Social Security Disability Resource Center
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How the Disability Approval Process works and how your case gets decided
What follows is a concise description of the disability approval process. This is based on my direct experience as a disability examiner, working on Social Security Disability and SSI claims. Reading this will allow you to understand how a case is worked on and how the decision is made. It will also illustrate the importance of your medical records and work history, as well as why you should supply good detailed information about these things when you file for disability benefits.
Before I go further, let me point out again that to qualify for disability, you must have a severe medical condition, it must last at least a year (you can apply for disability before you have had it for a year's time), and it must cause enough physical or mental limitations that you can't work and earn a substantial and gainful income, at your past work, or at any other work.
Now, here are the steps for how your claim will be decided by Social security.
1. After an application for disability benefits is made to social security, the case is transferred to the state agency responsible for making disability determinations, DDS. There, it is assigned to a disability examiner who will evaluate the claim. This is where the disability process really begins.
2. The disability examiner sends requests for medical records to all physicians and medical facilities listed by the claimant on the disability application. After receiving them, the disability examiner will evaluate the records; however, it is important to note that it could take months to receive the requested records back from doctors, hospitals, or other medical professionals. A lot of what a disability examiner does involves tracking down records and making lots of calls to check on requests for records.
3. The examiner may refer to the Social Security impairment listing manual (known as the blue book and published by the social security administration under the title "Disability Evaluation under Social Security") to evaluate the claimant’s physical or mental condition. If you have a medical condition on the list, you may get disability this way. However, most people don't win their benefits this way.
Impairments listed in the manual have strict disability criteria, and even being diagnosed with a listed condition will not necessarily result in approval if the medical records do not support the requirements of the listing.
4. In the majority of cases, a claimant will not be approved on the basis of meeting, or equaling, a "listing" in the manual (such as for depression, a specific form of cancer, or a condition of the spine). If it becomes obvious to the disability examiner that the obtained medical records do not support an approval on the basis of a listing, then the examiner will employ an evaluation method known as "sequential evaluation".
This is really a fancy phrase that means the disability examiner will use both your medical records and work history information to 1. determine what your past work required of you, and 2. determine if you have the ability to still do your past work or switch to some type of other work. Of course, if you can do neither, you may be approved for disability. Using "sequential evaluation" will require that the disability examiner do the following:
A. The examiner will determine what the claimant's residual functional capacity is. RFC, or residual functional capacity is simply an assessment of what a person is still capable of doing. If the claimant has one or more physical impairments, then the examiner will determine a physical RFC. If the claimant has one or more mental impairments, then the examiner will determine a mental RFC. Very often, they do both kinds of RFC assessment.
Just what the heck is RFC, or residual functional capacity, and how is it measured?
Your RFC is what you can still do. To measure it, Social Security looks at your medical records and decides what it is that you can't do because of your condition. Perhaps you have trouble bending at the waist, or reaching overhead, or sitting or standing more than a short amount of time. Maybe you have trouble with hearing, seeing, smelling, or balance. Perhaps you can't move your arm or neck in a certain way, or have difficulty remembering, or learning new things, or being around other people. These things get measured on an RFC assessment. And this measurement allows a disability examiner to decide what kind of work you can, and cannot, do.
If you have physical and mental issues
In many cases, of course, the examiner will determine both a physical and a mental RFC. Will the examiner do this with or without the input of medical and psychological consultants? In most cases, the examiner will be required to consult with either a physician or a psychologist who is part of their claim processing unit before the final RFC determination (or determinations) can be made.
B. After the claimant's residual functional capacity has been determined, the disability examiner will compare this rating (or ratings) to the requirements of the claimant's prior jobs. This will be done to determine if the claimant has the ability to go back to one of their former jobs.
If it is decided that the claimant cannot go back to one of their former jobs, the examiner will investigate the possibility of the claimant switching to some type of other work (that the claimant has never done before). This will be based on the claimant's work skills, as well as their age, education, and residual functional capacity.
C. If it is determined that the claimant cannot do their past work, or do some type of other work, they will be approved for disability benefits under SSD or SSI. If the claimant can do either their past work (any job they have held for an appreciable period of time in the last fifteen years) or some type of other work, then they will be denied on their claim for disability benefits.
There, in a nutshell, is how the disability process works. And this is, for the most part, how a judge will also decide a case at a hearing.
Social Security Disability and SSI Resource Center
The Most Basic questions about Getting Disability Benefits
Social Security Disability SSI and whether or not you can work
Common Mistakes to avoid after being denied for Disability
Social Security Disability SSI Questions and Answers
More Social Security Disability SSI Questions and Answers
Common Questions about Social Security Disability and SSI
Winning Social Security Disability or SSI Benefits
The SSI Disability Benefits Program
Medical exams for disability claims
Applying for Disability in various states
Social Security Disability SSI and Doctors - Yours and Theirs
Social Security Disability and SSI Claim Reviews
Social Security Disability SSI System and Benefits for Children
Denials, Appeals, and Getting a Disability Lawyer or Representative
What you should know about Social Security Disability and SSI Denials
Questions about Disability Lawyers and Hiring a Disability Attorney
Frequently asked questions about getting Denied for Disability Benefits
FAQ on Disability Claim Representation
Disability hearings before Judges
Selecting and hiring Disability Lawyers
Various Types of Benefits including SSI, Mental, and Child benefits
Social Security and SSI based on Mental Disability
Social Security Disability or SSI Benefits for Children
Disability Benefits through Social Security
Filing for Social Security Disability or SSI Benefits
Social Security Disability SSI: Medical Evidence and Records
Filing your claim for disability benefits
Eligibility for receiving disability benefits
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
Resources on this site
Social Security Disability, SSI Terms and Definitions
Previously answered questions regarding SSD and SSI
About the Author of SSDRC, Tim Moore
For Individuals living in North Carolina
Applying for Disability in North Carolina
North Carolina Disability Lawyer
The Social Security Disability Approval Process and the Criteria for Decisions
Disability Approval Chances at the Social Security Reconsideration and Hearing Levels
How will you be notified if you receive an Approval for Social Security Disability or SSI
Social Security Disability, SSI Decisions – What Is the Rate of Approval?
The Social Security Disability Approval
How long does it take to be approved for SSI or Social Security disability?
The Medical Vocational Allowance Approval for Social Security Disability and SSI cases
Can you be denied for disability even if your doctor recommends that you be approved?
When can I expect my first disability check and my back pay check?
Social Security Disability Temporary Benefits and Closed Periods
How to file a disability appeal in New Jersey
If you apply for disability in in New Jersey
These pages answer some of the most basic questions for individuals who are considering filing a claim.
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