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Social Security Disability SSI Criteria and the Evaluation Process

The social security disability and SSI evaluation process is fairly rigorous in a variety of ways. First, there's the sheer amount of time that a claim can take. True, some claimants will be approved for SSDI (social security disability insurance) or SSI disability just within a few months of filing an initial claim. But the majority of claimants will not be so lucky.

For most applicants, the initial claim, or disability application, will result in a denial of benefits. This by itself (for claimants who do not give up on their claim) will necessitate the filing of appeals that will take additional months. And if a disability hearing (the second appeal) is required, then the total amount of time required for a claim can stretch beyond two years. It is not unusual, in fact, for a claim to extend beyond three years before a person is finally awarded disability benefits.

Time makes the disability evaluation process rigorous because, in addition to causing anxiety about one's situation, it also results in financial chaos for claimants. The time factor also, for many claimants, means that while they wait for the claim to resolve, they will go without needed medical coverage (social security disability beneficiaries are eligible to receive medicare while SSI beneficiaries are eligible to receive medicaid).

Another way in which the process is rigorous has to do with the criteria for SSDI and SSI. To be approved for either type of disability benefit (both programs use the exact same criteria), a person's condition must be severe. And it must last for at least one full year. And it must further be severe enough to prevent a person from working at one of their past jobs while earning a substantial and gainful income.

However, while many claimants can surmount these criteria, social security has one criteria that often results in a denial of a claim, particularly at the levels of the system that precede a hearing before a federal judge.

And that criteria is this: a claimant's condition must be severe enough to prevent them from being able to perform "other work" that they have never even done before. Other work is a concept used by SSA and it basically states that if a person can be expected to transfer their job skills to another job (one they have not even done), they can be denied for disability benefits.

Other work is the single step of the five step sequential evaluation process used by SSA that makes it most difficult for individuals to get their claims approved. However, whether or not a claimant can actually transfer their existing job skills to another type of something of a subjective issue.

The "other work" step of the process is also highly dependent on a proper identification of a claimant's past work (for example, there is a substantial difference between being a small truck driver and a tractor-trailer-truck driver, both in terms of skills and exertional requirements).

Unfortunately, depending on disability examiners (the individuals who make decisions on disability applications and request for reconsideration appeals, whereas administrative law judges are the individuals who make decisions on claims at the hearing level) to make subjective judgements that lie in a claimant's favor is usually asking for too much. And this ties into what may be the most rigorous part of the disability criteria evaluation process which is that disability examiners tend to work in a culture of denial.

This can be clearly seen in the fact that seventy percent of all SSDI and SSI claims are denied by disability examiners. Yet, those same claims if they are taken to the level of a hearing before an ALJ (administrative law judge) will stand a better-than-not chance of being approved, particularly when able representation is involved.

Return to:  Social Security Disability Resource Center, or read answers to Questions

Related pages:

When does social security consider you eligible for disability benefits?
Who is eligible for SSI Disability?
Disability Criteria - Eligibility For Social Security and SSI Disability
Can I Be Eligible For SSI And Social Security Disability At The Same Time?
Social Security Disability and SSI Mental Claims and Criteria
Can you apply for disability on the basis of multiple health problems?
What makes a person eligible to receive disability benefits?
Inability to Work and Eligibility for Social Security Disability and SSI Benefits
What makes you eligible for Social Security Disability or SSI?
If You Are Currently Working Are You Eligible To Receive Social Security Disability Benefits?
Will Being A Veteran Affect Your Eligibility And Chances For Social Security Disability?
Are SSD and SSI disability cases decided the same way in terms of Eligibility?
Is the Medical Criteria to Get Social Security Disability or SSI Benefits hard?
Criteria for how Social Security Disability is Awarded
Social Security Disability SSI Criteria and the Evaluation Process

Information on the following topics can be found here: Social Security Disability Questions and in these subsections:

Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI

These pages answer some of the most basic questions for individuals who are considering filing a claim.

Filing for disability - How to file for SSD or SSI and the Information that is needed by Social Security
How to Apply for Disability - What medical conditions can you apply and qualify for?
Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?
What happens if I file a disability application and it is denied by a disability examiner or Judge?
How to Prove you are disabled and qualify to win disability benefits
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
Social Security Disability SSI - Eligibility Requirements and Qualifications Criteria