Disparities in health literacy

Have you had a healthcare experience that left you feeling confused and wishing you had more time with a doctor? You are not alone. Health literacy is low among all Americans, but especially among those with disabilities. Those with limited English skills also have lower health literacy. This information comes from two recent studies at the University of Missouri in Columbia, Mo.

Two factors contribute to health literacy. Patients may have difficulty understanding health care information, while doctors may have difficulty explaining medical information in layman's terms for their clients to better understand. This is especially true when there is a language barrier between the doctor and the patient.

The studies found that both those with disabilities and those with limited English speaking and comprehension skills often felt that their health providers did not listen, did not explain treatments and options of treatment, did not involve them in decision making about treatment, and also did not treat them with respect or spend enough time speaking with them.

These perceptions indicate that those who frequently see doctors with disabilities and those who have trouble communicating with their doctors, are missing an important aspect of the provider-patient relationship. Doctors' visits are in part an attempt to understand what is happening in a patient's health, and treat that in the best possible way. Part of this interaction involves the patient's understanding as well.

Those with limited English skills also had limited access to healthcare due to the small number of doctors and practices who are able or willing to provide multi-lingual accommodations for non or limited English speaking patients. This is especially true in rural areas, which already have limited access to good, and specialized, healthcare.

If you are interested in learning more and this research, the findings of these studies were published together in the Disability and Health Journal and will also be published in the Journal of Healthcare Disparities Research and Practice.




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Resource pages

Schizophrenia, Social Security Disability, and Applying for Benefits
How to get Disability Approved
Social security disability appeal
How much does social security disability pay?
Social security disability SSI requirements
How to file for social security disability
Social security definition of disability
Social security disability claim determination

Social Security Disability Claim Denied and what to do about it

If your claim for Social Security Disability (SSD) or Supplemental Security Income (SSI) is denied (and the vast majority, about 70% of those filed each year, are denied) then you should appeal the decision.

This first appeal is referred to as a request for reconsideration, and it is decided by the same agency that denied the initial application, the state disability determination services (DDS). Given the fact that the same organization that denied the initial application is in charge of reviewing the denial, the following statistic should not come as any surprise: about 85% of all reconsideration appeals are denied as well.

So why bother appealing? Well, the purpose of filing a first appeal is not so much that it affords a claimant any real chance of winning, but that it allows the claim to advance to the second level of appeal, which is far more likely to be decided in favor of the claimant. Second appeals are decided by federal administrative law judges (ALJs) who, though bound by the same Social Security rules as DDS examiners, have a lot more discretion when ruling on disability cases.

In addition, at a disability hearing claimants are afforded the opportunity to elaborate on both their symptoms and exactly how those symptoms prevent them from earning a living wage. Claimants also have the option to be represented by a disability attorney at their hearing, which can absolutely improve their chances of winning—about 60% of all disability denials are overturned by ALJs when the claimants have legal representation.

Is it ever a good idea to forgo the appeal and simply start all over with a new claim? Rarely. Unless there is some highly significant new medical evidence, a new claim is likely to yield the exact same result as it did the first time around.

There are some exceptions, however. If your initial claim denial was based on a technicality, such as the fact that you had too many assets, or made too much money at the time, then a new claim makes sense (if your financial situation has worsened).

It’s also a good idea to immediately file a new claim if you have already been turned down by an administrative law judge and are appealing the judge’s decision to the Social Security Appeals Council. The Appeals Council agrees to review very few ALJ decisions, so it’s prudent to go ahead and file a new disability claim while waiting to hear if they will act on a request for review. It’s the only time throughout the entire disability determination process in which a claim can be active at two levels of consideration.



For information on Social Security Disability, visit the

Social Security Disability Benefits Resource Center

Medical Evidence for Social Security Disability

Every decision in Social Security Disability (SSD) and SSI matters is based on a claimant’s medical records, and what they say about his or her ability to work (or not). Because medical records are critical to the outcome of disability cases, some applicants make the mistake of sending in far too much information in an effort to bolster their claims. This is not at all helpful, because it makes the disability examiner or judge’s job that much harder—sifting through a pile of records looking for acceptable medical evidence is both frustrating and time-consuming, when the ideal here is for the claimant to be as helpful as possible in providing a picture of his impairment and functional limitations.

Of course, some if not most people filing for disability don’t really know what types of medical documentation Social Security is looking for, so they figure they’ll throw in everything but the kitchen sink to be on the safe side, unaware that they are wasting everyone’s time and probably delaying a decision in their case.

When submitting medical records for a disability examiner or judge to review, it’s best to send in only medical records signed by a physician or psychologist. Medical opinions from nurses, chiropractors, acupuncturists, homeopaths, etc., are not considered acceptable medical evidence. X-ray films or other test results are not useful unless they are accompanied by a report and an interpretation—disability examiners and judges are not physicians, and do not know how to read these tests.

Pharmacy printouts are also not helpful—any medications you are taking should be covered in the notes or records from the treating physician or physicians.

So what kinds of medical records are useful? Admission or discharge summaries from hospitals, physician notes, X-rays, MRIs, or other test results that are accompanied by interpretive reports are all very useful to those making disability decisions.

Keep in mind that the point of submitting medical evidence is to help prove that A) you have a severe impairment and B) this impairment limits your functional capacity to the point that you are no longer able to earn a living wage. In order to prove these points you must have a written opinion from a physician or other approved medical treatment source that offers details about your symptoms and how they limit your ability to function. This should include how an impairment affects normal daily living activities, such as standing, lifting, walking, concentration, memory, etc., as well as a prognosis (how the medical condition is expected to progress over time).


For information on Social Security Disability, visit the

Social Security Disability Benefits Resource Center

Requesting a Disability Hearing After You are Denied

If you receive an initial Social Security or Supplemental Security Income disability denial, can you file immediately for your disability hearing with an administrative law judge? Unfortunately, no you must begin what is known as the Social Security disability appeal process and it can be a very time consuming arduous journey for disability applicants.

So how does the appeal process work? Well, if your initial claim is denied you begin with the request for reconsideration appeal. Reconsideration appeals generally take thirty to sixty days to receive a disability decision and are for the most the medical decision will be a denial as only about 15 percent of reconsideration appeals are approved. If your reconsideration appeal is denied what can you do? You should keep the disability appeal process moving toward the administrative law judge hearing, where you have the best chance of being awarded Social Security disability benefits. In fact, about two thirds of all disability applicants are awarded disability benefits at an administrative law judge hearing.

Regrettably, you may be waiting along time for your disability benefits if you have to avail yourself of the Social Security appeals process. Average wait times for disability hearings across the nation are months or even years. Social Security is working on reducing this workload, but with more disability applications being file than ever in the past, Social Security is struggling to reduce this workload.

In conclusion, you cannot request and immediate hearing if your claim has been denied. If you plan on winning your disability benefits you will most likely have to avail yourself of the disability appeal process including the administrative law judge hearing to win your disability benefits.



For information on Social Security Disability, visit the

Social Security Disability Benefits Resource Center