Social Securty Disability

How Social Security determines disability 

Social Security follows a five-step process in determining disability:

  • Step One:  Are you working at substantial gainful activity levels
  • Step Two:  Do you have a severe impairment?  An impairment is severe if it significantly limits your ability to work.
  • Step Three:  Is your disability one that is described in Social Security’s Listings of Impairments?  The Listing of Impairments can be found on the Social Security website.  If you meet or equal a Listing, you will be found disabled.  If not, you must proceed to Step Four.
  • Step Four:  Are you capable of returning to your past relevant work?  Past relevant work is work you have done in the last fifteen years.   
  • Step Five:  If you are unable to return to your past relevant work, is there other work you can do, given your age, education, and work experience?  If not, you will qualify for Social Security disability benefits.  

Social Security Disability vs. SSI

In addition to meeting the disability requirements, you must satisfy Social Security’s non-disability requirements.  These requirements differ depending on which programs you are applying for.  Although you may qualify for more than one disability program, people rarely receive benefits from both programs because they offset each other.  The two most common disability programs are Social Security Disability and Supplemental Security Income.

  • Social Security Disability (also called Title II or SSD) is an insurance program.  When you work and pay payroll taxes, it is as if you are paying disability insurance premiums.  In order to qualify for Social Security Disability, you must have paid into the social security system recently enough to be considered “insured” for Social Security purposes.  
    • People who receive Social Security Disability also become eligible for Medicare two years after the date of their entitlement to SSD benefits.
  • Supplemental Security Income (also called Title XVI or SSI) is a welfare program.  To qualify for SSI, you must meet income and resource guidelines.  
    • People who qualify for SSI also qualify for Medicaid.  

Social Security’s appeals process

There are four decision levels within the Social Security Administration:  Initial, Reconsideration, Hearing, and Appeals Council.  Each time you are denied you have 60 days to file an appeal to the next level.  We have all the forms required to file an appeal.  If you are denied at the Appeals Council level, you are entitled to file an appeal in Federal District Court.

  • The Initial and Reconsideration Stages:  At these stages, your case is reviewed by a state agency called Disability Determination Services.  Your case will be assigned to an examiner, who will make the final decision.  The examiner will order updated medical records and consult with a doctor who will review your file and give an opinion about your work limitations.  The odds of approval at these stages of the process are generally less than 30% so don’t be discouraged if you are denied.  Your best chances of approval are at the hearing level.
  • The Hearing:  At the hearing level, an Administrative Law Judge (ALJ) will review the evidence in your file and schedule a hearing.  Prior to the hearing, your attorney will obtain updated medical records and prepare you for the types of questions you can expect to be asked.  At the hearing, you will testify about how your disability prevents you from working.  Your attorney will be with you at the hearing and will ask questions to facilitate your testimony.  
  • The Appeals Council:  The Appeals Council does not take additional testimony, but reviews the records already in the file and the testimony that was taken at the hearing.  The Appeals Council rarely approves benefits; however, it does sometimes send the case back to the ALJ for a new hearing because of errors in the decision.

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