Understanding Social Security Disability Insurance - What Really Happens to Your Patients?

Background: Increasingly nurses are a primary gatekeeper for helping patients secure financial resources for medical care relating to recovery following treatment for a chronic illness or acute injury. At this time, there are limited educational resources for nurses to access to provide credible and timely information for patient counsel. Timely and credible information on financial resources provided by the nurse could assist those with disabilities and their families to secure monthly income that could assist them in paying their medical bills, maintain their insurance to pay these bills, and better adhere to pursuing medical care to overcome their disability or improve their health.

Objectives:

1. Learner will discern eligibility criteria between Social Security Disability Insurance (SSDI) vs. Long Term Disability (LTD) Insurance and Supplemental Security Income (SSI) to effectively evaluate disabled individuals and make referral
2. Learner will match stages in the SSDI appeal process with decision making steps from Social Security  Administration
3. Learner will list clinical indicators and events that often precipitate long term disability
4. Learner will review portions of medical records to recognize the decision making process used by SSA in evaluating medical source vs. non-treating, non-examining physicians

Methods: Teaching methods include but are not limited to:

1. lecture
2. specific audiovisual
3. PowerPoint presentation
4. case study
5. Q & A

Results: One third of the individuals who file for SSDI benefits lose health insurance. Healthcare providers report feeling overwhelmed and unprepared to answer questions regarding disability and whether or not an individual will qualify for benefits or when to apply. 

A review of the literature shows that while much is written on the policy issues of Social Security Disability Insurance, Medicare, Medicaid, and state based aid, very little is written to educate medical professionals on how to help their patients secure financial benefits or provide the resources to do so. The Social Security Administration’s information is a general overview of the program and what it may provide. It does not provide specific information that can help medical professionals counsel patients on the Social Security’s Sequential Evaluation as it applies to their individual case in seeking their Social Security Disability Insurance benefit.

Conclusions:

Knowledge is power.  Understanding the SSDI decision making process and the importance of timely filing and expert representation expedites access to important cash and insurance benefits for individuals with disabilities and minimizes the exposure to the provider of significant cost demands associated with treating patients without a steady source of income or insurance. Educated patients and providers can make well informed decisions that affect an individual's physical and financial health when facing long term disability.