What Ever Happened to Common Sense?

It happens every day.  A potential client comes in to our office and says that he deserves Social Security because he “feels” disabled.  Unfortunately, we have to tell this person that it is just not that easy.  “Feeling disabled” won’t cut it with Social Security.  You need proof – lots of proof- from lots of different people.

Just as often, we get folks visiting our office who already have won disability cases from things like Workers’ Compensation of the Veterans’ Administration.  They feel that because they have already won these cases, they should automatically get Social Security benefits as well.  Here again, it’s not that simple.  Social Security’s standards are the toughest around.  Many people who get benefits from other sources just don’t qualify for SSD or SSI. 

A “common sense” approach to disability would give benefits to everybody who couldn’t work anymore.  Any illness or injury that kept you out of your job for a long period would instantly earn you monthly financial support. Basically, if you had an “obvious” disability, you would get help – no questions asked.

As you can imagine, however, there are a number of problems with this simple “common-sense” approach.  The first one is that not all disabilities are so obvious.  For example, close your eyes right now and think of a disabled person.  What did you see?  Did it include a wheelchair?  It probably did, and this is a natural response.  Generally, we think of disabilities as making it difficult for a person to get around. But most disabilities are from internal conditions such as the heart, the lungs, the blood or even the brain. These medical problems can leave a person healthy-looking on the outside, but very sick on the inside. 

The second problem with the common sense approach is that not everybody is totally honest.  One bad apple can spoil the whole bunch.  There’s always going to be someone who tries to cheat the system by claiming that he can’t work when he actually can.  If Social Security used a common sense approach – where everybody was taken at their word – then many people who didn’t deserve benefits would get them anyway.  This would take money away from the people who truly need it, and that is more unfair than anything.  

The third reason that the common sense approach doesn’t work is that the same condition can affect different people in different ways.  Just because one person is very restricted by a particular medical condition does not mean that another person will be limited as much.  If Social Security were to give benefits to everybody who had a particular medical condition, there wouldn’t be enough money to go around.  They have to judge how each condition affects each applicant individually. 

So, now that we know that Social Security can’t use common sense, what do they do instead?  Their solution is something called the “5-Step Sequential Evaluation” process.  It is basically a series of questions about how the condition affects the claimant (the person claiming to be disabled).  Each person at Social Security who looks at a claim is supposed to follow these 5 steps.  Social Security feels that this is the fairest way to separate winning cases from losing ones. They feel that by using this process, it does not matter where you apply for benefits – The Social Security worker who gets your case is supposed to follow a set of black-and-white rules and procedures.

Does the 5-step process always work?  Does Social Security always get it right? Definitely not.  But it is their system (and, according to them at least, their money). So we’d better understand the process to have any chance at getting a fair shot. 

We will be discussing the Social Security 5-step process in our upcoming blogs. Stay tuned.