Showing papers on "Disability insurance published in 2007"

People with disabilities in India: from commitments to outcomes

Abstract: This report, prepared at the request of Government of India, explores the social and economic situation of this sizeable group. It comes over a decade after landmark legislation promoting the rights of persons with disabilities to full participation in Indian society, and finds that progress is evident in some areas. However, the policy commitments of governments in a number of areas remain in large part unfulfilled. The report explores primarily where and how it makes most sense for public sector interventions to improve the standard of living of disabled population, either directly or in partnership. To meet this objective, it first provides an overview of models of disability and the framework for the report. It then presents the socio-economic profile of people with disabilities, describes the societal attitudes faced by them, and identifies the main causes of disability in India. It then evaluates health policies and practice, both preventive and curative and the education, employment, and social protection situation of people with disabilities. The report then has a discussion of the policies and institutions affecting disabled people, before concluding with a chapter on accessibility issues for people with disabilities. The report uses the so-called bio-psychosocial model of disability reflected in the Second International Classification of Impairments, Disability and Handicaps (ICIDH-2), which recognizes that personal, social and environmental factors are all at play in turning physical or mental impairments into disabilities. The report concludes that it will take a multi-faceted approach for disabled people to realize their full individual potential and to maximize their social and economic contribution to society.

Distinguishing Income from Substitution Effects in Disability Insurance

Abstract: A set of studies conducted over the last 15 years has produced a near consensus that the Social Security Disability Insurance system (SSDI) has substantial disincentive effects on the labor supply of near elderly males, diminishing labor force participation, increasing the sensitivity of labor force exit decisions to adverse economic shocks, and encouraging those nearing retirement to claim disability benefits and subsequently transfer into the Social Security retirement program. Yet, efforts by the Social Security Administration (SSA) to encourage labor supply among the disabled by removing the work disincentives built into SSDI have been almost entirely unsuccessful. Most notably, in 1999, Congress authorized the Ticket to Work program, which provides an array of inducements for current SSDI beneficiaries to take up employment, including permitting a trial work period of up to nine months, providing 7.75 years of ongoing Medicare eligibility following return to work, and providing three years of automatic benefit reinstatement when claimants’ workplace earnings fall below a threshold level. Each of these steps reduces the implicit tax placed on labor supply by the SSDI program. Despite these lures, fewer than 1,400 (0.01 percent) of the 12.2 million tickets issued to date have led to successful workforce integration (Autor and Duggan 2006).

Health, disability, and life insurance experiences of working-age persons with multiple sclerosis.

Abstract: Working-age Americans with multiple sclerosis (MS) may face considerable financial insecurities when they become unable to work and lack the health, disability, and life insurance typically offered through employers. In order to estimate the rates of having these insurance policies, as well as how insurance status affects reports of financial stress, we conducted half-hour telephone interviews with 983 working-age persons across the US, who reported being diagnosed with MS. The interviews occurred from May through November 2005, and among the sampled individuals contacted and confirmed eligible, 93.2% completed the interview. The study population was largely female (78.9%), Caucasian (86.4%), married (68.6%), with at least some college education (71.5%), and unemployed (60.2%). Overall, 96.3% had some health insurance (40.3% with public health insurance, primarily Medicare), 56.7% had long-term disability insurance (36.4% with public programs), and 68.3% had life insurance. Notably, 27.4% indicated that, since being diagnosed with MS, health insurance concerns had significantly affected employment decisions. In addition, 16.4% reported considerable difficulty paying for health care, 27.4% put off or postponed seeking needed health care because of costs, and 22.3% delayed filling prescriptions, skipped medication doses, or split pills because of costs. Overall, 26.6% reported considerable worries about affording even basic necessities, such as food, utilities, and housing.

The Political Economy of the Disability Insurance. Theory and Evidence of Gubernatorial Learning from Social Security Administration Monitoring

Abstract: The dramatic rise in the disability insurance (DI) roles in the last 20 years has been the subject of much controversy in both popular and academic circles. While, the relationship between DI and labor force participation has been the subject of a growing literature, the mechanism of this transition from employment to DI remains unclear. We hypothesize that one mechanism is the state-level administration of the program which creates a classic principal-agent problem. This paper analyzes the impact of continuing conflict of interests for Disability Determination Services agencies—between Social Security Administration standards and state gubernatorial political interests—interacted with the increased demand for disability insurance as an alternative for low-skilled works during the period of 1982 to 2000. We find evidence that multi-term governors allow a greater fraction of applicants than do first term governors. We then develop a model that illustrates how these differences can be due to the type of monitoring conducted by the Social Security Administration. We provide additional evidence supporting this hypothesis in the form of sub-group analysis by economic and political constraints. Overall, we find evidence that the monitoring system is counter-productive and encourages over-use of the disability insurance program to serve political ends.

Hidden unemployment in disability insurance in the Netherlands; an empirical analysis based on employer data

Abstract: In this paper, we construct and estimate a (semi-) structural model, so as to uncover the fraction of hidden unemployment in the Disability Insurance (DI) enrolment rate. For this purpose, we use longitudinal administrative data of Dutch employers for 1994-2003. We find the (average) fraction of hidden unemployment in DI enrolment to amount to about 11%. This corresponds to 2.6% of the `true? unemployment insurance (UI) enrolment rate of employers. Over the years, we observe a strong decrease in this fraction, from 5.4% in 1995, to 0.7% in 2003. In addition, our estimates suggest that most of correlation that is observed between the UI and DI enrolment rates can be explained by substitution effects, and not by `true? correlation between the schemes that is exogenous to the firm.

An Algorithmic Approach to Discrete Time Non-homogeneous Backward Semi-Markov Reward Processes with an Application to Disability Insurance

Abstract: In this paper semi-Markov reward models are presented. Higher moments of the reward process is presented for the first time applied to in time non-homogeneous semi-Markov insurance problems. Also an example is presented based on real disability data. Different algorithmic approaches to solve the problem is described.

Cancer stage at diagnosis and survival among persons with Social Security Disability Insurance on Medicare.

Abstract: Populations with attributes marking social disadvantage in the United States—such as persons living in poverty and racial and ethnic minorities—often experience worse outcomes than others when diagnosed with cancer. They frequently have later-stage cancer diagnoses, less intensive or appropriate therapies, and shorter survivals than persons with greater social advantages (Haynes and Smedley 1999). In recent years, such observations have prompted nationwide efforts to track and eliminate disparities in health-related experiences of vulnerable populations. To date, much of the public focus on health disparities has targeted racial and ethnic minorities. However,Healthy People 2010, which set national health priorities, warns that persons with disabilities might also receive substandard health care. Noting well-documented disparities in their use of screening and preventive services (Nosek and Howland 1997; Chan et al. 1999; Iezzoni et al. 2000,2001),Healthy People 2010 cautions that “as a potentially underserved group, people with disabilities would be expected to experience disadvantages in health and well-being compared with the general population” (Department of Health and Human Services 2000). In a July 2005 “Call to Action,” the United States Surgeon General states that persons with disabilities sometimes lack equal access to care and encourages the inclusion of persons with disabilities in studies concerning disparities in health care access and outcomes (U.S. Department of Health and Human Services 2005). Exploring whether persons with disabilities do, in fact, experience worse cancer-related outcomes is complicated by the lack of information on disability in data sources typically used to conduct disparities research concerning cancer. Data from the Surveillance, Epidemiology, and End Results (SEER) cancer registries have produced important insights into racial and ethnic disparities (Klabunde et al. 1998; McCarthy et al. 1998; Bach et al. 1999; Ngo-Metzger et al. 2003; Jemal et al. 2004; Zeliadt et al. 2004; Shavers, Brown, Klabunde et al. 2004; Shavers, Brown, Potosky et al. 2004; Steyerberg et al. 2005). SEER data merged with Medicare claims have yielded additional findings about outcomes, treatments, and health care costs for Medicare beneficiaries with cancer (Potosky et al. 1993; Warren et al. 2002). Neither SEER nor Medicare data contain indicators of patients' functional status. However, one potential approach to investigate an important subpopulation of people with disabilities involves focusing on persons receiving Social Security Disability Insurance (SSDI) who eventually become eligible for Medicare. Persons with SSDI are presumably too medically disabled to work (an employability-based definition of disability). To qualify, persons must convince the Social Security Administration (SSA) that they cannot engage in “substantial gainful activity” because of medically proven sensory, physical, cognitive, or emotional impairments (Social Security Administration 2003a). Five months after qualifying for SSDI, they start receiving monthly cash payments, although many find their annual incomes plummet—posing another social disadvantage (Martin and Davies 2003/2004). Twenty-four months after first receiving cash benefits, SSDI beneficiaries become eligible for Medicare. In 2004, Medicare covered 6.4 million SSDI recipients under age 65 among its estimated 41.7 million beneficiaries (Centers for Medicare and Medicaid Services 2003). Prior studies using merged SEER–Medicare data have exclusively considered Medicare beneficiaries age 65 and older. Our study is the first to use these data to examine cancer experiences of Medicare beneficiaries under age 65. We examined stage at diagnosis and survival for disabled Medicare beneficiaries diagnosed with non-small cell lung, colorectal, female breast, or prostate cancers and compared their experiences with those of persons diagnosed in this same age group who do not have SSDI/Medicare. Because in previous studies we found that persons with certain types of disabilities (e.g., physical disabilities) are less likely to receive cancer screening and preventive services (Iezzoni et al. 2000,2001), we hypothesized that disabled Medicare beneficiaries would have delayed cancer diagnosis compared with others diagnosed under age 65.

Work Disability, Health, and Incentive Effects

Abstract: Disability insurance – the insurance against the loss of the ability to work – is a substantial part of social security expenditures in many countries. The enrolment rates in disability insurance vary strik-ingly across European countries and the US. This paper investigates the extent of, and the causes for, this variation, using data from SHARE, ELSA and HRS. We show that even after controlling for differences in the demographic structure and health status these differences remain. In turn, indicators of disability insurance generosity explain 75% of the cross-national variation. We conclude that country-specific disability insurance rules are a prime can-didate to explain the observed cross-country variation in disability insurance enrolment.

Social Security Disability Insurance (SSDI) in Parkinson's disease.

Abstract: Objective. Parkinson's disease (PD) causes significant economic burden for patients and caregivers. Social Security Disability Insurance (SSDI) provides insurance to workers in the United States who have been gainfully employed, but who are no longer able to work due to a medical condition. We performed a descriptive pilot study that examined PD patients' experience with SSDI.Methods. PD patients who were diagnosed with PD prior to age 60 and were followed at an academic movement disorders center were consecutively invited to participate in a survey concerning their employment history and experience with SSDI.Results. All 68 invited patients participated in the study (mean age 58 years, mean disease duration 9.5 years). Eighty-two percent of patients felt that they were too disabled to work full time at a mean of 3.4 years after PD diagnosis. Patients applied for SSDI at a mean of 5 years after diagnosis, and two-thirds of PD patients who applied for SSDI obtained it on their first attempt. The primary de...

The Impact of Late-Career Health and Employment Shocks on Social Security and Other Wealth

Abstract: Although health and employment shocks are fairly common at older ages and often derail retirement savings plans, Social Security's disability insurance, spouse and survivor benefits, and progressive benefit formula may provide important protections. By contrast, traditional employer-sponsored pension benefits may be especially vulnerable to health and employment shocks immediately before benefit take-up, because pension wealth generally grows rapidly near the end of the career and workers forfeit these increases if they separate early. This study examines the impact of disability onset and job layoffs on Social Security wealth, traditional employer-sponsored pension wealth, and other household wealth for a nationally representative sample of workers age 51 to 55 in 1992.

Disability testing and retirement

Abstract: This paper studies the design of retirement and disability policies. It illustrates the often observed exit from the labor force of healthy workers through disability insurance schemes. Two types of individuals, disabled and leisure-prone ones, have the same disutility for labor and cannot be distinguished. However, they are not counted in the same way in social welfare. Benefits depend on retirement age and on the (reported) health status. We determine first- and second-best optimal benefit levels and retirement ages and focus on the distortions which may be induced in the individuals' retirement decision. Then we introduce the possibility of testing which sorts out disabled workers from healthy but retirement-prone workers. We show that such testing can increase both social welfare and the rate of participation of elderly workers; in addition disabled workers are better taken care of. It is not optimal to test all applicants. Surprisingly, the (second-best) solution may imply later retirement for the disabled than for the leisure prone. In that case, the disabled are compensated by higher benefits."

Financial incentives in disability insurance in the netherlands

Abstract: In this article, we assess the impact of financial incentives on the inflow in the public Disability Insurance (DI) scheme in The Netherlands. For this matter, the variation in replacement rates over different sectors is exploited to estimate the probability of DI enrolment over a sample of employees from the Dutch Income Panel (1996–2000). On the basis of these administrative data, we find a point estimate of the elasticity of DI enrolment with respect to the DI wealth rate of 2.5. Simulations indicate that a 5%-point rise in replacement rates in the two first years of DI increases DI enrolment by 6%.

Improving the Social Security Disability Decision Process

Abstract: The Social Security Administration (SSA) provides Social Security Disability Insurance (SSDI) benefits to disabled persons of less than full retirement age and to their dependents. SSA also provides Supplemental Security Income (SSI) payments to disabled persons who are under age 65. For both programs, disability is defined as a "medically determinable physical or mental impairment" that prevents an individual from engaging in any substantial gainful activity and is expected to last at least 12 months or result in death. Assuming that an applicant meets the nonmedical requirements for eligibility (e.g., quarters of covered employment for SSDI; income and asset limits for SSI), the file is sent to the Disability Determination Services (DDS) agency operated by the state in which he or she lives for a determination of medical eligibility. SSA reimburses the states for the full costs of the DDSs. The DDSs apply a sequential decision process specified by SSA to make an initial decision whether a claim should be allowed or denied. If the claim is denied, the decision can be appealed through several levels of administrative and judicial review. On average, the DDSs allow 37 percent of the claims they adjudicate through the five-step process. A third of those denied decide to appeal, and three-quarters of the appeals result in allowances. Nearly 30 percent of the allowances made each year are made during the appeals process after an initial denial. In 2003, the Commissioner of Social Security announced her intent to develop a "new approach" to disability determination. In late 2004, SSA asked the Institute of Medicine (IOM) to help in two areas related to its initiatives to improve the disability decision process: 1) Improvements in the criteria for determining the severity of impairments, and 2) Improvements in the use of medical expertise in the disability decision process. This interim report provides preliminary recommendations addressing the three tasks that relate to medical expertise issues, with a special focus on the appropriate qualifications of medical and psychological experts involved in disability decision making. After further information gathering and analyses of the effectiveness of the disability decision process in identifying those who qualify for benefits and those who do not, the committee may refine its recommendations concerning medical and psychological expertise in the final report. The final report will address a number of issues with potential implications for the qualifications of the medical experts involved in the disability decision process.

Opportunities for Entrepreneurship in Later Life

Abstract: Stuart J was a s8-year-old executive with a Fortune soo technology company that sold computer systems to large retail companies. Stuart had become an expert in supply-chain management, financial transactions, inventory control, and employee training, all of winch are key to success in the retail industry. After twenty-two years with the company, Stuart filt he was well paid. He received the full range of benefits, including health, life, and disability insurance, and he had a generous pension plan. He expected to work for the company until he retired in about ten years. Then he was fired. Stuart's company had merged with another large computer-systems provider. The resulting company consolidated the retail computer-systems groups from both companies, eliminating Stuart's division. Stuart received a six-month severance package that left him about nine-and-a-half years short of the income and benefits he had thought would carry him to retirement. Replacing his job proved impossible- perhaps because of age discrimination, perhaps because companies prefer to promote from within, or perhaps because Stuart's salary expectations were out of line with the reality of smaller companies in other fields. After eight months of frustration, humiliation, and intermittent depression, Stuart decided to start an entrepreneurial venture. His plan was to become a consultant, create a newsletter for his industry, and run conferences. The transition was harder than he had imagined. He had no support servias at his disposal, and organizing a limited liability corporation, setting up an accounting system, designing a logo, and even naming his new company took much more time than he had anticipated. Stuart earned nothing for eighteen months, borrowed against his pension, and strained his marriage. But, finally, he made it work. Last year, his fourth in operation, Stuart worked widi eight clients, published a monthly online newsletter, and ran a conference. Most important, he made a profit. Now, Stuart loves his work, takes great pride in the success he has built, feels it was agreatgrowth experience, and now believes that being fired was the best thing that ever happened to him. Stuart J is a later-life entrepreneur whose story reveals the issues and challenges that many other people are currently facing. Stuart found the world of traditional employment less welcoming to him at his age than he had hoped, but he had financial goals that he had thought he could not meet any other way. When he was unable to replace the job he had lost, he had to make another choice. Becoming an entrepreneur was difficult, but ultimately rewarding. Working for a large organization had provided structure, identity, and interaction widi a group of colleagues, but being a home-based entrepreneur gave Stuart tremendous freedom. Smart was also a winner at a game that most people lose. Most new business ventures fail, often leading hopeful entrepreneurs to financial problems and subsequent careers that are far below their capabilities and ambitions- or to second and diird tries at other ventures. STATISTICS ON ENTREPRENEURSHIP AMONG OLDER ADULTS While there are numerous studies of the United States workforce, few have collected information about entrepreneurship among older workers. Among the few diat have is The National Study of die Changing Workforce, which surveyed workers of various types, most recendy in 2002. The large sample used provides an in-depdi look at employment issues among the working population. The study clearly shows a strong association between age and entrepreneurship. Table 1 shows diat while 8 percent of workers ages 50-59 are small business owners, 12 percent of workers over 60 years of age own their own businesses. Similarly, 13 percent of workers 50-59 years old are classified as self-employed independent workers, while 26 percent of workers over 60 are selfemployed independent workers. …

Disability Rights and the American Social Safety Net

Abstract: Disability Rights and the American Social Safety Net. By Jennifer L. Erkulwater. Ithaca, NY: Cornell University Press, 2006. 272p. $42.50. Political scientists who study the American welfare state tend to focus on a small number of social programs. Social Security and “welfare” (now called Temporary Assistance for Needy Families) are probably the best known. Typically, the goal is to show how much one or two factors—for example, public opinion, institutional design, policy elites, race, gender—influence these programs. This book is different. It focuses on two programs for the disabled, Disability Insurance (DI) and Supplemental Security Income (SSI), which are studied less often. And it tries to account for a wide range of influences on their development. The book is a genuine addition to our understanding of U.S. social policy and a fine example of how to create a rich explanation of policy change.

Working age Medicare beneficiaries with disabilities: population characteristics and policy considerations.

Abstract: Compared to older beneficiaries, disabled workers who become eligible for Medicare 25 months after they are deemed eligible for Social Security Disability Insurance (SSDI), receive little research attention or policy consideration. This is unfortunate, because of the special medical and vocational needs, high healthcare costs, and rapid growth of this population. Although disabled workers comprise only 14.1% of the total Medicare population, they account for about 17% ($71.6 billion) of total program expenditures. This review article finds that disabled workers are a medically heterogeneous population, with relatively high rates of psychiatric and cognitive conditions. Poor health, low incomes, and lack of access to affordable supplemental coverage make this group particularly vulnerable to program limitations and policy changes. Coverage gaps and co-payments may limit access to critical health services, including preventive services, rehabilitation, adaptive technology, personal assistance, and prescription drugs. Access to stable and affordable health insurance coverage is an essential part of return to work programming for SSDI beneficiaries.

Public Health Potential of a Disability Tracking System: Analysis of U.S. Navy and Marine Corps Physical Evaluation Boards 2005–2006

Abstract: Clinical and demographic data in administrative disability tracking systems have the potential to support disability reduction programs. We analyzed recent Navy Physical Evaluation Board data, compared our findings with previous studies, and evaluated the quality of the case-tracking database as a public health information system. The overall rate of cases was 50% higher than in 2000 and 40% higher than the rate of new long-term group disability insurance claims. The most common diagnostic categories remain musculoskeletal disorders, injuries and poisonings, mental health conditions, and neurological syndromes. Diagnosis rates have increased in every category since 2000. The tracking system provided unprecedented timeliness and data accessibility, but fell short of its full potential as a public health tool due to poor information quality. Improved interface design and data entry processes combined with improved reporting capability will enhance its epidemiological value. Continued system improve...

Allocation of rehabilitation measures provided by the Social Insurance Institution in Finland: A register linkage study

Abstract: OBJECTIVE To study the allocation of rehabilitation measures provided by the Finnish Social Insurance Institution in relation to the characteristics and health status of rehabilitants. DESIGN A register linkage study. SUBJECTS A total of 67,106 full-time local government employees with a minimum of 10-month job contracts in 10 Finnish towns during the period 1994-2002. METHODS Data on the rehabilitation granted between 1994 and 2002, special medication reimbursements for chronic diseases, and disability retirement, were derived from the registers of the Social Insurance Institution as an indicator of chronic morbidity and linked to the employers' records on demographic characteristics and rates of sickness absence. RESULTS In comparison with non-rehabilitants, the rate of sickness absence (> 21 days) was 2.2-2.9-fold (95% confidence interval (CI) 2.0-3.0) higher, the odds ratios of special medication reimbursement 1.5-6.1-fold (95% CI 1.3-6.9) higher and disability retirement 3.1-7.5-fold (95% CI 2.7-9.3) higher among rehabilitants. Older women and employees in manual or lower-grade non-manual jobs predominated in the rehabilitation groups. The proportion of temporary employees receiving rehabilitation was low. CONCLUSION Permanently employed older women with an excess burden of health problems predominate in the receipt of rehabilitation provided by the Social Insurance Institution.

Genetic Testing and the Future of Disability Insurance: Ethics, Law & Policy

Abstract: Predictive genetic testing poses a fundamental challenge for insurance, by revealing a probability (that can reach certainty) of future disease and disability. This has produced a substantial literature on the proper role of genetic testing in health insurance, as well as state statutes and federal law limiting insurers’ use of genetic testing. Yet analysis of the proper role of genetic testing in disability insurance is nearly nonexistent and both state and federal law have failed to face the attendant issues. This is an enormous oversight, as disability insurance funds basic needs when a disabling condition prevents income from work. This article, from a two-year project (funded by National Institutes of Health (NIH), National Human Genome Research Institute (NHGRI) grant #1-R01-HG02089), presents the first in-depth analysis of the challenging issues: Should disability insurerance be permitted to consider genetics and exclude predicted disability? May disabilities with a recognized genetic basis be excluded from coverage as pre-existing conditions? How should private insurers writing individual and group policies, employers, and public insurers deal with predictive genetic testing? Disability insurance is a complex set of products and programs spanning employment-based group and individual insurance, individually purchased private insurance, Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and Workers’ Compensation. Analysis of reported SSDI, SSI, and Workers’ Comp cases show genetics already in play. This article is the first comprehensive analysis of how genetics is surfacing in reported disability insurance disputes across the range of programs. The article also offers the first normative discussion of how genetics should figure in the range of disability insurance products and programs in use. This analysis grapples with the role of disability insurance, the implications of employer funding, and the definition of disability in the face of the reality that we all carry multiple deleterious genes.

Social Security Cost-of-Living Adjustments and the Consumer Price Index

Abstract: Social Security - Old-Age, Survivors, and Disability Insurance (OASDI) - benefits are indexed for inflation to protect beneficiaries from the loss of purchasing power implied by inflation. In the absence of such indexing, the purchasing power of Social Security benefits would be eroded as rising prices raise the cost of living. Recently, the consumer price index used to calculate the cost-of-living-adjustment (COLA) for Social Security (OASDI) benefits has come under increased scrutiny. Some argue that the current index does not accurately reflect the inflation experienced by seniors and that COLAs should be larger. Others argue that the measure of inflation underlying the COLA has technical limitations that cause it to overestimate changes in the cost of living and that COLAs should be smaller. This article discusses some of the issues involved with indexing Social Security benefits for inflation and examines the ramifications of potential changes to COLA calculations.

Recent trends in workers' compensation.

Abstract: Summary Workers' compensation provides cash benefits and medical care to employees who are injured on the job and survivor benefits to the dependents of workers whose deaths result from work-related incidents. Workers' compensation programs in the 50 states and the District of Columbia and federal programs together paid $56.0 billion in medical and cash benefits in 2004, an increase of 2.3 percent over 2003 payments. Of the total, $26.1 billion was for medical care and $29.9 billion was for cash benefits. Employers' costs for workers' compensation in 2004 were $87.4 billion, an increase of 7.0 percent over 2003 spending. Workers' compensation programs and spending vary greatly from state to state. As a source of support for disabled workers, workers' compensation is currently surpassed in size only by Social Security Disability Insurance (DI), which covers impairments of any cause that are significant, long-term impediments to work. Although most recipients of workers' compensation recover and return to work, those with lasting impairments may become eligible for DI benefits, subject to an offset to avoid excessive wage replacement from both programs. Origins of Workers' Compensation Workers' compensation was the first form of social insurance in the United States. The first U.S. workers' compensation law was enacted in 1908 to cover federal civilian employees engaged in hazardous work. The rest of the federal workforce was covered in 1916. Nine states enacted workers' compensation laws in 1911. By 1921, all but six states and the District of Columbia had workers' compensation laws. Today each of the 50 states has its own program, as do the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Federal laws provide benefits to coal miners with black lung disease and certain energy employees exposed to hazardous material. The laws also set rules for federal workers' compensation programs covering persons outside the jurisdiction of individual states, such as longshore and harbor workers and persons working overseas for companies under contract with the U.S. government. Before workers' compensation laws were enacted, a worker's only legal remedy for a work-related injury was to bring a tort suit against the employer and prove that the employer's negligence caused the injury. Under the tort system, workers often did not recover damages and experienced delays or high costs when they did. Although employers often prevailed in court, they were at risk for large and unpredictable losses when workers' suits were successful. Ultimately, both employers and workers favored legislation to ensure that a worker who sustained an occupational injury or disease arising out of or in the course of employment would receive predictable compensation without delay, irrespective of who was at fault. In return, the employers' liability was limited. Under the "exclusive remedy" concept in workers' compensation, the worker accepts program payments as compensation in full and gives up the right to sue for damages. Workers' compensation programs vary across states in terms of who is allowed to provide insurance, which injuries or illnesses are compensable, and the level of benefits. Generally, state laws require employers to obtain workers' compensation insurance or prove that they have the financial ability to carry their own risk (self-insure). Scope of Coverage Every state except Texas requires employers to provide workers' compensation coverage. In Texas, employers can choose not to cover their employees, but if they make that choice they are not protected from tort suits filed by injured employees. Some states exempt from mandatory coverage certain categories of workers, such as those in very small firms, certain agricultural workers, household workers, employees of charitable or religious organizations, or employees of some units of state and local government. Employers with fewer than three workers are exempt from mandatory workers' compensation coverage in Arkansas, Colorado, Georgia, Michigan, New Mexico, North Carolina, Virginia, and Wisconsin. …

Estimating the Prevalence of Substance Use, Abuse, and Dependence Among Social Security Disability Benefit Recipients:

Abstract: With the passage of Public Law 104-121, the Contract with America Advancement Act of 1996, the federal Social Security Administration was no longer allowed to grant disability benefits to persons whose primary diagnosis was one of substance abuse or dependence. The National Survey on Drug Use and Health (NSDUH; Substance Abuse and Mental Health Services Administration, 2004a), a nationally representative household survey, uses validated scales to measure rates of substance abuse and dependence among the U.S. population. In 2002, for the first time, the NSDUH also included questions about disability. Data from the 2002 survey is examined to determine whether issues of substance abuse and dependence are still relevant for the 2 Social Security programs that serve persons with disabilities: Social Security Disability Insurance (DI) and Supplemental Security Income (SSI). Results indicate that a substantial portion of DI and SSI beneficiaries continue to struggle with issues of substance abuse.

Health, Economic Resources and the Work Decisions of Older Men

Abstract: In this paper, we specify a dynamic programming model that addresses the interplay among health, financial resources, and the labor market behavior of men in the later part of their working lives. Unlike previous work which has typically used self reported health or disability status as a proxy for health status, we model health as a latent variable, using self reported disability status as an indicator of this latent construct. Our model is explicitly designed to account for the possibility that the reporting of disability may be endogenous to the labor market behavior we are studying. The model is estimated using data from the Health and Retirement Study. We compare results based on our model to results based on models that treat health in the typical way, and find large differences in the estimated effect of health on behavior. While estimates based on our model suggest that health has a large impact on behavior, the estimates suggest a substantially smaller role for health than we find when using standard techniques. We use our model to simulate the impact on behavior of raising the normal retirement age, eliminating early retirement altogether and eliminating the Social Security Disability Insurance program.

Method for providing insurance protection against the loss of group health insurance coverage in the event of a disability of a plan participant

Abstract: A method for providing insurance protection against the inability to pay for, and consequential loss of, group health insurance benefits if an individual employee who is an active participant in the employer's group health plan becomes disabled. The invention provides for a disability insurance policy, or alternatively a combination of a plurality of disability insurance policies, that will pay both the employer and participant's portions of health insurance premiums during the period of COBRA coverage, with the monthly benefit amount determined by determining the total premium due under COBRA guidelines for the participant's group health insurance.

The Impact of Late-Career Health and Employment Shocks on Social Security and Other Wealth

Abstract: Although health and employment shocks are fairly common at older ages and often derail retirement savings plans, Social Security’s disability insurance, spouse and survivor benefits, and progressive benefit formula may provide important protections. By contrast, traditional employer-sponsored pension benefits may be especially vulnerable to health and employment shocks immediately before benefit take-up, because pension wealth generally grows rapidly near the end of the career and workers forfeit these increases if they separate early. This study examines the impact of disability onset and job layoffs on Social Security wealth, traditional employer-sponsored pension wealth, and other household wealth for a nationally representative sample of workers age 51 to 55 in 1992...

Genetic Testing and the Future of Disability Insurance: Ethics, Law & Policy:

Abstract: Predictive genetic testing poses fundamental questions for disability insurance, a crucial resource funding basic needs when disability prevents income from work. This article, from an NIH-funded project, presents the first indepth analysis of the challenging issues: Should disability insurers be permitted to consider genetics and exclude predicted disability? May disabilities with a recognized genetic basis be excluded from coverage as pre-existing conditions? How can we assure that private insurers writing individual and group policies, employers, and public insurers deal competently and appropriately with genetic testing?

Workers' Compensation, Social Security Disability Insurance, and the Offset: A Fact Sheet

Abstract: This article offers a brief summary of the workers' compensation and Social Security Disability Insurance programs. Information highlighted includes the differences between the two programs' types and terms of coverage. It compares the differing patterns in workers' compensation and Social Security disability benefits as a percentage of wages over the past few decades and considers the potential causes for such trends. The article also explains the offset provision included in the 1965 Social Security Amendments, the intention behind the offset, and how and when offsets are applied.

Homeless people whose self-reported SSI/DI status is inconsistent with Social Security Administration records.

Abstract: Summary Clinicians routinely ask people with disabling psychiatric illnesses whether they receive Supplemental Security Income (SSI) or Social Security Disability Insurance (DI) benefits. We looked at self-reported receipt of SSI or DI by 7,220 homeless people with mental illness and compared those self-reports with information in Social Security Administration (SSA) databases. Overall agreement between the two sources was only fair (kappa = 0.60), and 41.3 percent (934/2,257) of clients reporting receipt of SSI or DI were not in SSA's databases. In multivariate analyses, people reporting receipt of SSI or DI that is unconfirmed by SSA administrative records had disproportionately more severe psychotic and medical illnesses than confirmed nonrecipients. Among recipients identified by SSA, those who did not report receiving SSI or DI were more likely to claim, apparently incorrectly, that they instead received Social Security retirement benefits. Clinicians should verify basic demographic information provided by clients, especially those who are psychotic or medically ill, because that information is often inaccurate. Introduction People disabled by psychiatric illness depend on Supplemental Security Income (SSI) and Social Security Disability Insurance (DI) benefits to meet their basic needs. Disability payments provide critical financial support in preventing homelessness among the indigent (Sosin and Grossman 1991) and contribute to improved outcomes when homeless mentally ill people receive treatment (Rosenheck, Frisman, and Gallup 1995). Clinicians routinely ask indigent new clients if they receive SSI or DI, and this information is incorporated into treatment planning. Given the importance of disability payments to people disabled by psychiatric illnesses, it is ironic that no prior studies have been done on the validity of self-reported SSI/DI status among the mentally ill. Some studies have described the low reliability (Jenkins and others 2005) and accuracy (Pedace and Bates 2001; Card, Hildreth, and Shore-Sheppard 2004; Jackle and others 2004) of self-reported income among poor people, but there are no studies to inform clinicians by describing specifi c psychiatric and medical characteristics of people whose self-reported SSI/DI status is inaccurate. The underreporting of symptoms and the inconsistency of information provided are considerable when people with substance abuse (Stephens 1972; Rounsaville and others 1981) or psychiatric disorders (Strauss, Carpenter, and Nasrallah 1978) are asked to describe their psychiatric history and symptoms. However, there is little data concerning whether homeless people with mental illness inaccurately report basic demographic information and, specifically, whether they accurately report receipt of SSI and DI. There are several potential explanations for why clients might report SSI/DI receipt inaccurately. The misreporting of SSI/DI benefits may reflect neuropsychological deficits. Inaccurate self-reports might track related constructs like the degree of knowledge about one's medical care, which is lower in people with cognitive deficits and reading difficulties (Baker and others 1995; Kalichman and others 2000; Baker and others 2002). Another possibility is that inaccurate self-reported income is influenced by subtle social pressures to underestimate income. Evidence for the underreporting of income by poor people is that families reporting low income in the Labor Department's Consumer Expenditure Survey reported much higher expenditures, and low income and high expenses are difficult to reconcile (Jencks 1997). The first goal of this study, conducted in 2004, was to document the degree of agreement between a client's self-report that he or she received SSI or DI benefits and SSA administrative records of whether the person was receiving benefits. We then characterized those clients whose self-reported SSI/DI status was not consistent with SSA administrative records using comprehensive clinical data, self-reported SSI/DI status, and SSA administrative data from participants in a large study of individuals who were homeless and mentally ill. …