Disability benefits exist to ensure that even people who are unable to work have enough income to cover their basic needs. In some cases, people who become disabled in their line of work can quickly and easily qualify for disability benefits, but in many others, the process is significantly more complicated. Some people who are disabled can’t get fully qualified for benefits, and others are overwhelmed with the stress of the process.
Why are disability benefits such a complicated business?
Multiple Types of Disability Benefits
For starters, there are multiple types of disability benefits that could be paid. For example:
- Veteran disability claims. Veterans may be qualified for disability if they’re injured or disabled in the line of duty.
- Social security disability. Through social security, most workers who meet certain minimum work qualifications will qualify for disability benefits.
- Private disability insurance. Many employers also carry private disability insurance, providing payments to employees who are disabled in the short-term or long-term.
Each of these systems has different requirements and procedures for people applying for disability benefits (or appealing a decision).
Things are even more complicated thanks to these important variables:
- Ability to work. “Disability” is a vague word that describes anyone unable to work. But what exactly counts as “work” and what conditions render someone “unable” to perform it? For example, should someone qualify for disability if they’re unable to perform jobs that require manual labor, but they are able to perform many white-collar jobs? Different institutions have different definitions, and proving someone’s ability or disability can be challenging.
- Disability severity and length of disability. The severity of someone’s disability may also be questioned. If someone is struggling with a condition that might get better after a few months, should they qualify for disability benefits? What if someone’s disability is associated with pain that comes and goes, and isn’t consistent? Again, the definitions get murky here.
- Medical conditions that qualify. The Social Security Administration has a list of medical conditions that qualify a person for disability, which does simplify things, but a diagnosis can still be called into question. For example, did this person take reasonable advice to try and avoid this condition?
- Special considerations. Some disability benefits also require some special considerations, or come with additional perks that make qualification harder to determine. For example, in some cases, a spouse may qualify for their partner’s disability benefits in the event of their spouse’s death.
Why Claims Are Denied
Many disabled Americans end up without benefits, even if they should hypothetically qualify for them through a public or private program. So why are so many disability claims denied?
These are some of the most common reasons:
- Previous denials. If someone has been denied for disability benefits in the past, it can be a red flag to whomever is reviewing someone’s case. While a previous denial won’t necessarily disqualify someone from consideration, it may force the reviewer to look for more concrete evidence of someone’s disability, or treat the case with greater scrutiny.
- Current income or work potential. If someone has sufficient income or if they’re able to work certain jobs, they may also be denied disability benefits. For example, if someone works a position that demands physical labor and they injure their back, but they pick up a white-collar job where they make $70,000 a year, it wouldn’t be appropriate for them to continue receiving disability benefits. Most cases aren’t this extreme.
- A lack of evidence. Disability providers, both public and private, require some kind of official evidence of a person’s disability. That usually means a medical diagnosis from a qualified professional. If the diagnosis seems suspicious, or if the evidence of the disability is called into question, it could cause the entire case to be disregarded.
- Failure to comply with medical advice. In many cases, the disabled person receives medical advice for how to avoid the condition, improve the condition, or mitigate the condition. For example, someone might be prescribed physical therapy or be told to cease a specific activity (like smoking). If they fail to comply with this advice and their condition gets worse (or doesn’t get better), they may no longer qualify for disability benefits.
If someone’s disability benefits are denied, they may still be able to file an appeal. For this, they’ll probably need the help of a disability benefits lawyer who specializes in these types of appeals.
The disability benefits system in the United States may be in need of overhaul. Most people agree that people who are disabled and unable to work need some kind of assistance, but it can be challenging to find a system that’s fair for buyers and disabled people alike. These complexities are just scratching the surface of disability systems overall.