Making Justice Real

The Official Blog of the Legal Aid Society of the District of Columbia

Current Evidence Standards Deny Benefits to Qualified SSI/SSDI Applicants

Westra Miller, Staff Attorney

The National Law Center on Homelessness & Poverty recently released a report that raises concerns about the evidence standards applied to qualified applicants for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits.  The report, Improving Access, also discusses the shortages that certain communities, such as the homeless and those in rural areas, face in locating medical providers acceptable for SSI/SSDI applications.

Social Security Administration (SSA) standards currently limit the medical sources considered to be acceptable support for SSI and SSDI applications.  Although these rules are meant to protect against fraudulent applications, they often work to prevent vulnerable SSI and SSDI applicants from receiving disability benefits.  For example, a doctor’s diagnosis would be accepted as medical evidence by the SSA, but a nurse practitioner’s would not.  This practice does not reflect the reality of the health care available to many of our clients.

 

As our health care system changes, it has become increasingly common for individuals to receive the majority of their primary physical and mental health care from nurse practitioners, physicians’ assistants, and licensed clinical social workers—rather than from physicians or specialists.  We at Legal Aid have seen this first hand, as it is not unusual for a client to report having weekly meetings with a therapist, but only brief once-a-month visits with a psychiatrist.  Often, it is these regular, non-physician providers who are best positioned to make detailed observations about the symptoms and effects of an individual’s medical condition.  Despite this, many SSI/SSDI applicants find that their social workers’ records are not sufficient to support their applications for disability benefits.  Many are required to submit to additional examinations by doctors hired by the SSA, which creates further delay in an already long application process.

SSI and SSDI benefits serve as crucial income sources for individuals who are unable to work due to a disability.  A successful application for these federal benefits can also translate to more than just financial help.  Recipients of SSI typically qualify for Medicaid and recipients of SSDI are entitled to Medicare.  For SSI and SSDI recipients, access to these insurance programs can be a key component of federal disability benefits.  Indeed, by failing to give appropriate weight to diagnostic evidence provided by non-physicians, the SSA denies more than financial benefits.

 

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