How Social Security Disability and SSI benefits are determined
Social Security Disability Insurance, or SSDI (title 2 benefits administered by the social security administration) is awarded to those whose medical records indicate that they--
1) have a severe physical impairment or severe disabling mental illness;
2) that this impairment is severe enough to prevent them from earning an amount equivalent to SGA, or substantial gainful activity (anyone earning more than this will not satisfy SSA requirements to qualify for disability);
3) that their medical condition is not expected to improve to a non-disabling degree, regardless of treatment, for a period of not less than one year.
1. Being Determined Medically Disabled for Social Security Disability
2. If I Am Determined Disabled, How Far Back Will Social Security Pay?
3. Will The Condition You have Determine How Much You Get For Disability?
4. How does Social Security determine the amount of money you receive on disability?
5. Getting a Social Security Disability Determination After Seeing a Psychologist
6. Who makes the Determination of a Social Security Disability Claim?
Supplemental Security Income, or SSI (title 16 benefits administered by SSA) is awarded to those who can prove these three criteria for disability eligibility and also have assets totaling not more than $2,000. This is because SSI is not a type of disability insurance that a worker has paid into, but rather a program designed to help those in financial need, regardless of their work history.
However, it is important to realize that a large percentage of disability claims are denied, not because the individual was not found to have a severe medical impairment, but because a disability examiner determined that, in spite of the fact that their symptoms prevent them from performing their current job, the applicants are still able to perform some type of gainful employment, or other work.
When listing all types of other work an applicant can perform, a disability examiner can include any job that is available in the country. It doesn't matter if the job is available in your town, or state, or if your physical or mental or financial situation makes it possible for you to relocate'as long as somewhere out there exists a job for which you may be qualified, a disability examiner can use this as a basis for denial of your claim.
There are some safeguards built into the system that are supposed to provide a measure of fairness to the disability determination process. A claimant's age, education, and work skills are taken into consideration (in general, those who are older have less employment opportunities, and those who are less educated have less transferable job skills). Another factor that the disability examiner must consider is a claimant's residual functional capacity (RFC), or what he is still capable of doing in light of his impairment. For instance, diagnosis with a mental impairment that causes symptoms of confusion, fatigue, depression, etc., will further limit one's employment opportunities (especially given the unfortunate fact that some employers still discriminate against the mentally ill). Likewise, diagnosis with certain physical impairments may make it difficult to perform any job that includes lifting, sitting for long periods of time, climbing stairs, etc.
Despite these safeguards, quite often a disability denial is based on a disability examiner's decision that the claimant is qualified to perform a job that, for whatever reason, is not a realistic option. There's not much a claimant can do to avoid this possibility at the initial application stage or even at the first level of appeal (all of those who are denied disability have the right to appeal the decision by filing a request for reconsideration) other than filing a detailed work history specifically listing your job skills and past employment.
However, at the second level of appeal, which is a disability hearing before an administrative law judge, an applicant will have the chance to argue, through their disability attorney or non-attorney representative, that the disability examiner did not fairly or realistically assess their employability. Not surprisingly, it is at this second level of appeal that disability applicants have their best chance of being approved for benefits. As many as 60% of all disability denials are overturned by federal administrative law judges.
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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