The U.S. Congress has recently completed work on and the President has signed legislation affecting key provisions of the Social Security Disability Insurance and Supplemental Security Income programs. The final version of the legislation is a compromise between the bill passed by the House of Representatives and the bill passed by the Senate. Unfortunately, the compromise resulted in the adoption of most of the provisions of the Senate Bill, which are both less favorable to mentally impaired claimants and more ambiguous than the House proposal.
Standard of Review for Termination of Disability Benefits (Medical Improvement Standard) and Frequency of Reviews
Pursuant to a 1980 Amendment to the Social Security Act, some years ago the Administration began its continuing disability investigation (or continuing disability review) process in an effort to remove from the Social Security disability roles those persons who were not truly disabled. In this process, many disabled persons were determined to be no longer disabled, based either on the same evidence which supported the earlier disability determination or on evidence which indicated there was no material improvement in their medical condition.
A number of federal courts ruled that determinations based on such evidence were illegal, but the Social Security Administration did not change its policy. Many of the persons whose benefits were terminated appealed the terminations and had their benefits restored. However, many disabled persons could not or did not pursue the complex and confusing multi-step appeals process. For a number of reasons, the review process has been particularly detrimental to persons with mental impairments.
The standard of review adopted in the new legislation is quite complex and somewhat confusing. A person's disability benefits can now be terminated based on substantial evidence of any one (or more) of the following:
(1) that there has been any medical improvement in the person's condition and the person is now able to work, or
(2) that there is new medical evidence and a new assessment of the person's capacity to work which demonstrates that, although the person's medical condition has not improved, the person is a beneficiary of advances in vocational or medical therapy or technology (or the person has undergone vocational therapy) and the person is now able to work; or
(3) that new or improved diagnostic techniques or evaluations reveal that the person's impairment was not as disabling as previously determined and the person is now able to work, or
(4) that a prior determination that the person was disabled was in error.
This standard will probably afford less protection to a person who is currently receiving disability benefits than does the majority of federal court rulings on this issue. In fact, to the extent that subsection (4) is interpreted to allow the decision-makers merely to examine old evidence in the file and change their conclusions on the question of disability, this standard will legalize a policy which many federal courts had previously held to be illegal. However, to the extent the subsection is interpreted to require some objective basis for the determination that the prior ruling was "in error," the subsection will offer a degree of protection against arbitrary terminations.
The effective date of this standard is also quite complex. Basically, the new standard will apply to all determinations on or after the date of enactment Claimants who are plaintiffs in certain pending class action lawsuits have rights with differing effective dates. Any claimant who is currently litigating this issue in federal court should contact his or her lawyer for further information.
Finally, the Administration is required to promulgate regulations within 180 days which establish the frequency with which future termination reviews are conducted. …