On March 27, the U.S. Supreme Court refused to second-guess the Social Security Administration, deferring to the agency’s authority to work out the details for implementing and applying its disability rules.
“The statute’s complexity, the vast number of claims it engenders, and the consequent need for agency expertise and administrative experience lead the Court to read the statute as delegating to the Agency considerable authority to fill in matters of detail related to its administration,” wrote Justice Stephen Breyer for the majority. The Court reached unanimity in two of three parts of the decision; on the third, Justice Antonin Scalia filed a separate opinion concurring in part and concurring in the judgment.
It may be up to Congress—on whose power to tax all Social Security funding depends—to clarify the rules.
Twelve Months … or Not?
Since the 1950s, the disability component of Social Security has paid formerly employed people who become unable to work. In order to get disability coverage, an applicant must be “… unable to do any type of substantial gainful employment for 12 months …” or longer.
Litigation over Social Security disability coverage usually revolves around the claimant’s ability to engage in “any” gainful activity. But the matter recently decided by the Court involved an interpretation of the 12-month requirement.
In Barnhart v. Walton, 235 F.3d 184, Cleveland B. Walton claimed he was disabled by a serious mental illness involving both schizophrenia and depression. The illness caused him to lose his job as a full-time teacher. But he began to work again part time as a cashier before the completion of 12 months of disability; within six months of his part-time employment, he was working as a cashier full time. He earned an income that under the Social Security regulations constituted gainful employment.
On its face, the 12-month requirement would seem to prohibit Walton’s receipt of disability payments. However, Social Security rules actually prohibit disability payments only during the first five months of disability. If a claimant can convince Social Security he will be disabled and unable to work for longer than the full 12 months, his payments can start … even if only six of those 12 months have run.
Trial Work Period
Adding complexity to the matter, the Social Security Administration (SSA) recognizes there is merit in encouraging the disabled to return to work. Thus, a person may be found to be disabled before the 12 months have run, may begin to draw benefits, and then may continue to receive those benefits even if he or she finds work. Social Security refers to this as a “trial work period.”
A trial work period allows the claimant to cash a disability check and a paycheck at the same time, at least for a while. Other components of the trial work period are similarly designed to encourage the disabled to attempt to return to the workforce.
The Social Security Administration had concluded that Walton’s mental illness had prevented him from engaging in any significant work for 11 months. Because the statute demanded an “inability to engage in any substantial gainful activity” for 12, not 11, months, SSA determined Walton was not entitled to benefits. He sued, and the District Court affirmed SSA’s decision. Walton appealed to the Court of Appeals for the Fourth Circuit, which ruled in his favor, reversing the lower court. In turn, the Supreme Court reversed the Court of Appeals, determining SSA had the authority to interpret its rules and regulations.
Barnhart v. Walton makes readily apparent the potential for inconsistency in the SSA’s application of its disability rules.
Consider, for example, Claimant A, who applied to SSA for disability payments and received a favorable decision in his sixth month of disability. If he became gainfully employed in his 11th month of disability, he could take advantage of the trial work period, allowing him to receive a paycheck without losing his disability benefits.
Claimant B, by contrast—in the same health, employment, and disability position as Claimant A—might not receive a final decision on her disability claim until the 14th month of disability. This is not an uncommon occurrence. Unlike Claimant A, Claimant B would lose her claim entirely if she became employed in the 11th month of her disability.
A Social Security disability claimant considering returning to work near the end of the 12-month period will be sorely tempted to wait until SSA issues its decision, or at least until after the 12-month period has expired. This hardly qualifies as an effort to encourage the disabled to return to work.
One Size Does Not Fit All
The SSA rules on disability are merely administrative interpretations of the Social Security Act passed by Congress—the statute that legally authorizes payment of disability insurance benefits and Supplemental Security Income to individuals with disabilities. Congress has the authority to amend the Act, and has done so many times since the Act was passed in 1935.
Adopted in 1954 as part of extensive amendments to the Act, the disability component exemplifies that era’s post-war, “one-size-fits-all” mentality of government-mandated and -funded retirement and disability plans. The Act’s disability coverage may have been as good as it could get in the 1950s.
Much has changed since then. The Act could be amended to provide for more choice and options for the person who is supposed to be protected by law: the disabled employee. Modifications of the law could allow for better coverage at a lower overall cost, which would benefit all of us.
If Cleveland Walton had a choice, he might have been willing to seek out private insurance and pay for a plan defining disability as commencing in the third month, or the sixth, or even the 10th. Given freedom of choice, he might have preferred a plan that didn’t pay until the 24th month of disability. Or, knowing his personal health history and that of his family, Walton might have preferred to sink a disability premium into extra life insurance or nursing home protection.
The status quo isn’t fair, as Cleveland Walton discovered. It can’t be fair. The U.S. is simply too large and its population too diverse to expect a disability plan mandated by Washington, DC to work for everyone, everywhere, all the time.
Dewey L. Crepeau, a private practice attorney in Columbia, Missouri, focuses on workers’ compensation and Social Security Disability. He is a former assistant prosecuting attorney. A contributing editor to Health Care News, Crepeau can be reached at [email protected].
For more information …
The full text of the U.S. Supreme Court’s decision in Barnhart v. Wilson is available on the Internet at http://supct.law.cornell.edu/supct/html/00-1937.ZS.html.
A history of Social Security is available on the Internet at http://www.ssa.gov/history/history6.html.