Legal Update: Social Security Disability Insurance
Glenn Pransky Director, Liberty Mutual Center for Disability Research, Associate Professor, Department of Family Medicine and Community Health, University of Massachusetts Medical School, 71 Frankland Road, Hopkinton, MA 01748

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Radoslaw Wasiak Liberty Mutual Center for Disability Research, University of Massachusetts Medical School

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Jay Himmelstein Director, Center for Health Policy and Health Services Research, University of Massachusetts Medical School

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Abstract

The US Social Security Disability Insurance (SSDI) system does not use the AMA Guides to the Evaluation of Permanent Impairment, but examinees who are evaluated for permanent impairment frequently also are receiving SSDI benefits. The latter are restricted to workers who have long-term impairments that are so severe they preclude any type of gainful compensable activity, and the impairment must be medically determinable and expected to last at least a year or result in death. Both SSDI and the Supplemental Security Income plan (primarily for workers who have insufficient past work contributions) require the examining physician to provide specific medical information such as the medical history, physical examination, laboratory findings, and impairment, often using standardized forms. Examiners should know that the observations of the treating physician have legal significance, especially in areas of controversy. Social Security may approve additional diagnostic testing in order to conclusively establish the extent and severity of an illness. Based on the patient's history and observations during the examination, physicians also are asked to report any impairments in daily functioning, but examiners are advised not to address work-relatedness and are discouraged from discussing ability to work, which is determined by the state disability agency. Infrequent follow-up reports may be requested because most accepted claims are reviewed on a periodic (yearly) basis.

Contributor Notes

Glenn Pransky, MD, MOccH (Corresponding author)
  • 1.

    Social Security Administration. A Brief History of Social Security. Washington, DC: Social Security Administration; 2000. Publication No. 21-059.

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  • 2.

    Social Security Administration. Disability Evaluation under Social Security. Washington, DC: Social Security Administration; 1998. Publication No. 64-039. Available at: http://www.ssa.gov/disability/professionals/bluebook/.

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