Section 2. Disability Insurance Program
The disability insurance (DI) program provides monthly cash
benefits for disabled workers under age 65 and their
dependents. Benefits were provided to disabled workers age 50
or older by the 1956 Social Security Amendments; benefits for
their dependents were provided by the 1958 Social Security
Amendments; and benefits to disabled workers under age 50 were
provided by the 1960 amendments.
GENERAL
Many provisions of the DI program are identical to those of
the OASI program. For example, all workers who are covered by
OASI are also covered by DI. Contributions are made under the
same provision of the Internal Revenue Code and are made on the
same wage base.
The DI portion of the OASDI tax is allocated to the
Disability Insurance Trust Fund, which is the source of payment
for monthly benefits to disabled workers and their dependents
and for administrative expenses of the program. In addition,
the revenue derived from the taxation of disability benefits is
credited to the trust fund.
The purpose of both OASI and DI benefits is to replace
income lost when the wage-earner is no longer able to work.
However, significant differences exist between the two
programs, primarily because of the different nature of the
event insured. The OASI program insures a worker, his
dependents and survivors against loss of income due to the
worker's retirement or death. The DI program insures against
the loss of income due to the worker's physical or mental
disability. In addition, the OASI program is administered
solely by Federal employees in Federal installations, whereas
the DI program is administered both through Federal Social
Security offices and State disability determination services
staffed by State employees.
BENEFITS
Summary
In general, DI monthly cash benefits are paid and computed
on the same basis as in the OASI program. Benefit amounts are
related to the past earnings of the insured worker. Medicare is
provided to disabled workers, widow(er)s, or adult children
after they have been entitled to disability benefits for 24
months.
In December 1993 there were 5.2 million DI beneficiaries in
current-payment status. The total monthly benefits paid out
were $2.6 billion. Table 2-1 summarizes various types of
beneficiaries of the DI program currently receiving benefits,
average benefit amounts, and the number of new awards during
1993.
TABLE 2-1.--DISABILITY CASH BENEFITS: NUMBER IN CURRENT PAYMENT
STATUS AND AVERAGE BENEFIT AMOUNT (DECEMBER 1992) AND NUMBER OF BENEFITS
AWARDED DURING THE YEAR AND AVERAGE BENEFIT AMOUNT, 1993
------------------------------------------------------------------------
Current payment New awards
---------------------------------------------
Number (in Average Number (in Average
thousands) payment thousands) payment
------------------------------------------------------------------------
Disabled workers.......... 3,726 $642 635 $638
Wives and husbands of
workers.................. 273 156 75 158
Children of disabled
workers.................. 1,255 173 399 158
------------------------------------------------------------------------
Source: Office of Research and Statistics, Social Security
Administration.
Description of major benefit types
Disabled-worker benefit.--A monthly benefit payable to a
disabled worker under age 65 insured for disability.
Spouses' benefit.--Monthly benefit payable to a spouse or
divorced spouse of a disabled worker under one of the following
conditions: (1) wife or husband (a) is aged 62 or older, or (b)
has 1 or more entitled children of the worker who are disabled
or under age 16 in his or her care; or (2) divorced wife
(husband) is aged 62 or older and her (his) marriage to worker
lasted 10 years before the divorce became final.
Child's benefit.--A monthly benefit payable to an unmarried
child or eligible grandchild of a disabled worker who is under
age 18 or a full-time elementary or secondary student under age
19.
Disabled adult child's benefit.--A monthly benefit payable
to a disabled person aged 18 or over--a son or daughter or
eligible grandson or granddaughter of a retired, deceased, or
disabled worker--whose disability began before age 22.
Disabled widow (or widower).--A widow or widower may
qualify for benefits on the deceased spouse's work record at
age 50 through age 59. Effective January 1991, the definition
of disability a widow or widower must meet to qualify for
disability benefits is the same as that for a worker.
Definition of disability
Generally, disability is defined as an inability to engage
in substantial gainful activity by reason of a physical or
mental impairment. The impairment must be medically
determinable and expected to last for not less than 12 months
or to result in death. Claimants may be determined to be
disabled only if, due to such an impairment, they are unable to
engage in any kind of substantial gainful work, considering
their age, education, and work experience, which exists in the
national economy. The work need not exist in the immediate area
in which the claimant lives, nor must a specific job vacancy
exist for the individual. Moreover, no showing is required that
the worker would be hired for the job if he or she applied.
There is a special definition and eligibility requirements
for persons who are blind.
Waiting period
An initial 5-month waiting period is required before DI
benefits are paid. Benefits are payable for the 6th month.
However, benefits may be paid for the 1st full month of
disability to a worker who becomes disabled within 60 months
(for a disabled widow or widower the period is 84 months) after
termination of DI benefits from an earlier period of
disability.
Insured status
Workers are insured for disability if they are fully
insured and, except for persons who are blind or disabled
before age 31, have a total of at least 20 quarters of coverage
during the 40-quarter period ending with the quarter in which
the worker became disabled. Workers who are disabled before age
31 must have total quarters of coverage equal to half the
calendar quarters which have elapsed since the worker reached
age 21, ending in the quarter in which the worker became
disabled. However, a minimum of 6 quarters is required.
BENEFIT COMPUTATION
DI benefits are computed in the same manner as old age and
survivors benefits except that the number of years of earnings
which is excluded when determining the benefit amount is less
than 5 for workers under age 47. (The number of drop-out years
allowed increases with the age of the insured worker at
disablement.) The amount of the monthly benefit is based on the
insured worker's primary insurance amount (PIA).
The following table lists major disability benefits with
the percentage of the insured worker's PIA.
TABLE 2-2.--TYPE OF MONTHLY BENEFIT
------------------------------------------------------------------------
Percent of
PIA
------------------------------------------------------------------------
Disabled worker (any age)................................... 100
Dependents of disabled worker:\1\ Wife or husband (age 62),
mother, father, children and grandchildren................. 50
Survivors:\1\ Disabled (age 50-59), widows or widowers...... 71.5
------------------------------------------------------------------------
\1\Subject to maximum family benefit limitation.
Substantial gainful activity
The Secretary of HHS\1\ has specific regulatory authority
to prescribe the criteria for determining when earnings derived
from employment demonstrate an individual's ability to engage
in substantial gainful activity (SGA).
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\1\Throughout the remainder of this section when Secretary is used,
it is the Secretary of Health and Human Services.
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The Secretary has published regulations specifying the
monetary amounts which indicate substantial gainful activity.
Effective January 1, 1990, the SGA earnings level was raised to
$500 a month (net of impairment-related work expenses). Table
2-3 shows SGA amounts since 1968.
TABLE 2-3.--MONTHLY SGA AMOUNTS
------------------------------------------------------------------------
Year SGA
------------------------------------------------------------------------
July 1968-73.................................................... $140
1974-75......................................................... 200
1976............................................................ 230
1977............................................................ 240
1978............................................................ 260
1979............................................................ 280
1980-89......................................................... 300
1990-94......................................................... 500
------------------------------------------------------------------------
Work incentives
The law provides a 45-month period for disabled
beneficiaries to test their ability to work without losing
their entitlement for benefits. The period consists of (1) a
``trial work period'' (TWP) which allows disabled beneficiaries
to work for up to 9 months (within a 5-year period)\2\ with no
effect on their disability or (if eligible) Medicare benefits,
and (2) a 36-month ``extended period of eligibility,'' during
the last 33 of which disability benefits are suspended for any
month in which the individual is engaged in SGA. Medicare
coverage continues so long as the individual remains entitled
to disability benefits and, depending on when the last month of
SGA occurs, may continue for 3 to 24 months after entitlement
to disability benefits ends. When Medicare entitlement ends
because of the individual's work activity, but he or she is
still medically disabled, he or she may purchase Medicare
protection.
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\2\Only one TWP is allowed in any one period of disability. The TWP
is completed only if the 9 months are within a 60-month period. By
regulation, earnings of more than $200 a month constitute ``trial
work.''
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If beneficiaries medically recover to the extent they no
longer meet the definition of disability, disability and
Medicare benefits are terminated regardless of the trial work
period or extended period of disability provisions. However,
persons who contest this determination may choose to continue
to receive disability benefits (subject to recovery) and
Medicare benefits while their appeal is being reviewed, until a
decision is rendered by an administrative law judge.
DI maximum family benefit
The maximum monthly amount of DI family benefits which is
payable on a disabled worker's earnings record for workers who
first become entitled after June 1980, is the smaller of 85
percent of the worker's average indexed monthly earnings or 150
percent of the worker's primary insurance amount. However, in
no case can the benefit be reduced below 100 percent of the
worker's primary insurance amount.
Offset for other public disability benefits
When a disabled worker under age 65 qualifies on the basis
of total or partial disability (whether or not permanent) for
benefits that are provided by Federal, State and local
governments and worker's compensation, the Social Security
benefits payable to him and his family are reduced by the
amount, if any, that the total monthly benefits payable under
the two or more programs exceed 80 percent of his average
current earnings before he became disabled. Needs-tested
benefits, Veterans' Administration disability benefits, and
benefits based on public employment covered by Social Security
are not subject to the provision. A worker's average current
earnings for this purpose are the larger of (a) the average
monthly earnings used for computing his Social Security
benefits, or (b) his average monthly earnings in employment or
self-employment covered by Social Security during the 5
consecutive years of highest covered earnings after 1950, or
(c) the average monthly earnings during the calendar year of
highest covered earnings during a period consisting of the year
in which disability began and the preceding 5 years without
regard to the limitations which specify a maximum amount of
earnings creditable for Social Security benefits. The combined
payments after the reduction are never less than the total
amount of the DI benefits payable before the reduction. In
addition, the Social Security benefit after the reduction is
increased by the full amount of the cost-of-living increase as
applied to the unreduced benefit. Every 3 years the original
amount of benefits subject to reduction is redetermined to
reflect changes in average wage levels. If increases in the
average national wages would result in a higher benefit than
that payable based on the original computation, the benefit is
increased effective January of the redetermination year.
The offset begins in the month during which concurrent
entitlement begins under a Federal or State law.
The offset of the Social Security disability benefit will
not be made if the State worker's compensation law provides for
an offset against Social Security disability benefits. However,
this waiver of the offset only applies where the State program
began offsetting on or before February 18, 1981.
DETERMINATION OF DISABILITY
State agency determinations of disability
Disability determinations are made by State agencies that
agree to make such determinations and substantially comply with
the regulations of the Secretary. The Secretary is required to
issue regulations specifying, in such detail as he or she deems
appropriate, performance standards and administrative
requirements and procedures to be followed in performing the
disability determination function ``in order to assure
effective and uniform administration of the disability
insurance program throughout the United States.'' Certain
operational areas are cited as ``examples'' of what the
regulations may specify. These include such items as the nature
of the administrative structure, the physical location of and
relationship among agency staff units, performance criteria and
fiscal control procedures.
The law also provides that if the Secretary finds that a
State agency is substantially failing to make disability
determinations consistent with his regulations, the Secretary
shall, not earlier than 180 days following his findings,
terminate State administration and make the determinations
himself. The law also allows for termination by the State. The
State would be required to continue to make disability
determinations for not less than 180 days after notifying the
Secretary of its intent to terminate. Thereafter, the Secretary
would be required to make the determinations.
Determining disability: Application of law and regulations
The adjudication of claims is accomplished on a sequential
basis. The first step is to determine whether the individual is
engaging in substantial gainful activity (SGA). Under current
administrative practice, if a person is actually earning more
than $500 a month (net of impairment-related work expenses) he
or she ordinarily will be considered to be engaging in SGA. By
law, this limit is $930 a month for disabled blind individuals
in 1994. If it is determined that the individual is engaging in
SGA, a finding is made that he or she is not disabled without
consideration of medical factors. If an individual is found not
to be engaging in SGA, the severity and duration of the
impairment are explored. If the impairment is determined to be
``not severe'' (i.e., it does not significantly limit the
individual's capacity to perform work), the individual is
denied.\3\ If the impairment is ``severe,'' a determination is
made as to whether the impairment ``meets'' or ``equals'' the
medical listings published in regulations by SSA\4\ and whether
it will last for 12 months. If it neither ``meets'' nor
``equals'' the listing (which will result in an allowance) but
meets the 12-month duration rule, a determination is then made
of whether the claimant is able to carry out his former
occupation. If he can, he is denied benefits; if he cannot, the
nonmedical factors come into play.
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\3\It is important to note that the ``severity'' step became very
controversial in the 1980s, with several Federal circuit courts ruling
that SSA's procedures violate the intent of the law that every claimant
receive an individual determination based on medical and vocational
factors. However, in a 1987 decision, the Supreme Court, while raising
a number of concerns about SSA's procedures, upheld the Agency's
application of the ``severity'' test at this stage of the sequential
process. Bowen v. Yuckert, No. 85-1409, June 8, 1987.
\4\The Listing of Impairments contains over 100 examples of medical
conditions that would ordinarily prevent an individual from engaging in
any gainful activity. Each listing describes a degree of severity such
that an individual who is not working and has such an impairment is
considered unable to work by reason of the medical impairment. The
listing describes specific medically acceptable clinical and laboratory
findings and signs which establish the severity of the impairments. An
impairment or combination of impairments is said to ``equal the
listings'' if the medical findings for the impairment are at least
equivalent in severity and duration to the listed findings of a listed
impairment.
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At this stage, because of a judicial opinion and subsequent
administrative and legislative ratification, the burden of
proof switches to the Government to show that the individual
can, considering his impairment, age, education, and work
experience, engage in some other kind of substantial gainful
activity which exists in the national economy. Such work,
however, does not have to exist in the immediate area in which
he lives and a specific job vacancy does not have to be
available to him. Work in the national economy is defined in
the law as work which exists in significant numbers either in
the region where such individual lives or in several regions of
the country.
SSA has developed a vocational ``grid'' designed to reduce
the subjectivity and lack of uniformity in applying the
vocational factor. The grid regulations embody in a formula
certain worker characteristics such as age, education, and past
work experience, in relation to the individual's residual
functional capacity (RFC) to perform work-related physical and
mental activities. If the claimant has a particular level of
residual work capability--characterized by the terms Sedentary,
Light, Medium, Heavy and Very Heavy--an automatic finding of
``disabled'' or ``not disabled'' is required when applied to
various combinations of age, education, and work experience.
Federal review of State determination
The Secretary may, on his own motion, review any
determination by a State agency.
The law requires that the Secretary review 50 percent of
the disability allowances and a sufficient number of other
determinations to ensure a high degree of accuracy.
Periodic review of individuals receiving disability benefits
The 1980 Disability Amendments required that the Social
Security Administration reexamine every individual on the rolls
who is determined to be nonpermanently disabled for benefit
eligibility at least once every 3 years. Where there is a
finding of permanency, the Secretary may reexamine at such
times as is determined to be appropriate. These reviews are in
addition to the administrative eligibility review procedures
existing prior to the 1980 amendments. Legislation enacted in
late 1982 provided authority for the Secretary to slow down the
rate of continuing eligibility reviews mandated by the 1980
amendments.
Medical improvement standard
The 1984 Disability Benefits Reform Act amended the law to
require that in continuing eligibility review cases, benefits
may be terminated only if the Secretary finds that there has
been medical improvement in the person's condition and that the
individual is now able to engage in substantial gainful
activity. There are several statutory exceptions to this
standard, which are described in greater detail in the ``Recent
Legislation'' section of this chapter.
Medical evidence
An individual is not considered under a disability unless
he furnishes such medical and other evidence as the Secretary
may require.
Under the law, the Secretary will generally reimburse
physicians or hospitals for supplying medical evidence in
support of claims for DI benefits. The Secretary also pays for
medical examinations that are needed to adjudicate the claim.
Attorneys' fees and representation
Attorneys and other individuals who represent disability
claimants on appeal and who wish to charge a fee for their
services must have the fee approved by the Social Security
Administration (SSA). Under the law in effect through June 30,
1991, representatives must submit a fee petition detailing the
number of hours spent on the claim and requesting a specific
fee.
The Omnibus Budget Reconciliation Act of 1990 (Public Law
101-508) generally replaced the fee petition process (effective
July 1, 1991) with a streamlined process in which SSA will
approve any fee agreement jointly submitted by the claimant and
the representative if the claimant is successful in his or her
appeal for benefits and if the agreed-upon fee does not exceed
25 percent of past-due benefits, but not to exceed $4,000.
As under previous law, the Secretary withholds 25 percent
of the past-due benefits of a claimant represented by an
attorney and pay the attorney the approved fee directly.
A court which renders a decision favorable to a claimant
for social security benefits is permitted to set a reasonable
fee for the attorney who represented the claimant before the
court. The fee cannot exceed 25 percent of the past-due
benefits that result from the court's decision. The Secretary
may certify for payment to the attorney, out of the total of
the past-due benefits, the amount of the fee set by the court.
VOCATIONAL REHABILITATION
The Social Security Act requires that persons applying for
a determination of disability be promptly referred to State
vocational rehabilitation agencies for necessary rehabilitation
services. The act provides for withholding of benefits for
refusal, without good cause, to accept rehabilitation services
available under a State plan approved under the Vocational
Rehabilitation Act in such amounts as the Secretary shall
determine.
Public Law 97-35 eliminated reimbursement from the trust
funds to the State vocational rehabilitation agencies for
rehabilitation services except in cases where the services have
resulted in the beneficiary's performance of substantial
gainful activity (SGA) for a continuous period of at least 9
months. Such a 9-month period could begin while the individual
is under a vocational rehabilitation program and may also
coincide with the trial work period or the individual's waiting
period for benefits. The services must be performed under a
State plan for vocational rehabilitation services under title I
of the Rehabilitation Act. In the case of any State that is
unwilling to participate or does not have a plan that meets the
requirements of the Vocational Rehabilitation Act, the
Commissioner of Social Security may provide such services by
agreement or contract with other public or private agencies,
organizations, institutions or individuals. The determination
that the vocational rehabilitation services contributed to the
successful return of the individual to SGA, and the
determination of the amount of costs to be reimbursed, are made
by the Commissioner of Social Security in accordance with
criteria formulated by him. Payments under this provision can
be made in advance or by way of reimbursement, with necessary
adjustments for overpayments or underpayments.
DISABILITY CLAIMS AND APPEALS STRUCTURE
The Social Security appeals and case review process is a
complex multilayered structure that is inextricably linked with
the disability determination process. Since about 94 percent of
the hearing requests in fiscal year 1993 involve disability
claims (both Social Security and supplemental security income),
the process described will be for that type of claim. The
application for disability benefits is made at the Federal
Social Security district office where the claimant is
interviewed and the sources of medical evidence are recorded.
After determining whether the applicant meets the insured
status requirements, the case is then sent to the State agency
which, operating as an agent of the Social Security
Administration, makes the initial determination of disability.
If a claimant or terminated beneficiary is dissatisfied with an
initial denial or termination of disability benefits by the
State agency, he can request a reconsideration within 60 days
of receipt of the notice of denial. The reconsideration is also
carried out by the State agency, but by personnel other than
those who made the initial determination. If upon
reconsideration the claimant is again denied benefits, he will
be given a hearing before an administrative law judge (ALJ),
providing he files a request within 60 days of receipt of the
notice of denial. If the claim is denied by the ALJ, the
claimant has 60 days to request review by the Appeals Council.
The Appeals Council may also, on its own motion, review a
decision within 60 days of the ALJ's decision. The 1980
Disability Amendments required the Secretary to review a
percentage of ALJ hearing decisions, and this review is being
conducted by the Appeals Council.
The Appeals Council may review, affirm, modify or reverse
the decision of the ALJ, or it may remand it to the ALJ for
further development. The claimant is notified in writing of the
final action of the Appeals Council, and is informed of his
right to obtain further review by commencing a civil action
within 60 days in a United States district court.
Under current law, as amended by the 1984 Disability
Benefits Reform Act, DI beneficiaries whose benefits have been
terminated for medical reasons, e.g., recovery or improvement
in the medical condition that was the basis for the disability,
can elect to continue to receive disability and Medicare
benefits through the hearing stage of the appeals process. The
disability benefits are subject to recovery, however, if the
initial termination decision is upheld as the final decision of
the Secretary.
Table 2-4 shows the number of cases allowed and appealed at
various levels of appeal for application decisions and
Continuing Disability Reviews (CDRs) processed by State
agencies. Table 2-5 presents information for fiscal years 1979
through 1993 of the number of cases which are reviewed and
reversed at the ALJ level. Table 2-6 presents information on
the number of continuing disability reviews--title II cases--
that were conducted in fiscal years 1977-93. Note that due to a
sharp increase in initial claims, the number of CDRs processed
has declined in recent years from a high of 291,000 in 1988 to
49,000 in 1993.
TABLE 2-4. DISABILITY DETERMINATIONS AND APPEALS, FISCAL YEAR 1993
TABLE 2-5.--ADMINISTRATIVE LAW JUDGE FAVORABLE RATES--DISABILITY INSURANCE\1\ INITIAL DENIALS AND
TERMINATIONS,\2\ FISCAL YEARS 1979-93
----------------------------------------------------------------------------------------------------------------
Percent
Fiscal year Dismissed Unfavorable Favorable Total favorable
----------------------------------------------------------------------------------------------------------------
Initial denials:
1979............................................... 6,332 31,485 48,934 86,751 56.4
1980............................................... 7,093 31,703 56,733 95,529 59.4
1981............................................... 15,141 59,930 98,129 173,200 56.7
1982............................................... 15,403 67,481 91,865 174,749 52.6
1983............................................... 14,334 65,626 79,427 159,387 49.8
1984............................................... 15,075 63,381 88,301 166,757 53.0
1985............................................... 14,806 61,161 92,118 168,085 54.8
1986............................................... 28,792 44,223 78,737 151,752 51.9
1987............................................... 15,271 58,412 98,180 171,863 57.1
1988............................................... 18,213 58,788 111,748 188,749 59.2
1989............................................... 19,695 54,284 122,070 196,049 62.3
1990............................................... 19,297 45,264 127,707 192,268 66.4
1991\3\............................................ 19,880 44,594 144,945 209,419 69.2
1992\3\............................................ 19,665 48,407 166,661 234,733 71.0
1993\3\............................................ 20,190 47,579 171,508 239,277 71.7
Terminations:
1979............................................... 1,401 4,078 8,052 13,531 59.5
1980............................................... 1,431 4,197 9,909 15,537 63.8
1981............................................... 2,623 6,945 16,685 26,253 63.6
1982............................................... 4,670 17,502 37,306 59,478 62.7
1983............................................... 9,247 37,284 73,821 120,352 61.3
1984............................................... 25,681 22,590 56,327 104,598 53.9
1985............................................... 4,176 2,415 3,126 9,717 32.2
1986............................................... 1,095 2,129 2,014 5,238 38.4
1987............................................... 812 1,954 2,014 4,780 42.1
1988............................................... 1,031 2,807 3,426 7,264 47.2
1989............................................... 1,220 3,482 4,882 9,584 50.9
1990............................................... 1,166 2,940 4,695 8,801 53.3
1991\3\............................................ 1,007 2,140 3,935 7,082 55.6
1992\3\............................................ 812 1,642 2,812 5,266 53.4
1993\3\............................................ 720 1,281 2,079 4,080 51.0
----------------------------------------------------------------------------------------------------------------
\1\Includes title II and concurrent title II/title XVI disability cases and concurrent title II/title XVI aged
cases.
\2\Includes all termination cases regardless of the basis for termination.
\3\Final data.
Source: Office of Hearings and Appeals, Social Security Administration.
TABLE 2-6.--CONTINUING DISABILITY REVIEWS (CDR) INITIAL DECISIONS: TITLE II DISABLED WORKERS, DISABLED
WIDOWS AND WIDOWERS, AND DISABLED CHILDREN CESSATIONS AND CONTINUATIONS, FISCAL YEARS 1977-93
----------------------------------------------------------------------------------------------------------------
Cessations Continuations Total cases
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Cessations Total
Number Percent Number Percent and disabled Percent
continuations persons reviewed
----------------------------------------------------------------------------------------------------------------
1977............................... 41,475 38.7 65,745 61.3 107,220 \1\3,322,230 3.2
1978............................... 38,847 46.4 44,804 53.6 83,651 3,447,767 2.4
1979............................... 45,216 48.1 48,868 51.9 94,084 3,457,837 2.7
1980............................... 44,273 46.8 50,227 53.2 94,550 3,454,010 2.7
1981............................... 80,956 47.9 87,966 52.1 168,922 3,413,602 4.9
1982............................... 179,857 44.8 221,325 55.2 401,182 3,263,354 12.3
1983............................... 182,074 41.7 254,424 58.3 436,498 3,226,888 13.5
1984\2\............................ 31,927 24.6 97,752 75.4 129,679 3,249,367 4.0
1985\2\............................ 475 14.6 2,785 85.4 3,260 3,332,870 .1
1986............................... 2,554 5.6 42,805 94.4 45,359 3,261,768 1.4
1987............................... 20,343 12.4 143,712 87.6 164,055 3,433,524 4.8
1988............................... 33,565 11.5 257,377 88.5 290,942 3,492,762 8.3
1989............................... 24,102 9.2 237,722 90.8 261,824 3,559,840 7.4
1990\3\............................ 15,154 10.5 129,026 89.5 144,180 3,678,509 3.9
1991\4\............................ 5,697 12.5 39,749 87.5 45,446 3,866,645 1.2
1992............................... 6,923 15.0 39,291 85.0 46,214 4,165,133 1.1
1993\5\............................ 4,886 9.9 44,316 90.1 49,202 4,457,500 1.1
----------------------------------------------------------------------------------------------------------------
\1\In current pay at end of fiscal year.
\2\The decline in the number of reviews in 1984 and 1985 was due to the national moratorium on reviews pending
enactment and implementation of the new legislation with revised criteria for CDR's (enacted in fiscal year
1984, regulations promulgated late fiscal year 1985).
\3\The decline in CDR processing in 1990 was due to the unanticipated processing of approximately 40,000 class
action court cases.
\4\The continued decline in CDR processing is due to the increase in the initial claims workloads.
\5\Includes non-State CDR mailer continuations.
Source: Office of Disability, Social Security Administration.
RECENT EXPERIENCE IN THE DISABILITY PROGRAM
DI awards and beneficiaries
Over the past 15 years, the DI program has experienced a
period of sharp cost curtailment followed by a rebound in
growth. The number of DI beneficiaries (disabled workers and
their dependents) on the rolls peaked at 4.9 million in May
1978. The beneficiary population then declined sharply to 3.8
million in July 1984. Thereafter, the number of beneficiaries
rose steadily, again reaching 5.3 million in January 1994.
Similarly, the number of new DI benefit awards declined
from 592,000 in 1975 to approximately 299,000 in 1982. As shown
in table 2-7, with the exception of a dip in 1987 and 1988,
awards then rose steadily, reaching a high of 637,000 in 1992
before falling slightly to about 635,000 in 1993. (The large
1992 increase is partially attributable to SSA's short-term
measures for dealing with increased DI applications. By
increasing the volume of applications processed, these measures
resulted in both increased awards and increased denials.)
The incidence of disability (number of awards per 1,000
insured workers) fell from an all-time high of 7.1 in 1975 to
an all-time low of 2.9 in 1982. In 1993, this rate stood at 5.1
percent.
Tables 2-7 and 2-8 show the number of DI awards and
applications, award rates, and the number of beneficiaries for
selected fiscal years.
Backlogs and applicant waiting times
In recent years, the combination of increasing workloads
and reduced staff has left the State Disability Determination
Services unable to keep pace with their workloads.\5\ As shown
in table 2-9, backlogs of pending claims have risen sharply,
subjecting qualified applicants to long waits for benefits.
Between 1988 and 1992, applications pending at the DDSs rose
from 323,000 to 725,000, causing claimants to wait 50 percent
longer, or three months instead of two, for an eligibility
decision.
---------------------------------------------------------------------------
\5\Between 1984 and 1990, DDS staff was cut by 19 percent--from
14,500 to 11,800.
---------------------------------------------------------------------------
TABLE 2-7.--DISABLED WORKERS' APPLICATIONS, AWARDS AND RATIO OF AWARDS TO APPLICATIONS AND AWARDS PER 1,000
INSURED WORKERS FOR SELECTED YEARS, 1960-93
----------------------------------------------------------------------------------------------------------------
Number of Awards per
applications Total Awards as a 1,000
(in awards percent of insured
thousands) applications workers
----------------------------------------------------------------------------------------------------------------
1960...................................................... 418.6 207,805 50 4.5
1965...................................................... 532.9 253,499 48 4.7
1970...................................................... 868.2 350,384 40 4.8
1971...................................................... 924.4 415,897 45 5.6
1972...................................................... 947.8 455,438 48 6.0
1973...................................................... 1,066.9 491,616 46 6.3
1974...................................................... 1,330.2 535,977 40 6.7
1975...................................................... 1,285.3 592,049 46 7.1
1976...................................................... 1,232.2 551,460 45 6.5
1977...................................................... 1,235.2 568,874 46 6.5
1978...................................................... 1,184.7 464,415 39 5.2
1979...................................................... 1,187.8 416,713 35 4.4
1980...................................................... 1,262.3 396,559 31 4.0
1981...................................................... 1,161.3 345,254 30 3.4
1982...................................................... 1,020.0 298,531 29 2.9
1983...................................................... 1,017.7 311,491 31 3.0
1984...................................................... 1,035.7 357,141 34 3.4
1985...................................................... 1,066.2 377,371 35 3.5
1986...................................................... 1,118.4 416,865 37 3.8
1987...................................................... 1,108.9 415,848 37 3.7
1988...................................................... 1,017.9 409,490 40 3.6
1989...................................................... 984.9 425,582 43 3.7
1990...................................................... 1,067.7 467,977 44 3.9
1991...................................................... 1,208.7 536,434 44 4.4
1992...................................................... 1,335.1 636,637 48 5.2
1993...................................................... 1,425.8 635,238 45 5.1
----------------------------------------------------------------------------------------------------------------
Source: Office of the Actuary, Social Security Administration.
In its budget proposal for fiscal year 1995, SSA projected
that its backlog of initial disability claims would continue to
rise sharply, increasing from 720,000 to 1,102,000 during 1995.
Table 2-9 shows disability backlogs and applicant waiting times
since 1988.
TABLE 2-8.--NUMBER OF DISABILITY INSURANCE BENEFICIARIES FOR
SELECTED YEARS: 1960-93
[Current payment status, December]
------------------------------------------------------------------------
Disabled
workers Spouses Children Total
------------------------------------------------------------------------
Year:
1960.................. 455,371 76,599 155,481 687,451
1965.................. 988,074 193,362 557,615 1,739,051
1970.................. 1,492,948 283,447 888,600 2,664,995
1975.................. 2,488,774 452,922 1,410,504 4,352,200
1980.................. 2,861,253 462,204 1,358,715 4,682,172
1981.................. 2,776,519 428,212 1,251,543 4,456,274
1982.................. 2,603,713 365,883 1,003,869 3,973,465
1983.................. 2,568,966 308,060 935,904 3,812,930
1984.................. 2,596,535 303,984 921,285 3,821,804
1985.................. 2,656,500 305,528 945,141 3,907,169
1986.................. 2,727,386 300,592 965,301 3,993,279
1987.................. 2,785,885 290,895 967,944 4,044,724
1988.................. 2,830,284 280,821 963,195 4,074,300
1989.................. 2,895,364 271,488 961,975 4,128,827
1990.................. 3,011,294 265,890 988,797 4,265,981
1991.................. 3,194,938 266,219 1,051,883 4,513,040
1992.................. 3,467,783 270,674 1,151,239 4,889,696
1993.................. 3,725,966 272,759 1,254,841 5,253,566
------------------------------------------------------------------------
Source: Office of Research and Statistics, Social Security
Administration.
TABLE 2-9.--DISABILITY BACKLOGS AND APPLICANT WAITING TIMES
[Claims pending and weeks of work on hand at the State Disability
Determination Services (DDSs)]
------------------------------------------------------------------------
Total claims
Year pending at end Weeks of work
of year on hand\1\
------------------------------------------------------------------------
1988.................................... 323,000 8.4
1989.................................... 479,000 10.0
1990.................................... 538,000 11.3
1991.................................... 693,000 14.3
1992.................................... 725,000 12.1
1993.................................... 717,398 10.7
------------------------------------------------------------------------
\1\The number of weeks of work pending in the DDSs provides the best
approximation of the amount of time an applicant must wait for an
eligibility decision.
Source: National Council of Disability Determination Directors.
CHARACTERISTICS OF DI BENEFICIARIES
Tables 2-10 and 2-11 present data on the demographic,
social, and medical characteristics of the disabled population
over time. For instance, table 2-10 shows the increase in the
receipt of benefits by women, which reflects larger societal
trends in female workforce participation. Table 2-10 also
indicates the higher levels of educational attainment that
characterize the present disabled population in comparison to
that of 1970.
GAO STUDY OF TERMINATED BENEFICIARIES: 1981-84
In response to a request from the House Ways and Means
Subcommittee on Social Security, the General Accounting Office
(GAO) issued a report in November 1989, which compared the
health, employment, and financial status of Disability
Insurance (DI) beneficiaries with that of denied applicants and
beneficiaries removed from the rolls during 1981-84. Based on
written and oral interviews with a random sample of these
individuals, the GAO found that:
1. Most DI beneficiaries removed from the rolls
between 1981 and 1984 have been reinstated. However, of
those who were not, nearly half are not working.--As of
1987, 63 percent of the beneficiaries who were
determined ineligible for benefits during SSA's 1981-84
review had been reinstated to the disability benefit
rolls. Another 4 percent had begun to receive Social
Security retirement benefits, and 7 percent had died.
Altogether, only about 26 percent of those found
ineligible remained terminated; 58 percent of these
terminated individuals (or 15 percent of those earlier
found ineligible) had returned to work.
2. Denied applicants continue to have employment
problems.--About 58 percent of the applicants who were
denied benefits in 1984 and were not receiving benefits
as of 1987 reported they were not working. Over two-
thirds of these nonworking denied applicants had been
out of work for at least 3 years, and 54 percent said
they did not expect to ever work again. Of the denied
applicants who were working at the time of GAO's
survey, 71 percent said that because of their health,
they were limited in the kind or amount of work that
they could do. Over 40 percent were earning less in
1986 than they were before applying for disability.
3. Both DI beneficiaries and denied applicants who
are not working report poor health.--GAO assessed the
survey respondents' health status on the basis of their
self-perceptions and reported abilities to perform the
activities of daily living and personal care. Although
the health status reported by denied applicants was
slightly better than that of the allowed population,
both generally reported poor health. In addition, self-
reported health status differed significantly between
the denied who worked and those who did not. After
separating the denied into working and nonworking
groups, the self-reported health status of the
nonworking denied group closely resembled that reported
by the allowed population; and bothP
TABLE 2-10.--PERCENT DISTRIBUTION BY AGE, SEX AND EDUCATION OF TITLE II DISABLED WORKER BENEFICIARIES ALLOWED BENEFITS IN SELECTED CALENDAR YEARS
1970-93, COMPARED WITH ADULT U.S. POPULATION IN 1990
--------------------------------------------------------------------------------------------------------------------------------------------------------
Year allowed benefits
Characteristics ------------------------------------------------------------------------------------------------ Adult U.S.
1970 1975 1979 1982 1985 1987 1988 1989 1990 1991 1992 1993 population\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total percent...................... 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Age:
Under 35............................... 9.0 11.0 13.6 14.4 16.8 17.1 15.2 16.2 15.7 15.7 16.8 16.2 46
35 to 44............................... 11.0 10.0 11.5 12.3 15.0 16.0 16.5 17.9 18.7 19.6 20.4 20.9 24
45 to 54............................... 26.0 26.0 27.2 26.5 25.7 22.9 23.3 24.7 24.7 25.1 25.6 26.8 16
55 to 59............................... 24.0 23.0 27.0 27.2 23.9 20.8 20.6 20.4 19.9 19.5 18.5 18.6 7
60 and over............................ 30.0 30.0 20.6 19.6 18.7 23.2 24.4 20.9 21.0 20.1 18.7 17.6 7
Median age (years)..................... 56.0 55.6 53.4 53.1 51.7 53.0 53.3 52.1 51.9 51.4 50.5 50.3 32.9
Sex:
Male................................... 74 68 69 70 67 66 66 64 64 64 63 62 49
Female................................. 26 32 31 30 33 34 34 36 36 36 37 38 51
Education (years of school completed):
No schooling\2\........................ 2 1 1 1 2 1 1 1 1 1 1 1 1
Elementary school (1 to 8)............. 44 37 29 26 23 18 18 17 16 16 12 11 9
High school............................ 46 52 55 56 59 57 59 60 62 62 50 45 45
9 to 11.............................. 23 24 23 22 22 19 20 19 19 19 15 14 11
12................................... 23 28 32 34 37 38 39 41 43 43 35 31 34
Some college........................... 9 10 12 14 14 16 15 17 17 17 14 12 45
Unknown................................ 0 0 3 3 2 8 7 5 5 5 23 31 0
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\Derived from 1990 census. Figures for age based on population aged 18 to 64. Figures for education based on persons aged 25 and over.
\2\Also includes special schools for handicapped.
Source: Office of Disability, Social Security Administration.
TABLE 2-11.--PERCENT DISTRIBUTION BY DISABLING CONDITION OF TITLE II DISABLED WORKER BENEFICIARIES ALLOWED
BENEFITS IN SELECTED CALENDAR YEARS 1970-93
----------------------------------------------------------------------------------------------------------------
Year allowed benefits
Disabling condition and -----------------------------------------------------------------------------------
mobility 1970 1975 1979 1982 1985 1987 1988 1989 1990 1991 1992 1993
----------------------------------------------------------------------------------------------------------------
Total percent\1\...... 100 100 100 100 100 100 100 100 100 100 100 100
-----------------------------------------------------------------------------------
Disabling condition:
Infective and parasitic
diseases\2\.............. 3 1 1 1 1 1 0 1 6 6 7 7
Neoplasms................. 10 10 14 17 15 12 16 18 17 16 13 15
Allergic, endocrine
system, metabolic and
nutritional diseases..... 4 3 3 4 5 5 3 3 3 4 5 5
Mental, psychoneurotic and
personality disorders.... 11 11 11 11 18 23 22 22 23 24 25 26
Diseases of the nervous
system and sense organs.. 6 7 8 9 8 8 8 9 9 8 8 7
Circulatory system........ 31 32 28 25 19 17 18 17 16 15 14 15
Respiratory system........ 7 7 6 7 5 5 5 5 5 5 4 5
Digestive system.......... 3 3 2 2 2 1 2 2 2 2 2 2
Skeletal musculo.......... 15 17 17 16 13 14 14 11 12 13 13 12
Accidents, poisonings and
violence................. 8 6 6 6 4 5 5 4 4 4 4 3
Other/unknown............. 2 3 3 2 11 9 7 9 5 5 5 5
----------------------------------------------------------------------------------------------------------------
\1\Due to rounding, may not add to 100 percent.
\2\Beginning in 1990, AIDS/HIV cases are included in this category.
Source: Office of Disability, Social Security Administration.
were significantly worse than that of the working denied. For
example:
--80 percent of the nonworking denied group and 78 percent
of the allowed population perceived their health as
fair to poor, with about 44 percent of both stating
they were in poor health; in contrast, only 13
percent of the working denied said they were in
poor health;
--40 percent of the nonworking denied group and 51 percent
of the allowed population said they had to depend
on others for at least one personal care activity,
such as dressing, eating, or getting in and out of
bed; only 12 percent of the working denied needed
any help; and
--71 percent of the nonworking denied group and 76 percent
of the allowed population could be classified as
having severe functional limitations; in
comparison, only 41 percent of the working denied
could be so classified.
4. DI beneficiaries' impairments differed from those
of denied applicants.--The denied applicants (both
working and nonworking) reported back problems as the
impairment that limited them the most; the allowed
population most often reported mental and heart
problems.
5. Both the allowed and denied populations reported
serious financial problems.--The median family income
reported by the nonworking denied was about $6,500 in
1986. Total family income was below Census's poverty
level for 61 percent of this group, and 35 percent
depended on government programs other than Social
Security (mainly public assistance) for half or more of
their total family income.
Despite receiving DI benefits, 33 percent of the
allowed population said they lacked enough income to
get along; 43 percent reported income that is below the
poverty level. At the time of GAO's survey in 1987, a
significant proportion of the denied groups were
without medical insurance coverage. Twenty-nine percent
of the working denied and 25 percent of the nonworking
denied reported no medical insurance coverage. Most of
those without insurance said they had been without it
since 1984 or earlier.
LEGISLATIVE CHANGES, 1984-93
98TH CONGRESS: THE DISABILITY BENEFITS REFORM ACT OF 1984
Public Law 98-460, the Disability Benefits Reform Act of
1984, made several substantial changes in the standards for
review of disability beneficiaries, and in other provisions of
the program as well. The following is a summary of the law.
1. Medical improvement standard
Public Law 98-460 established a medical improvement
standard under which the Secretary may terminate disability
benefits on the basis that the person is no longer disabled
only if:
(1) There is substantial evidence demonstrating that
(a) there has been any medical improvement in the
individual's impairment or combination of impairments
(other than medical improvement which is not related to
the person's ability to work), (b) the individual is
now able to engage in substantial gainful activity
(SGA); or
(2) There is substantial evidence consisting of new
medical evidence and a new assessment of RFC which
demonstrates that although there is no medical
improvement, (a) the person has benefited from advances
in medical or vocational therapy or technology related
to ability to work, and (b) that he or she is now able
to perform SGA; or
(3) There is substantial evidence that although there
is no medical improvement (a) the person has benefited
from vocational therapy and (b) the beneficiary can now
perform SGA; or
(4) There is substantial evidence that, based on new
or improved diagnostic techniques or evaluations, the
person's impairment or combination of impairments is
not as disabling as it was considered to be at the time
of the prior determination, and that therefore the
individual is able to perform SGA; or
(5) There is substantial evidence either in the file
at the original determination or newly obtained showing
that the prior determination was in error; or
(6) There is substantial evidence that the original
decision was fraudulently obtained; or
(7) If the individual is engaging in SGA (except
where he or she is eligible under section 1619), fails
without good cause to cooperate in the review or follow
prescribed treatment or cannot be located.
In making the determination, the Secretary was required to
consider the evidence in the file as well as any additional
information concerning the claimant's current or prior
condition secured by the Secretary or provided by the claimant.
Determinations under this provision had to be made on the
basis of the weight of the evidence, and on a neutral basis
with regard to the individual's condition, without any
inference as to the presence or absence of disability based on
the previous finding of disability.
Effective date: Applied only with respect to the following
categories:
(1) Determinations by the Secretary made after the
date of enactment;
(2) Cases pending at any level of the administrative
process on the date of enactment;
(3) Cases of individual litigants pending in Federal
court on the date the conference report was filed;
(4) Cases of named plaintiffs in class action suits
pending on that date;
(5) Cases of unnamed plaintiffs in class action suits
certified prior to that date; and
(6) Cases where a request for judicial review was
made on a decision of the Secretary made during the 60
days preceding enactment.
Cases in categories (3), (4), (5), and (6) had to be
remanded to the Secretary for review under this standard.
Individuals in (5) were to be sent a notice via certified mail
informing them that they had 120 days after the date of receipt
of the notice to request a review under the medical improvement
standard.
No class action could be certified after the date the
conference report was filed which raised the issue of medical
improvement with respect to an individual whose benefits were
terminated prior to that date.
Persons whose cases were remanded to the Secretary were to
receive benefits pending the Secretary's decision and appeal of
that decision if they so elected. If found eligible, any person
whose case was remanded under this provision was to receive
benefits retroactive to the date they were last found
ineligible.
2. Evaluation of pain
The Secretary of HHS was required, in conjunction with the
National Academy of Sciences, to conduct a study concerning the
questions of using subjective evidence of pain in determining
whether a person is under a disability, and the state of the
art of preventing, reducing or coping with pain. This study was
completed and a report was submitted to the House Committee on
Ways and Means and the Senate Committee on Finance in 1986.
While making many recommendations, it basically supported the
existing treatment of allegations of pain in disability
determinations.
The provision also established a statutory standard for
considering pain which was in effect until December 31, 1986.
3. Multiple impairments
In determining whether a person's impairment or impairments
are of a sufficient medical severity to be the basis of a
finding of eligibility for benefits, the Secretary was required
to consider the combined effect of all of the person's
impairments, whether or not any one impairment would alone be
severe enough to qualify the person for benefits. The provision
became effective for all determinations made on or after 30
days after enactment.
4. Moratorium on mental impairment reviews
A moratorium was imposed on reviews of all cases of mental
impairment disability until the mental impairment criteria in
the Listing of Impairments were revised to realistically
evaluate the person's ability to engage in SGA in a competitive
workplace environment. The moratorium applied to all cases on
which an administrative or judicial appeal was pending on or
after June 7, 1983. All persons claiming benefits based on
mental impairment disability who received an unfavorable
initial or continuing disability decision after March 1, 1981
were permitted to reapply for benefits within 12 months of
enactment. The revised criteria were published in 1985.
5. Pretermination notice
The Secretary was required to initiate demonstration
projects on providing face-to-face interviews for (1)
pretermination continuing disability cases and (2) for all
initial denial cases, in lieu of face-to-face evidentiary
hearings at reconsideration, to be done in at least five States
with a report due to the House Committee on Ways and Means and
the Senate Committee on Finance on April 1, 1986. The Secretary
was also required to notify individuals, upon initiating a
periodic eligibility review, that termination of benefits could
be the result of the review, and that medical evidence may be
provided. Although these studies have been completed, the
report has not yet been submitted to Congress.
6. Continuation of benefits during appeal
This provision provided for continuation of disability and
Medicare benefits during appeal for all continuing disability
review cases through the decision of the ALJ, at the election
of the individual. Where the ALJ's decision is adverse to the
individual, the disability benefits were to be repaid. The
provision was made permanent for SSI disability recipients, and
applied to DI beneficiaries through December 1987. The Omnibus
Budget Reconciliation Act of 1987 extended the provision for DI
beneficiaries through December 1988; the 1988 tax technical
corrections bill extended the provisions through December 1989;
and the Omnibus Budget Reconciliation Act of 1989 extended them
through December 1990.
7. Qualifications of medical professionals
This provision required the Secretary to make every
reasonable effort, in cases based on mental impairments, to
insure that a qualified psychiatrist or psychologist completes
the medical portion of the case review and of the residual
functional capacity assessment before any determination is made
that an individual is not disabled. The Secretary was given the
authority to contract directly for such services if the State
agency is unable to do so.
8. Standards for consultative examinations/medical evidence
The Secretary was required to promulgate regulations
regarding consultative examinations, including when they should
be obtained, the type of referral to be made, and the
procedures for monitoring the referral process. Further, the
Secretary was required to make every effort to obtain necessary
medical evidence from the treating physician before evaluating
medical evidence from any other source, and to consider all
evidence in the case record and development of complete medical
history over at least the preceding 12-month period.
9. Administrative procedure and uniform standards
As required, regulations were published setting forth
uniform standards for DI and SSI disability determinations
under section 553 of the Administrative Procedure Act, to be
binding at all levels of adjudication.
10. Nonacquiescence
While the conference agreement dropped both the House and
Senate provisions relating to the Secretary's acquiescence with
Court rulings, the intent was not to endorse the practice of
``nonacquiescence.'' The conferees noted that questions had
been raised about the constitutional basis of the practice,
that many of the conferees had strong concerns about the
practice, and that a policy of nonacquiescence should be
followed only where steps have been taken or are intended to be
taken to receive a review of the disputed issue in the Supreme
Court. The conferees also urged the Secretary to seek a
resolution of the nonacquiescence issue in the Supreme Court.
In January 1990, SSA issued regulations relating to its
adherence with circuit court decisions which are in conflict
with SSA's policies. Their key provisions are that: (a) SSA
will apply a circuit court decision that conflicts with SSA
policy, within the circuit and at all levels of administrative
adjudication, unless the Government decided to appeal the
decision; and (b) SSA will publish in the Federal Register an
Acquiescence Ruling explaining how adjudicators should apply
the circuit court decision. SSA will also publish all other
Social Security Rulings in the Federal Register.
11. Payment of costs of rehabilitation services
The provision permitted reimbursement to State agencies for
costs of VR services provided to individuals receiving DI
benefits under section 225(b) of the Social Security Act who
medically recover while in VR, whether or not the person worked
at SGA for 9 months, and whether or not the person failed to
cooperate in the program.
12. Direction for Quadrennial Social Security Advisory Council
The provision required the next quadrennial advisory
council (as required in the Social Security Act) to study the
medical and vocational aspects of disability using ad hoc
panels of experts where appropriate. The study was to include
alternative approaches to work evaluation for SSI recipients,
effectiveness of VR programs, and other disability program
policies, standards, and procedures. The Council issued its
report in March of 1988.
13. Staff attorneys
The Secretary was to report, within 120 days of enactment,
to the House Committee on Ways and Means and the Senate
Committee on Finance, on the actions taken by the Secretary to
establish positions which enable staff attorneys to gain the
qualifying experience and quality of experience necessary to
compete for ALJ positions. Statement of managers stated that it
was assumed, given U.S. Office of Personnel Management (OPM)
actions at the time, that statutory requirements for
establishing specific positions were not required, and the
Secretary was urged to take all reasonable steps to see that
the OPM actions resulted in SSA staff attorneys becoming
qualified for GS-15 ALJ positions.
14. SSI benefits for persons working despite impairment
This provision extended sections 1619 (a) and (b) through
June 30, 1987, and required the Secretaries of HHS and
Education to establish training programs for staff personnel in
SSA district offices and State VR agencies, and disseminate
information to SSI applicants, recipients, and potentially
interested public and private organizations. Sections 1619 (a)
and (b) were made permanent in 1986.
15. Frequency of continuing eligibility reviews
The Secretary was required to promulgate regulations
establishing standards for determining the frequency of
continuing eligibility reviews. Final regulations were to be
issued within 6 months and during that period no individual
could be subjected to more than one periodic review.
16. Representative payees for Social Security and SSI beneficiaries
The Secretary was required to (1) evaluate qualifications
of prospective payees prior to or within 45 days following
certification, (2) establish a system of annual accountability
monitoring where payments are made to someone other than a
parent or spouse living in the same household with the
beneficiary, and (3) report to Congress on implementation, and
annually on the number of cases of misused funds and
disposition of such cases.
LEGISLATIVE CHANGES IN THE 100TH CONGRESS
Public Law 100-203, the Budget Reconciliation Act of 1987
1. Continuation of benefits during appeal.--The existing
provision for continued payment of disability benefits during
the administrative appeal process was extended through 1988.
2. Lengthening of the extended period of eligibility for
disability benefits.--The extended period of eligibility during
which a disability beneficiary who returns to work may become
automatically reentitled to benefits, was lengthened from the
current 15 months to 36 months. Medicare eligibility is not
continued beyond the period provided under current law.
3. Payment of attorneys' fees.--The administrative policy
which permits ALJs to authorize attorneys' fees of up to $3,000
without approval by an SSA regional office was reinstated.
Public Law 100-647, the Technical and Miscellaneous Revenue Act of 1988
1. Continuation of benefits during appeal.--The existing
provision for continued payment of benefits was again extended,
through 1989.
2. Interim benefits in cases of delayed final decisions.--
Interim benefits will be paid to individuals who have received
a favorable decision from an administrative law judge but whose
cases are under review by the Appeals Council and the Council
has not rendered a decision within 110 days. These interim
payments are not subject to recovery as overpayments if the
final determination is unfavorable.
LEGISLATIVE CHANGES IN THE 101ST CONGRESS
Public Law 101-239, the Omnibus Budget Reconciliation Act of 1989
1. Continuation of benefits during appeal.--The existing
provision for continued payment of benefits was again extended,
through 1990.
2. Extension of disability insurance program demonstration
authority.--The authority of the Secretary to waive compliance
with the benefit requirements of titles II and XVIII for the
purpose of conducting work incentive demonstration projects was
extended for 3 years, through June 9, 1993.
3. Representation of claimants.--Effective June 1, 1991,
the Secretary would be required to maintain an electronically
retrievable list of claimants' legal representatives.
Public Law 101-508, the Omnibus Budget Reconciliation Act of 1990
1. Continuation of benefits during appeal.--The existing
provision for continued payment of benefits during appeal was
made permanent.
2. Improvement of the definition of disability applied to
disabled widow(er)s.--The stricter definition of disability
that was previously applied only to widow(er)s was repealed.
Instead, a disabled widow(er) is subject to the same definition
of disability as is already applied to disabled workers.
3. Creation of a rolling five-year trial work period for
all disabled beneficiaries.--Effective January 1, 1992, the
current trial work period will be liberalized so that a
disabled beneficiary will exhaust this period only after
completing 9 trial work months in any 60-month period. In
addition, the provision prohibiting a TWP for beneficiaries,
who qualified for disability benefits without serving a waiting
period, was repealed.
4. Continuation of benefits on account of participation in
a non-State vocational rehabilitation program.--Beneficiaries
who medically recover while participating in an approved non-
State vocational rehabilitation program are granted the same
benefit continuation rights as those who medically recover
while participating in a State-sponsored program.
5. Pre-effectuation review of favorable decisions by the
Social Security Administration.--The percentage of favorable
decisions made by State disability determination services that
must be reviewed by SSA was reduced from 65 percent of all such
decisions to 50 percent of allowances and a sufficient number
of other determinations to maintain a high level of accuracy in
such decisions. The reviews are to be targeted on those cases
most likely to contain errors.
6. Vocational rehabilitation (VR) demonstration projects.--
The Secretary is required to conduct demonstration projects
permitting disabled beneficiaries to select a public or private
rehabilitation provider which would furnish rehabilitation
services aimed at enabling them to engage in substantial
gainful activity and to leave the disability rolls. Legislative
changes in the 103d Congress no legislative changes to the
disability insurance program were made in the first session of
the 103d Congress.
LEGISLATIVE CHANGES IN THE 102D CONGRESS
No legislative changes to the disabilty insurance program
were made in the 102d Congress.
LEGISLATIVE CHANGES IN THE 103D CONGRESS
No legislative changes to the disability insurance program
were made in the first session of the 103d Congress.