Why Thousands of Obviously Disabled Americans Can't Get Disability

One would assume that a person who is an American citizen, fully disabled, and unable to care for their basic needs would qualify for disability benefits. Sadly, the fact remains that many are totally denied any amount of disability benefits as well as related (Medicare) health care programs every day!

Example: A local fully disabled woman can't get a disability check

Jennie is a 33 year old, married, American mother of two, who after devoting her life to home and family, is now a paraplegic. Thanks to a careless driver, who insisted on passing seven cars at once on the highway, she was struck head-on. When her car finally came to a stop, she was badly mangled and barely holding on to life. Luckily, she survived, but now she finds herself at the mercy of her husband and children, who care for her every need on a daily basis, including basic needs such as bathing or using the restroom. She is well educated, but it is difficult to use one's mind and skills when it is impossible to sit up unsupported, let alone walk, drive, or use the telephone.

She made the choice shortly after obtaining her bachelor's degree to stay home with her children while her husband earned a decent wage. For them, this arrangement was economically feasible, considering the high cost of daycare, after school care, extra gasoline or other incidentals, let alone the lack of decent employment in her geographical area. Therefore, for the last 13 years she has served her family in the homemaker tradtions. But now, because of this debilitating accident, she can no longer fulfill her duties. All hope of recovery is gone. The other driver was never caught, and Jennie's auto insurance policy covered her initial hospital expenses only.

The sad state of a disabled person who deserves disability benefits

It is obvious to anyone that Jennie is permanently disabled, unable to perform even the simplest of tasks, yet the Social Security Administration denied her application for disability benefits. Likewise, because of this disability denial, she is not eligible to receive health care through Medicare or the Department of Human Services.

As of late, Jennie feels completely hopeless and helpless, as if she is a burden to her family and the world. She spends her days laying in bed, staring at the ceiling as she cries herself to sleep. Why doesn't the government think she is disabled, she wonders to herself.

Is the denial of disability payments common, or is this a rare story?

Jennie's story is not uncommon. Thousands of otherwise deserving disabled people in America are denied disability benefits every day, even in the face of obvious, debilitating conditions. When someone applies for disability benefits, the first two questions that the interviewer will ask are: "Did you engage in full-time employment for five of the last ten years," and "Does your current monthly income fall below the poverty line?" If the applicant or inquiring party answers "No" to both of these questions, they will be denied disability benefits, regardless of their degree of disability or inability to work.

When I first heard about Jennie's story, these facts were rather disturbing to me. I myself am a stay-at-home mom, and I am proud to do so. But, considering these circumstances, I wonder if my choices are best. I had always assumed that anyone who was an American citizen could apply and be approved for disability payments if their disability was severe enough. After all, I personally know of people who are currently receiving disability payments but spend their days driving around on motorcycles, doing non-paying heavy labor, and living their lives like everyone else. And certainly these people do have a disability or they would not have been approved for disability benefits. Then again, when I compare the lives of these individuals to that of Jennie's, I can only shake my head in disbelief.

Personal reflection about the Social Security Disability program: What about me?

I think to myself, "What would happen to me if I were in Jennie's shoes? What if my scoliosis condition progresses to a point that I can't function anymore? What if my eyesight weakens and thick glasses are ineffective? What if I developed depression or some other mental disorder? Would I be left on a shelf, too?"

Research on disability determination, disability payments, and eligibiltiy for disability benefits in America

I decided to research this fact for myself. I placed a call on April 22, 2010 to the nation-wide Social Security toll-free hotline (1-800-772-1213). I asked to speak to a representative for new Social Security disability claims. A few minutes later I was greeted by Sandra, a customer service specialist in the disability applications department. The following is a transcript of our conversation:

Me: Hello. I am calling to inquire on the behalf of a friend about possibly getting disability benefits.

Sandra: Okay, what type of benefits will they be applying for?

Me: Well, I'm not really sure. Tthis lady is young and well educated. She is also an American citizen. And she had a bad car accident a few months ago so that now she is a paraplegic and has to stay in bed all day.

Sandra: And she cannot work?

Me: Um, no, she can't even get a drink of water without someone to help her.

Sandra: I see. Well, I cannot answer any specific questions related to any one individual, but I can tell you about the requirements for Social Security disability payments on a general level as well as the two programs that someone might qualify for.

Me: Okay, that sounds great!

Sandra: Alright. Well, Social Security has two disability payment programs, the traditional Social Security disability insurance program and the SSI program. If the person is under the age of 65 they must meet at least one of two requirements. To be eligible for disability insurance payments, which most people know as getting a disability check, the applicant must have been gainfully employed at a full-time job and had worked for 5 of the last 10 years. In the case of SSI, the total family income is taken into consideration. The applicant must make less than $550 per month if they are a single person, or $1,100 for a couple. If the applicant does not meet one of these two critera, they will be denied disability benefits.

Me: So you mean to say, it doesn't matter how badly someone is disabled, only if they worked or if they are poor?

Sandra: Essentially, yes, that is correct.

Me: Wow. That seems odd to me. I always thought that if somebody was obviously disabled then they should be able to get a check.

Sandra: Well, there are circumstances, of course, but those are rare. As a general rule, these criteria must be met first and foremost.

Me: And what if somebody didn't care about getting any money every month, but they really needed health care and couldn't get it anywhere else, like Medicare?

Sandra: As far as I am aware, someone who is not retired or receiving disability payments cannot access Medicare services.

Me: Okay. Well, this lady I am thinking about, she has no health insurance. Her husband works, but his job does not offer health insurance, and even if they did her family couldn't afford the premiums or co-pays. And then, the DHS and other charities say that they earn too much money to qualify for help. So she just lays in bed all day because that is all she can do, and if she gets sick its even worse.

Sandra: I understand your concerns, Ma'am, and I do sympthasize, but these are the criteria set forth by the government for the determination of disability.

Me: I know. It is just so frustrating to know that she is that way and can't help herself but the government doesn't think she is disabled.

Sandra: Again, Ma'am, the initial application process does not take into consideration the degree or level of severity of the party's disability. Rather, what matters most at that point is whether or not the person has paid into the system for the minimum number of years or if they are living below the poverty threshold.

Me: Yes, I understand, and I didn't mean to sound rude or argumentative. I am sorry if I came across that way. I will tell my friend about these policies. Thank you for taking time to talk with me today.

Sandra: You are most certainly welcome. Is there anything else that I can do for you today?

Me: No, that will be all.

Sandra: All right. Thank you for calling the Social Security Administration. Have a good day.

(end of conversation)

What I have learned: The number one reason why disabled people are denied Social Security Disability benefits

It is now apparent why some people, who seem able bodied or otherwise able to do a non-demanding job, are approved for Social Security disability benefits, while someone else, like Jennie, gets denied. One's physical or mental condition is considered as an after-thought, not as an initial qualification.

If you are an individual who chooses not to work at a full-time job for whatever reason, take note of these facts. Like Jennie, your choices could put you, your health, and the financial welfare of you and your family at risk. Mothers or wives who stay at home, house dads, long-term college students, people who work part-time, and people who work for cash can expect to be denied disability benefits as well as health care through the Medicare program should they become disabled.

I once had the foolish assumption that disability payments were intended for people who are disabled. Today, I know otherwise. Granted, the payments do go to disabled people, but only if they worked long and hard enough to qualify.

A disabled person without health care struggles to live her life

At present, Jennie is having difficulty breathing and her heart seems to beat in unusual patterns. On top of this, it is also allergies season, and the high pollen levels are wreaking havoc on her respiratory system. It scares her to think that something very serious could be wrong with her, aside from her paraplegic condition. She grins and tries not to show her worry to her children, knowing that she cannot obtain any medical attention without a hefty monthly premium (her lowest quote was $750 per month, including a yearly deductible and high co-pays). Jennie prays that the Obama health care reforms will open the door for her and thousands of others across America who are disabled and without health care. She doesn't really care about getting a dime of disability benefit payments, but she would like to be able to see a doctor sometimes.

Her only hope for getting approved for any sort of disability benefits or disability related health care requires that she and her family make some very difficult choices: either she can get a divorce and establish her own residence or her husband can quit his job and allow the family to slip into poverty. In either case, Jennie would qualify for SSI payments and health care, but neither will warrant her a traditional disability check.

What can the American citizens do about this loophole in the disability determination process?

Who knows. Maybe some day a group of political enthusiasts will fight for the rights of disabled people like Jenny, who not only need disability benefits and health care, but deserve it too!

Sources:

Visits with Jennie, a local resident of my home town
Phone call to the Social Security Administration on April 22, 2010