• Functional evaluation is an important and necessary way of making a decision about a person's ability to work in certain circumstances. However, SSA also needs to give more attention than has been given in the past to issues around the segmentation in the disability population. Different types of people present themselves for disability evaluation, and there are different ways of evaluating disability in relation to where a person is at any moment in time and what his or her future holds by way of improved function or removing barriers.

  • The purpose of a disability benefit program is important to keep in mind. Is it to compensate for the loss of work, or is it in some way a requirement to compensate for the medical condition by paying for anything it will take to get the person back to work, or is there a different threshold, which is to pay enough for replacement of the minimal gainful employment equivalent? This is a policy question and it goes back to the definition of disability. The SSA has a system that only pays one type of benefit, but it does not divide the world into totally disabled and not disabled. It pays for partial disability; a person can earn up to the SGA limit and still be eligible for some benefits.

  • In the private sector there are two different concepts of assessment techniques—contractual obligation and discretionary obligation on the part of the insurer. The contractual obligation involves assessment to decide if the individual meets the test of disability that is in the insurance contract so that the person can get earnings replacement benefits. The purpose of a subsequent assessment, which was quite different criteria, is to determine what additional services this person should have along with assuring that the person is getting appropriate medical care to help him or her get back to work. One of the primary criterion of this assessment is the person's motivation to get back to work. Case management for these individuals starts at the beginning of the process.

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