Disability Determination for Social Security Disability Benefits
Claimants who are working or who have a partial or short-term disability that is not expected to last at least 12 months will not qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Social Security Disability benefits, administered by the United States Federal government, are long-term disability benefits available for claimants who are completely disabled by one or more mental or physical health conditions and are unable to work for at least 12 months.
How does the Social Security Administration make their disability determination? First they will ensure each claimant meets the non-medical criteria for the applicable disability program. Claimants who have enough work credits for Social Security Disability Insurance or meet the resource and income limitations for Supplemental Security Income will have their Social Security Disability application sent to the Disability Determination Services office for further review.
The Disability Determination Services office gathers all relevant medical documentation from the claimants medical sources (hospitals, clinics, doctors statements and lab reports). Social Security Disability claimants who lack the proper medical information to prove their medical claim are sent to a Consultative Examiner for a diagnostic review. The Consultative Examiner is responsible for sending a medical report to the disability examiner for review. After the disability examiner has reviewed the claimants medical case file and the report from the Consultative Examiner, they will make a disability determination.
How is the disability determination made? The disability examiner uses what the Social Security Administration calls the sequential evaluation process to determine disability. The main points of the sequential evaluation are as follows:
- Is the claimant engaged in substantial gainful activity? Work is considered substantial if the claimant is making a minimum amount or $1,000 per month in 2010. Work can, however, be considered substantial even if a profit is not realized. For instance, a self-employed worker may be performing substantial work even if their business operating at a loss.
- Does the claimant have a severe mental or physical health impairment? The claimant can have one or more conditions, and the conditions will be considered in their totality. According to SSR 96-4p, claimants must have a medically determinable condition which can be substantiated by medical evidence. The claimants mental or physical health condition must be expected to last 12 months, but the claimant does not have to wait 12 months to apply for Social Security Disability benefits.
- Is the Social Security Disability claimants condition found in the Social Security Administrations List of Impairments? Claimants with a mental or physical health condition which meets or exceeds a listing will be awarded benefits. Claimants whose condition does not meet a listing must meet the additional criteria listed below.
- Can the Social Security Disability claimant work their past job? All work the claimant has performed within the last 15 years will be considered relevant. It is not unusual for a claimant to be unable to perform past relevant work, but they will only be awarded disability benefits if they can pass the next test.
- Can the Social Security Disability claimant work any other jobs available in the national economy? The Social Security Administration will evaluate a claimants ability to be retrained for additional work based on their age, educational level and work experience. It does not matter if the claimant wants to perform the job or they could be hired, only if they have the residual mental or physical functional capacity to work.
The disability determination process is complicated, and the Social Security Administration has very specific rules and processes they must follow to make a disability decision. If you have questions regarding the disability decision process contact the Social Security Administration or a Social Security Disability lawyer for more information.