social-Security program with the hope that you will receive monthly payments after you retire. For nearly fourteen million Americans with a mental or physical impairment that prevents them from working, the Social- Security program has another meaning: payment of disability benefits. The Social-Security-disability program has reached a critical mass, in terms of the number of claims filed and the amount of benefits paid out. Social-Security-disability insurance payments account for $1 of every $5 spent by the Social Security Administration (SSA). To further complicate issues, current projections estimate that the disability benefits fund will be depleted by 2034. Social-Security-disability law is rarely a topic of conversation amongst families or American workers until it has to be. Congress is similarly silent on the issue and its future, despite the fact that the program cost $132 billion in 2011, “[M]ore than the combined annual budgets of the departments of Agriculture, Homeland Security, Commerce, Labor, Interior and Justice.” Despite public reticence on Social-Security disability, or perhaps because of it, a basic knowledge of Social-Security law is arguably more important now than ever. The aging baby-boomer generation, in combination with the economic downturn, has catalyzed an unprecedented increase in applications for old-age and disability benefits. In 2012, former SSA Commissioner Michael Astrue told Congress that, when he leaves office in 2013, “[T]he agency will have about the same number of employees that [it] had when [he] arrived in 2007, even though . . . workloads have increased dramatically. Since FY 2007, retirement and survivor claims have increased by 26 percent and disability claims have increased by over 31 percent.” One commentator explained that the recent increase in Social- Security-disability applications, and the resulting benefit awards, has been caused by several factors, including “the baby boom demographic bump” as well as: [R]ecurrent or sustained economic recessions; a trend toward corporate downsizing of less productive workers; the elimination or reduction of other benefit programs for people with disabilities and people living in poverty; the rise in the Social Security retirement age to 66; declining access to quality ongoing and preventive health care for low-wage workers; transformations in the low wage economy; the rise in community-based alternatives to institutional care for claimants with mentally [sic] illness; outreach efforts to homeless persons with disabilities; state and local welfare agency requirements that certain persons apply for federal disability benefits; and technological, scientific, medical and psychiatric diagnostic advances that more readily reveal clinical and objective bases for impairments and their severity, among other reasons. Although the ongoing recession, the resulting increase in disability-benefits applications, and an incident with an outlier judge approving almost 100% of his cases complicated Astrue’s tenure as SSA Commissioner, his successors will be challenged by the task of saving the entire program. As previously mentioned, current estimates project that the Social-Security disability fund will be depleted by 2034. In the upcoming years, the SSA will have to begin looking to other avenues to make payments to America’s disabled workers. A massive overhaul of the Social- Security-disability-benefits program is long overdue. As the President of the Association of Administrative Law Judges testified before Congress: “In the context of disability adjudication, the government is the trustee of billions of taxpayer dollars.” Social-Security law has far-reaching and direct impacts on a large percentage of the American populace, and in recent years, the spotlight has focused on Social-Security disability. This area of the law is ripe with opportunities for law students to study, claimants’ representatives to build a practice, and for Americans to educate themselves on issues that may directly affect their families. With those opportunities in mind, this primer provides an insider’s view on Social-Security- disability law. While the disability-claims process has many steps, the heart lies with the Office of Disability Adjudication and Review (ODAR) and the administrative law judges who issue decisions after an initial application for benefits is denied at the state level. Part I of this primer addresses the underpinnings of the Social- Security-disability-benefits adjudication process, consisting of: (1) the function of administrative law judges (ALJs); (2) the distinction between federal trials and administrative hearings; and (3) the path of a disability claim from the initial application to a hearing at the ODAR. Next, Part II discusses the importance of efficiency in the claims process and the ODAR’s efforts to streamline hearings. Part III then provides an in-depth explanation of the sequential evaluation ALJs must use to determine whether an individual is “disabled” under the Social Security Act. Finally, Part IV lists a collection of practitioner best practices recommended by a Chief ALJ and other ALJs. This primer concludes that Social-Security-disability law is experiencing a resurgence. Consequently, a variety of interested parties will benefit from a basic understanding of the fundamentals of the disability-adjudication process. The average American worker may use this understanding to develop his case. Social-Security-disability claimants and their representatives will benefit from this primer on the law, and can strengthen their disability practice after reading the best practices for practitioners. Finally, for those who have neither personal nor professional experience with disability law, this primer may inform future career choices and will leave such readers with a thorough understanding of the basics of this distinctive area of law.