Newly disabled workers are often unemployed, uninsured, and indigent. They are in desperate need of Social Security OASDI monthly benefits, and the Medicare health insurance that follows 24 months after benefits begin. Applicants must prove that their medical conditions (excluding drug and alcohol abuse) have resulted in severe functional limitations that prevent them from any gainful employment. Delays and denials of benefits result when applicants cannot find or retrieve medical records from providers familiar with their medical history, health status, and functional limitations. The disability application workflow is complex, particularly for applicants with cognitive and mental health impairments. Health information technology (HIT) has been used to automate care delivery workflow through provider-controlled, electronic health record systems (EHRs). Disability applicants’ workflow could, just as well, be automated through consumer-controlled, unbound, and intelligent personal electronic health record systems (PHRs), which are not tethered to a health plan or employer network, and which automatically exchange information updates with authorized providers’ EHRs. Applicants’ PHRs may later prove helpful with self-management of chronic conditions prior to Medicare coverage and with periodic reevaluations of their medical status.
TopIntroduction
“A 20-year-old worker has a 3 in 10 chance of becoming disabled before reaching retirement age” (http://www.ssa.gov/history/briefhistory3.html). In 1935, President Roosevelt signed the Social Security Act (SSA), creating a contributory system in which workers prepared for their retirement through taxes that they paid while employed. In 1956, an amendment to the Act provided benefits to disabled workers aged 50-64 and disabled adult children. In 1960, President Eisenhower signed an amendment permitting SSA disability benefits for disabled workers of any age and their dependents. In 1996, President Clinton signed a bill (P.L. 104-121) that changed eligibility for SSA disability benefits from a medical condition that prevents work, to a medical condition other than drug addiction or alcoholism that prevents work.
About 48.4 million people received Old Age, Survivors, and Disability Insurance (OASDI) monthly benefits in December 2005. Disabled workers and their dependents were 17% of OASDI beneficiaries, their average monthly benefits were $938. In 2005, OASDI payments exceeded $44 billion a month, approached $521 billion for the year, and represented 4.2% of the U.S. gross domestic product. At the same time, employees, self-employed workers, and employers contributed $593 billion to the OASDI trust funds (SSA, 2007).
Two recent studies indirectly suggest the importance of SSA disability benefits. In Sweden, 197 individuals granted disability pensions reported less illness, larger social networks, and less work and family role limitations than 96 individuals who did not receive disability pensions (Ydreborg, Ekberg, & Nordlund, 2006). In the U.S., a survey of 4,918 veterans found that their odds of impoverishment were reduced considerably if they applied for and received VA benefits for posttraumatic stress disorder (Murdoch, van Ryn, Hodges, & Cowper, 2005).