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Steps To Your Social Security Disability Claim Evaluation

The federal government pays qualified workers who are or become disabled and their families' monetary benefits known as social security disability (SSD). The Social Security Administration defines a disability as the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. To meet this definition, you must have a severe impairment(s) that makes you unable to do your past relevant work or any other substantial gainful work that exists in the national economy.

So long as a social security claimant has a work history and is deemed disabled by the Social Security Administration, benefits should be awarded. However, proving your disability can be much more challenging than you may have thought. Every day, numerous workers are denied social security disability benefits because it is determined they are not disabled within the meaning of the Social Security rules. The good news is that you typically can appeal this determination.

Your Initial Disability Claim and Determination
If you have been diagnosed with a disabling condition or sustained a disabling injury that prevents you from working, you need to file a claim with the Social Security Administration (SSA) for disability benefits. You can make your claim over the phone or by visiting the nearest SSA office.

Once your claim is filed, the SSA will refer your case to the appropriate state agency known as a disability determination service (DDS). This is where your case will be evaluated and an initial determination will be made. A claims evaluator at the DDS will decide your eligibility for benefits based on a five step evaluation process:

1. Substantial Gainful Activity

The first thing a claims evaluator will look at is whether you are currently working or worked since you applied for benefits. If you are or had been working and making money for your work, then you have engaged in substantial gainful activity (SGA). If you make $1,090 per month or more working, then you have surpassed the SGA limit and will not be entitled to benefits. This is true whether or not you are disabled or severely impaired.

If you do not meet or surpass the $1,090 limit, then the claims evaluator will decide if you are disabled, to what extent and whether you are entitled to benefits.

2. Severity of Your Impairment

The second step in evaluating your claim asks how severe your injury or impairment is. Your impairment must be considered severe enough to qualify as a disability under SSA standards. If you have multiple injuries or impairments that affect your ability to work, the combined effects of these impairments must be deemed severe enough.

Importantly, you must not only show that you have a severe impairment or injury to qualify for benefits, your condition must not be easily correctable or controllable with modern medical advancements. For instance, you may have high blood pressure which can significantly restrict your work; however, your blood pressure can be safely controlled by taking daily medication. In this scenario, the case evaluator will deny your claim because your impairment is not severe enough to constitute a disability.

If your impairment(s) are deemed severe enough, the evaluation will move to step three: meeting the Listing of Impairments.

3. Listing of Impairments

The third part of your disability claim evaluation looks to the SSA's officially compiled List of Impairments. The List contains the most common severe disabilities or impairments and the degree of severity needed for the impairment to cause someone to be disabled according to SSA standards.

If your condition matches one (or a combination) of those contained on the List of Impairments and the required degree of severity to be disabled, you will automatically be entitled to benefits.

If your condition(s) does not match one or a combination of those on the List of Impairments, your claims evaluator will have to review your case to see if you have an impairment similar to those listed. This process is called equaling a listing. The claims evaluator will determine whether your condition should be considered severe enough to constitute a disability under SSA standards. If the evaluator determines that it does, you will be entitled to benefits.

If you do not qualify for disability compensation because your condition does not meet or equal one or a combination of the disabilities on the List of Impairments, your case will proceed to step four.

4. Can You Perform Your Prior Job

Next, your evaluator will look at whether, despite the fact that your condition does not qualify as a disability under SSA criteria, your impairments are severe enough to prevent you from engaging in the type of work you did previously. Obviously, if your case evaluator determines that you can perform the same work, your disability claim will be denied.

However, if it is decided that you can no longer perform your prior job, your claim will proceed to the final step.

5. Can You Do Any Other Job

The final step in evaluating your claim asks whether, despite your condition, there is other work available in the country that you can perform. If your case evaluator determines that there is other, less mentally and/or physically demanding work you can engage in, your request for disability benefits will be denied.

The SSA criterion does not require that the work available to you is of the same type you were doing before, near where you live, or that the work pays similar to as much as you were earning before. All that matters is that some type of work is somewhere available to you.

Importantly, the SSA has no duty or obligation to (and will not) find you a suitable job that you can perform if your disability claim is denied.

Can I Appeal?

If your disability claim is denied, you will likely want to challenge this determination. Luckily, you can appeal the SSA decision denying benefits. Claimants can appeal their denial by asking for a reconsideration of their case by the SSA, appealing the decision to an administrative law judge with the SSA, appealing to the SSA Appeals Council and lastly, you can petition the federal district court to review your case.

Determining whether you are impaired and entitled to disability benefits is not so cut and dry and is based on a claim evaluator's understanding of your condition as compared to SSA standards. If you are considering applying for disability benefits or want to appeal a denial of your disability claim, you need a qualified attorney who knows the SSA rules and regulations. The experienced social security disability lawyers at Murphy & Garner, LLC have decades of experience handling disability cases and will fight for the compensation you deserve. Call us today for a free consultation at (770) 537-5201.

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