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How to Insure Your Income: Eligibility vs. Qualification

Almost everyone is eligible for Social Security disability benefits. But that doesn't mean everyone qualifies. Making a successful claim is tough.

The following chart summarizes disability income requirements and benefits:

Disability Benefits Eligibility

Under age 65 Fully and disability insured Worker satisfies the definition of total disability The disability is expected to last 12 months and/ or end in death

Benefits

Equal to the worker's primary insurance amount and subject to the family maximum benefit Benefits offset for workers' compensation and/or statutory benefits

The 1993 decision Betty Dodrill v. Donna Shalala, Secretary of Health and Human Services, shows how hard it is to qualify for Social Security disability benefits.

Dodrill applied for the benefits, claiming that she suffered from "a real bad problem with breathing. If I move around or do any exercise at all, I get completely out of breath and have to use my breathalizer."

She also testified to "excruciating pain in my lower back and my right leg," especially if she sat for any length of time or walked. These problems prevented her from driving a car.

She claimed she was unable to do any household chores and could not bend over to get anything out of the clothes dryer, dishwasher or cabinets.

Dodrill also stated that she left the house approximately twice a month and otherwise would sleep and take care of herself.

There was medical evidence of an impairment. A consulting physician who had treated Dodrill reported that she suffered from "back pain syndrome ... quite convincing for some degree of disc [sic] disease with classicle [sic] sounding sciatica."

He saw "no reason to doubt her account of pain, made especially worse by her obesity." And added, "This would certainly be disabling so far as she would be unable to carry out heavy, physical lifting or bending."

He also noted that Dodrill "relates a good story for exercise-induced asthma and chronic bronchitis," which "also would limit her ability to perform any physical work," and suggested she could perform "clerical or other nonphysical activities."

Nevertheless, the Social Security Administration ruled that Dodrill had the capacity to perform her past work as a business license inspector -- a job that daily entailed two hours of walking, one hour of standing, approximately five hours of driving and frequent lifting of up to 25 pounds.

Dodrill appealed the decision. An administrative law judge (ALJ) reviewing the case rejected the testimony of Dodrill and her doctor, noting that Dodrill had left her job not because of medical necessity but to follow her husband to the state of Washington when he retired. The judge also noted that her general condition "appears to be the same as when she was employed."

Beyond these observations, he merely repeated that there was little or nothing in the record to support Dodrill's claims of "fatiguability," severe pain, exercise-induced asthma and limited activities.

Dodrill appealed to federal court and got a better hearing. The court overturned the judge's rulings. Specifically, it wrote:

Dodrill offered testimony of lay witnesses as to her physical condition. The ALJ dismissed the evidence of these witnesses because he believed that they were merely repeating Dodrill's complaints. That may have been the case as to some of the witnesses, such as her daughters, whose statements did not explain sufficiently when and to what extent they had the opportunity to observe their mother. Other witnesses, however, like Dodrill's husband, grandson and friend, clearly saw her on a frequent basis. These witnesses could observe her symptoms and daily activities and were competent to testify as to her condition.

The ALJ also had paid attention to the fact that Dodrill's obesity complicated, if not caused, some of her problems. He observed that she had once lost significant weight and that "there is nothing to show that, through proper diet and some exercise, she would not be able to do so in the future."

The appeals court rejected this argument, too:

The ALJ's focus on Dodrill's failure to lose weight suggested that he did not include her obesity in determining the degree of her impairment or give proper weight to its accompanying symptoms in making his disability evaluation. He could not do so without a preliminary finding that the obesity was in fact remediable.

The court ruled that the case be reversed and remanded. It also ruled that, on remand, the ALJ should evaluate whether Dodrill's obesity was reasonably remediable. If it was not, he "must consider [her] obesity as a factor contributing to her disability," and weigh the combination of her impairments accordingly.

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