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.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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

Social Security Disability SSI Criteria