How does social security decide if you are disabled
The Social Security Administration has a five step evaluation process called the Sequential Evaluation Process to determine if you are disabled and should qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
Steps in the Sequential Evaluation process
1. Is the claimant performing substantial gainful activity?
When the SSA receives your disability evaluation, before they review your condition, they will determine if you are working and performing what they call substantial gainful activity (SGA work). If you are able to work and earn $1,070 or more a month or $1,800 if you are blind, the SSA will automatically deny your disability claim, regardless of the severity of your condition.
Work can also be considered "substantial" even if it is not "gainful" and you are paid less than the amount listed above. For instance, if you are able to work 40 hours per week this can be considered substantial even if the amount you earn is less than $1,070.
2. Does the claimant have a medically determinable physical or mental impairment which is expected to last for at least 12 continuous months or result in death?
Next, the SSA will review the severity of your condition to determine if it will last at least 12 continuous months. If you have a short-term condition which will not last 12 months, regardless of the severity, you will be denied disability benefits.
3. Does the claimant's condition meet or exceed a listing on the SSA Listing of Impairments?
If the SSA determines you are not performing SGA work and your condition is going to last at least 12 continuous months they will evaluate whether or not your condition meets or exceeds a condition on their Listing of Impairments (also called the Blue Book). If your condition is listed or it is considered as severe as a listed condition, the SSA will determine you are disabled. If not, they will proceed to step 4.
4. Does the claimant's condition allow them the residual functional capacity to perform past relevant work?
The SSA will attempt to determine if you could perform work you have done in the past. If they decide you could return to old employment, they will deny your case. If not, they will proceed to step 5.
5. Does the claimant have the residual functional capacity to retrain for new work?
Finally, the SSA will review your age, education, work experience and ability to retrain for new work to determine if you could work another job. If they determine you do not have the residual capacity to work they will award you disability benefits. If they believe you can another job, you will be denied benefits.
If you are working too much you will be denied benefits. If your condition is short-term, you will be denied benefits. If you do not have enough work credits to be insured for SSDI, you will be denied SSDI benefits. Additionally, if you are young and you cannot prove your condition meets or exceeds a listed condition (Step 3), it will be very difficult to prove you do not have the residual capacity to retrain for some type of sedentary job.
Previous QuestionHow can I increase my SSDI and SSI payment?
Insurance companies may have a specific formula for calculating compensaton for your injuries.
Category: Injury Law