 SSDRC What is the Application Process for Social Security Disability and SSI? How do you Win Benefits under Social Security Disability or SSI? If I am determined disabled, how far back will Social Security pay benefits? How do you prove your disability case if you have a mental condition? What Can I Do to Improve My Chances of Winning Disability Benefits Common Mistakes after Receiving a Denial of Social Security Disability or SSI Benefits How to File for Disability - Tips for Filing If You Get Approved For SSDI Will You Also Get Medicare? How much does a Social Security disability attorney get paid? Social Security Disability SSI Criteria and the Evaluation Process How long does it take to be approved for SSI or Social Security disability? What do you Need to Prove to Qualify for Disability Benefits? Social Security Disability SSI and Fibromyalgia Social Security Disability SSI and Degenerative Disc Disease Can I Qualify For Disability and Receive Benefits based on Depression? Answers to questions about SSD and SSI disability What Disabilities Qualify for SSI and Social Security Disability Benefits? Social Security Disability Status Social Security Disability Tips — how a claim gets worked on Social Security Disability, SSI Disability - Terms, Definitions, Concepts |
How are Social Security Disability Decisions made?How to prove you are disabled and win disability benefits Social Security always evaluates an individual’s work when they file for disability. The definition of disability for Social Security purposes includes the inability to work at a substantial gainful activity (SGA) level for twelve continuous months or the expectation that a person will be unable to perform SGA-level work actvity for twelve continuous months due to a medically determinable mental or physical impairment. SGA, or Substantial gainful activity, is a monthly earnings amount that Social Security sets each year as an amount of earnings that can be considered self-supporting. In fact, Social Security disability is more concentrated on an individual being unable to perform substantial work activity rather than their specific impairment. To reiterate, Social Security always looks at an individual’s work and work history to some degree. Actually, there are plenty of individuals who might meet the criteria established in a Social Security impairment listing (listings are approval criteria for certain mental and physical conditions), but do not qualify for disability benefits because they are still working over the SGA amount. In these cases, it does not matter that the individual meets or equals the strict medical criteria of an impairment listing--their disability claim will be denied for the performance of SGA. In other words, if you work and earn more than the allowable SGA limit, you will be denied disability benefits even if you have a verifiable disabling condition. As far as the social security administration is concerned, if you can work at a certain level, you are not considered to be disabled. How are Social Security Disability and SSI decisions made? Social Security uses a five step sequential evaluation process to make all disability determinations. Step 1 The first step concerns whether or not the disability applicant is performing substantial and gainful work activity. If they are, their disability claim will be denied prior to being sent to a disability examiner for a disability decision. Additionally, an individual’s disability claim could be denied during the disability decision process if they return to work that earns them at least the SGA amount. If the individual is working but it is determined that they are not working at the SGA earnings level, their disability claim moves to the second step. Step 2 The second step is determining if the disability claimant actually has a medically determinable mental or physical impairment. This must be done through objective medical evidence from acceptable medical sources. If the disability claimant does have a medically determinable impairment, Social Security must move to the third step. Step 3 The third step is used to evaluate the severity of the impairment. As was indicated earlier, disability examiners use a listing of impairments to help reach decisions on claims and to evaluate the severity of an individual’s impairment. The social security disability list of impairments is contained in the Social Security disability guidebook, “Disability Evaluation Under Social Security“ (also known as the blue book). The impairment listings address all body systems and establish the medical disability criteria needed to meet the severity requirements for winning disability benefits. If an individual meets or equals an impairment listing, the sequential evaluation process ends here. The disability claimant will be awarded disability benefits. However, many disability applicants do not meet or equal the medical eligibility criteria established in the impairment listings. It is at this point that disability examiners must take a closer look at an individual’s job history or past work. Step 4 involves an evaluation of all relevant work that an individual has done in the past fifteen years. Relevant work is any job the disability claimant had three months or more at which they earned SGA and in which they had time to learn the job. If the disability examiner determines that the claimant can do any of their past relevant work, their disability claim will be denied at this level. Conversely, if the disability examiner determines that they are unable to do any of their past work, they must move on to step five of the social security determination process. Step 5 Step five involves a social security determination as to whether or not an individual can be expected to do some other kind of work considering their residual functional capacity (what they are able to do in spite of their physical and mental limitations), education, age, and the transferability of their job skills. If the disability examiner (or judge if the case is at a hearing) determines that the individual is unable to perform "other work", they may be approved for disability benefits on the basis of a medical vocational allowance, or approval. Medical vocational approvals use age, education, and residual functional capacity to award disability benefits. By the same token, if an individual is found to be able to do other types of work, their disability claim will be denied. 
Return to: SSDRC, or the Questions, Answers, Tips, and Advice page Individual Questions and Answers SSD and SSI are Federal Programs The title II Social Security Disability and title 16 SSI Disability programs operate under federal guidelines and, therefore, the program requirements--medical and non-medical--apply to all states: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming Recent approval and denial statistics for various states can be viewed here: Social Security Disability, SSI Approval and Denial Statistics by state Special Section: Disability Lawyers and unnecessary claim denials |