How Does SSA Examine Your Disability Claim?

If you are chronically injured or ill and cannot continue working, entitlement to Social Security Disability Insurance (SSDI) benefits seems like a straightforward question. The Social Security Administration (SSA), however, must comply with complex federal laws and regulations when handling SSDI claims. The SSA is the federal agency charged with administering Social Security programs.

How do you define disability? 

Many people believe that disability for purposes of SSDI eligibility is similar to the definition used in workers’ compensation or private disability insurance, but it is entirely different. 

To be considered disabled and eligible for SSDI or Supplemental Security Income (SSI), the claimant must have a severe physical or mental disorder (or multiple disorders) that is or are expected to last at least 12 months or result in death. 

When getting Disability Benefits, this condition must prevent the claimant from engaging in “substantial gainful activities,” which means that the person cannot be engaged in employment that pays income in excess of the minimum monthly wage thresholds set by SSA. This amount may vary according to the average national wage level. In 2021, the monthly amount for non-blind people was $1,310. 

So, the bottom line is that if the person’s income is less than the monthly income threshold amount prescribed by SSA, the person may be able to work to some degree and still be considered eligible for SSDI.

Social Security’s evaluation process

The Social Security Administration has established a multi-step sequential assessment process in accordance with the Social Security Act to determine whether you have a disability. 

If SSA determines that you are disabled during the first step of the evaluation process, the evaluation will end and you will not need to proceed to the next step. Social Security Disability Rules After Age 50 are different. So, if you are fifty years of age or older, you can look into the rules relevant to older adults before taking any further steps. 

These are the steps that are followed:

  • A large number of profitable activities 

In the first step, SSA determines whether you are engaged in any profitable activities. Substantial gainful activities (SGA) are defined as work activities that are substantive (important physical or mental activities) and paid (work performed for remuneration or profit). 

If you participate in any SGA, you will not be determined disabled regardless of the severity of your physical or mental disorder and your age, education, or work experience. If you do not participate in any SGA, the SSA proceeds to the second step. 

  • Serious Impairment

In the second step, the SSA determines whether you have a “severe” medical condition, determinable injury or a combination of “severe” injuries. If your ability to perform basic work activities is severely restricted, the damage or combination of damages under SSA may be deemed “serious”. 

If you do not have a severe condition or multiple medically determinable impairments, you may not be determined to have a disability for the purpose of entitlement to SSDI or SSI. If you face significant challenges or numerous obstacles, SSA will proceed to the third step.

  • List of impairments

In step 3, SSA determines whether your injury or combination of injuries and impairments meets or is medically equivalent to the criteria in the disability listing. 

If your condition meets the listed criteria and is expected to last 12 months or longer, or result in death, you may be determined to have a qualifying medical condition and be entitled to receive benefits. If, however, your injury does not meet the listing criteria, the SSA’s analysis will proceed to the next steps. 

  • Residual functional capacity 

Before the next step of the process (which some consider to be step 3.5 or an extension of step 3), the SSA must determine your remaining ability to perform workplace functions. 

Your Residual Functional Capacity (RFC) is your ability to continue to perform physical and mental work activities in a competitive work environment, in spite of limitations imposed on you by your health conditions. 

  • Past Work

In the next step of the process, SSA must determine if, based on your RFC, you can continue to work. They may review previous work experience, including all jobs and occupations you have held in the last 15 years.

If your RFC reveals that your conditions render you unsuitable to perform similar work as you have in the past or are unsuited to perform alternative work, the SSA will precede to the last step. 

  • Other jobs 

During this step, the SSA will determine if you can make adjustments for any other job based on your RFC, age, education, and work experience. If you cannot do other work and meet the other qualifying criteria, you may be found to have a qualifying disability that will entitle you to receive benefits from the Social Security Administration. 

While the process may appear simple and straightforward as it is laid out here, the fact is that it is riddled with hazards and traps for the unsuspecting. 

Contact a Chicago Disability Lawyer to answer all your questions regarding your medical condition and employment. A qualified attorney can assist you with applying for and successfully obtaining disability benefits.

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