Recommending Elimination of the Five Month Waiting Period

The National Association of Disability Examiners (NADE) is deeply concerned about the hardship the five-month waiting period creates for disabled individuals, and their families, at one of the most vulnerable periods of their lives.  NADE believes that requiring some individuals to serve a waiting period before becoming eligible to receive disability cash benefits while not requiring others to serve the same (or any type of a) waiting period is a gross inequity to American citizens with disabilities and a disservice to the American public.

NADE is a professional association whose mission is to advance the art and science of disability evaluation. Although our membership includes treating sources and consultants, attorneys, claimant advocates and others interested in the Social Security and Supplemental Security Income (SSI) disability programs, the majority of our members work in the state Disability Determination Service (DDS) agencies, on the “front-line” of the disability evaluation process, and are directly involved in processing claims for Social Security and SSI disability benefits.  The diversity of our membership, our extensive program knowledge and our “hands on” experience enables NADE to offer a perspective on these disability programs that is both realistic and pragmatic.

In 1956, Congress passed Social Security legislation establishing a disability program for workers over age 50 in an effort to provide for the financial well being of American workers who became disabled before reaching retirement age.  In addition to providing cash benefits to disabled workers aged 50-64, provisions were put in place to pay cash benefits to adult children of retired, disabled or deceased workers, if the children had been disabled before age 18.

In 1960, Congress expanded the scope of the Social Security disability program by providing cash benefits to disabled workers under age 50.

In 1967, the Social Security Act was further amended to provide cash benefits for disabled widows and widowers aged 50-64 at a reduced rate.

All disabled workers, as well as all disabled widow(er)s and disabled surviving divorced spouses aged 50 to 65, are required to serve a full five-month waiting period prior to receiving Social Security disability cash benefits. Disabled adult children of disabled, retired or deceased workers and individuals who receive SSI disability benefits are not required to serve any type of waiting period before receiving cash benefits.   Though many other changes have been made to the disability program since 1967, the only change that has been made to the waiting period provision was in 1972 when the waiting period was reduced from the original six-month period to five months.

NADE members have first-hand experience with the hardships that serving a five-month waiting period places on disabled beneficiaries.    The statement “I have to wait five months to get my first check?  I could be dead by then!” is heard all too frequently by our members who work on the front-lines in adjudicating on an annual basis over three million Social Security and SSI disability claims.  The fact that this waiting period is prescribed by federal law does not offer any comfort to these individuals, nor does it diminish the perception that the Social Security Administration fails to provide assistance to these individuals and their families in their time of desperate need.

NADE supports the elimination, or at the very least, a reduction of the five-month waiting period for Social Security disabled workers, disabled widow(er)s and disabled surviving divorced spouses.  This change is needed to ensure fairness and equity in the disability program and for the American public.

Underpinning the entire Social Security disability program is the need for public confidence in the process.  A program that was designed to offer compassionate support to American citizens at the time when it is most needed has come to be perceived as offering only frustration and emotional distress to people and families who are already hurting.

Because the waiting period does not begin until after the first day of the month following onset of disability, the waiting period may sometimes be closer to six months. Furthermore, once cash benefits do begin, they are not retroactive for the waiting period.

Consequently, for the first five months after the onset of disability, the majority of claimants filing for disability benefits under Title II of the Social Security Act do not receive any financial compensation.  For most Title II claimants, this waiting period imposes a severe financial hardship since the costs of medical care, added to their day-to-day living expenses, can quickly deplete any savings these claimants and their families may have accumulated.

In addition to the economic hardship imposed by the five-month waiting period, NADE members recognize – and experience – the emotional impact when, for technical reasons, the Social Security office must deny Social Security disability claims because the individual died during the waiting period.  In those situations, neither the disabled beneficiary nor their family members are entitled to cash benefits.  In many instances the individual’s death leaves the family with tremendous medical bills and other debts with no means to pay them.   Even if a disabled beneficiary survives the five-month waiting period, financial pressures created by the loss of the disabled worker’s income are compounded by no cash benefits during the five-month waiting period.

NADE members strongly believe that disabled beneficiaries and their families, who are forced to deal with the trauma of disability, should not then be forced to deal with the onset of financial hardship made necessary by having to wait five full months to receive cash benefits.  While it is possible for an individual and his or her family to prepare for retirement, it is rarely possible to prepare for disability. It is logical to assume that for the majority of disabled workers Social Security benefits constitute a larger percentage of their family’s income than they do for retirees.

The five-month waiting period is a public relations disaster for the Social Security Administration and fosters a perception that SSA is denying cash benefits to disabled workers at a time when they need these benefits the most.  This is especially true for claimants who suffer from a terminal illness and have a short life expectancy.

Further eroding arguments for retaining the five-month waiting period, the Social Security Administration is proposing changes to the initial disability determination process which are intended to ensure that beneficiaries who are clearly disabled (such as those with terminal illnesses) receive determinations within 20 calendar days or less of the date that their completed application for benefits is sent to the State agency for adjudication.  NADE acknowledges and supports the need to allow these claims as quickly as possible.  However, we question the rationale for dramatically changing the process without also changing the five-month waiting period for disabled beneficiaries to begin receiving cash benefits.  No matter how quickly a claim is adjudicated, as long as the individual is required to serve a waiting period before being eligible to receive cash benefits, the waiting period will continue to create economic and emotional hardships for those individuals during an already stressful period.

For both the Social Security and the SSI disability programs the definition of disability is the same, the medical listings are the same, and the adjudicative procedures used to process the claims are the same.  However, because the SSI disability program has no waiting period, the perception clearly exists that the individual who has worked and contributed to the nation’s workforce and economy is penalized for having done so!   Eliminating, or at least reducing, the five-month waiting period would not only be an extremely humane gesture for these disabled workers and their families, it is the “right thing to do!”

NADE recognizes that there are costs involved with eliminating the five-month waiting period.  Thus, our members would also support an incremental approach to reducing this.  The waiting period could be reduced to four months, then later to three and so on.  A cost analysis at each incremental step could show the specifics of the financial impact of each reduction and how much revenue is needed to pay for each reduction and where the revenue could be obtained.  The incremental process of eliminating the waiting period could be slowed if sufficient funds are not available to pay projected costs.

On several occasions legislation has been introduced that would eliminate the waiting period for individuals who were determined to have a terminal illness.  NADE has considered that option.  However, further discussions made it clear that such a proposal would have serious future consequences, none of which would produce positive results or cast the Social Security Administration in a positive light.  For example, the question of who would make the determination of whether or not a claimant is terminally ill would create unnecessary debate and prolong the effort to pay disabled workers as quickly as possible.  Also, in question is whether individuals would be allowed to file an appeal of a finding that they were not terminally ill.  Negative publicity in the media could be expected, especially in those situations where the disability applicant subsequently died while the determination that their medical condition was not terminal was being appealed.

In addition, litigation from certain special interest groups and other individuals with disabilities would be expected.  Such litigations would argue such questions as whether it was lawful to eliminate the waiting period for only a selected group of beneficiaries.  NADE does not support eliminating the waiting period for one group of disabled beneficiaries, even though we recognize that  two select groups of individuals, those with chronic renal disease (CRD) and those with amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig’s Disease, are not required to serve the twenty-four month Medicare waiting period.  NADE sees this as inherently unfair.  There are other conditions (for example, but not exclusively, cerebral vascular accidents, aggressive cancers, severe traumatic brain injuries, etc.) that can also be just as physically, mentally and financially devastating from the onset date of the disability as CRD and ALS.

When the Social Security Act was created, the intent and vision of President Roosevelt was to “be constantly seeking to perfect and strengthen it in the light of our accumulating experience and growing appreciation of social needs.”  No changes have been made since 1972 in the waiting period required for disabled Americans to receive cash benefits under the Social Security program.  It is time to recognize the need for compassion and fairness in the disability programs and eliminate or reduce the five-month waiting period to reflect 21st century realities.

NADE Position Paper

Approved by the NADE Board,  August 2005