Articles Posted in Developments in the Law Affecting the Social Security Program

When filing a claim for benefits from the Social Security Disability Insurance (SSDI) program, a claimant has a duty to provide honest and accurate information to the Social Security Administration (SSA). An attorney representing an SSDI claimant has a duty to provide diligent and competent professional services in accordance with the rules of the state in which they are practicing law. SSA regulations also place duties on the attorney to deal openly with the SSA, to promptly respond to requests for information, and to generally comply with the agency’s rules.

A new regulation, which took effect in April 2015, changes the duties placed on both SSDI claimants and their legal representatives, essentially requiring claimants to provide all evidence related to their claim, regardless of whether it supports or detracts from the claim. It also modifies the duties of a claimant’s legal representative to reflect these new duties.

New Evidence Requirements

The new rule modifies numerous SSA regulations, but one of its most important changes is to the regulation regarding evidentiary requirements in SSDI claims, found in Title 20 of the Code of Federal Regulations, Section 404.1512.

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As an agency of the federal government, the Social Security Administration (SSA) has the authority to determine which illnesses and injuries qualify for coverage under the Social Security Disability Insurance (SSDI) program. It maintains a list of impairments, known as the “Blue Book,” which examiners use to determine if an applicant meets the SSA’s definition of “disabled.” The Blue Book offers an important guide to SSA examiners’ methods for evaluating SSDI claims and making decisions.

The Blue Book

Officially titled Disability Evaluation Under Social Security, the Blue Book is the product of administrative rulemaking by the SSA. The complete list is codified in Title 20 of the Code of Federal Regulations, as Appendix 1 to Subpart P of Part 404 of the SSA’s regulations. It is also published in book form and on the SSA’s website.

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The Social Security Administration (SSA), through the U.S. Department of the Treasury, maintains multiple accounts for funds held in trust to pay benefits under various programs. Benefits payable through the Social Security Disability Insurance (SSDI) program are held in the SSDI Trust Fund. This account is running out of money, and it is expected to be depleted by the end of 2016. At that point, the SSA would have no choice but to make substantial cuts in SSDI benefit payments.

People have been calling on Congress to address this problem for years, but it seems as though Congressional leaders are only just beginning to recognize the need for action. What they have done so far does not seem to be enough, and what they should do instead is a matter of much dispute.

What Is the SSDI Trust Fund?

The SSDI Trust Fund is an account in the U.S. Treasury that receives funds from payroll taxes withheld from employee paychecks and paid by employers under statutes like the Federal Insurance Contributions Act (better known as FICA). The SSA has automatic spending authority, without needing periodic Congressional approval, to disburse SSDI benefits from this account.

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Social Security Disability Insurance (SSDI) has gained a fair amount of attention in recent months, as the U.S. Congress finally begins to take notice of some serious problems that it and other Social Security benefit programs are facing. The general consensus is that the SSDI Trust Fund, from which the Social Security Administration (SSA) disburses disability benefit payments, will run out of money by the end of 2016. Without further action by Congress, this could result in cuts of up to 20 percent in benefit payments. SSDI beneficiaries and claimants, as well as the disability attorneys who advocate for their rights in Maine and elsewhere around the country, eagerly await some positive news on this issue.

Much of the attention Congressional leaders have given to the SSDI program, however, focuses on details like alleged fraud among some beneficiaries, rather than the bigger picture. Congress has held numerous hearings on the issue of beneficiaries who receive payments from both SSDI and federal or state unemployment insurance programs. Several bills currently pending in the House of Representatives and the Senate would limit people’s ability to receive benefits from both sources, despite valid reasons that they might do so.

SSDI versus Unemployment

Unemployment benefits are financed through payroll taxes collected by state and federal agencies, and they are administered by state agencies, such as the Maine Unemployment Insurance Program and the New Hampshire Employment Security program. These programs support people who are temporarily out of work while they look for a new job. Benefits are restricted to a relatively brief time period, usually six months or less.

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