Total Disability - Will social security try to determine if a person is totally disabled?

Yes, both SSD and SSI try to determine if a claimant is totally disabled. In other words, the SSD and SSI disability programs operate under the premise that a person will not be considered disabled and eligible to receive disability benefits unless they are totally disabled, as far as SSA standards are concerned.

What is total disability according to the social security administration? It is the inability of a person to engage in work activity while earning a substantial and gainful wage for at least one full year.

Another way of putting it is that for a person to receive disability benefits in the SSD or SSI program, they must satisfy the following conditions:

1. Their condition (which can be the result of a single mental or physical impairment, or several impairments combined) must be severe. This means that it must be obvious to both the disability examiner (and the medical consultant who works with the disability) that the claimant's condition is more than simply a non-severe impairment, such as a minor sprain, for example. Usually, most conditions will easily meet the litmus test for being "severe"; however, there are some cases in which the claimant is actually denied for having an NSI, or non-severe impairment.

2. The condition must not only be severe, it must be severe enough that it prevents the individual from being able to work at a level that allows them to earn a substantial and gainful income. What is a substantial and gainful income? Social Security defines it as SGA, or "substantial gainful activity", which means earning at least a certain amount each month (to see the current SGA limit). Being able to work and yet not being able to earn at least the SGA amount can mean that a person is disabled according to SSA. On the other hand, being able to work and earn the SGA limit, or more, will always mean that the individual will be denied on their disability claim.

3. The condition must be severe enough that it lasts for a full year. The one year time period is somewhat arbitrary; however, it is used because it is thought by SSA that if a condition is severe enough to make it impossible to engage in substantial work activity for at least a year, the individual's condition is probably disabling, possibly in a permanent sense.

For the purpose of acertaining whether or not a claimant meets the social security definition of disability, a claimant's medical records will be obtained and evaluated by a disability examiner at a agency known in most states as DDS, or disability determination services. DDS is the agency that decides disabiltity claims for the social security administration and Disability examiners render decisions on claims at the levels preceding the disability hearing where the decision is made by a judge.

In addition to using the information from medical records, the disability examiner will review and analyze the claimant's work history to gain insights into whether or not the claimant will be able to return to work they have done in the past, or do some type of other work, utilizing their education and job training.

At the first two levels, the disability application and reconsideration appeal, it is fairly common for disability examiners to conclude that an individual has the capability to return to their past work, or switch to some form of other work. In fact, disability examiners deny up to 70 percent of all the cases that they review for one of these reasons.

For claimants who do get denied based on the presumption that they can still work, their chances of receiving disability benefits will likely hinge on the outcome of a disability hearing. Fortunately, though hearings usually take quite some time to schedule, they offer claimants (and their disability attorneys if they are represented) the opportunity to rebut the conclusion that a return to work is possible. This is done by interpreting the medical evidence and possibly disputing the conclusions that were previously reached by disability examiners as to what the claimant's remaining functional abilities are (disability examiners very often assume that claimants have more physical and mental functionality than they really do and this results in denials of claims).

Refuting the position that a claimant can return to a former job is also done by taking a closer look at how the claimant's past work was categorized since the disability examiners who previously worked on the claim may have determined that the claimant had certain job skills, or levels of job skills, that they, in fact, did not have.

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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