Disability Lawyer Explains SSA Disability Claim Review Process
Watch the following video as our resident Disability Lawyer explains how the SSA reviews Disability claims:
SSA Non-Medical Eligibility Requirements
The non-medical eligibility requirements are different for SSDI (Social Security Disability Insurance) and SSI (Supplemental Security Income).
SSDI Non-Medical Criteria
The SSDI non-medical eligibility requirements consist of what are called work credits. In order to be eligible for the system, you have to pay into it. It's like an insurance policy. As you pay the premiums you eventually become insured under the SSDI program.
Work Credits: Non-Medical SSDI Requirement
- Work Credits are based on payments from your earnings
- A single work credit requirement is $1,470
- A person can accumulate up to 4 work credits per year
- Must earn a total fo 40 work credits
- Half (or 20 work credits) must be accumulated in last 10 years
In other words, you have worked for 10 years, five of those 10 need to have occurred in the last ten years.
For younger individuals who could not have accumulated ten years worth of work credits, the requirement is smaller.
SSI Non-Medical Criteria
The SSI non-medical eligibility requirements are needs-based. Similar to food stamps, you must demonstrate a financial need in order to qualify for the program.
SSI Needs-Based Requirements
The requirements, generally speaking, are different for individuals & couples.
- Individuals with income or assets of less than $2,000 for an individual
- Couples with income or assets of less than $3,000
Next Steps After Non-Medical Requirements
If you meet the non-medical eligibility requirements, Social Security will send your claim to Disability Determination Services (DDS). DDS will make the Initial Application or Reconsideration determinations based on your medical eligibility requirements.
SSA Medical Eligibility Requirements
The definition of disability requires someone to have an ailment that is so severe that it keeps an individual from being able to work to accomplish Substantial Gainful Activity (SGA).
The SSA defines SGA as:
- Working 40 hours a week
- Income of about $1,300 a month
If you're unable to accomplish SGA because of your medical conditions, then you'd meet the medical eligibility requirements.
SSA Disability Benefits 5-Step Decision-Making Process
The SSA runs your disability claim through a 5-step process to determine whether or not you are truly unable to accomplish SGA & meet their definition of disability.
Step #1: Are You Working?
The first step in the process determines if individual is working. If you are working, there is no attorney that can convince a judge that you're unable to work. If you are working, you're not eligible for disability benefits. If you are not working, advance to Step #2.
Step #2: Do you have a severe impairment?
While most disability applicants have a severe impairment, it’s important to emphasize that you must have a severe impairment that prevents you from working. You're not going to get disability benefits for a hangnail. If you have a severe impairment, advance to Step #3.
Step #3: Does your ailment meet a specific disability listing?
The SSA has compiled a database of nearly all qualifying ailments, along with their definitions. For example, let’s say you have a back issue. You can look up disability listings on Google, and you can find out what specific eligibility requirements need to be occurring with your back in order to meet the SSA’s definition.
If you are found to meet or equal a listing, you'll be declared disabled at Step 3. If you're not, the determination process isn't over. You’ll advance to Step #4 if your specific ailment is not listed.
Step #4: Can you return to your past work?
If you are capable of performing your past work, then disability Social Security is going to say you're not disabled. If you are not capable of performing your past work, advance to Step #4.
Step #5: Are there other jobs that you'd be capable of performing?
The SSA’s definition of disability does simply apply to your past work. It requires that you have an inability to do any job. This is not limited to your past work. You must be incapable of accomplishing Substantial Gainful Activity at any job.
If Social Security determines that there are jobs out there that you're capable of doing, with some limited exceptions for the grid rules, then you will not be found to be disabled.
If Social Security determines that you're not able to do any full-time work, then you'll get a Favorable decision.
Disability Lawyer Provides Example
I use the example of a ticket-taker at a movie theater. That person can sit, they can stand, they can alternate between sitting and standing as often as they need to, as long as they stay in that general area. The heaviest thing they have to lift is a ticket, and the most complicated thing they need to know is theater 7 is on their left and Theater 8 on the right. What would keep you from doing a job like that 8 hours-a-day, 5-days a week.
Free Disability Case Assessment
So that's how Social Security runs through the eligibility requirements first is the non-medical. If you satisfy that, then they move to medical criteria. Under that medical question, they'll run it through the 5-step process.
If you feel that you might be eligible for SSDI or SSI, take this free Disability Case Assessment. If you pre-qualify, you'll be able to speak with a Disability Specialist, and possibly receive help with your disability benefits application or In the event you disagree with a decision, you can appeal it. Appeals are common after the initial and reconsideration levels. More.
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