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What is the Disability Determination Process the Social Security Administration (SSA) uses to determine if you are eligible for Disability Benefits?

SSA’s Sequential Disability Determination Process can cover up to 5 steps and is based off of combination of financial, medical, and vocational criteria. Initial disability determinations are based on these 5 steps.

Step 1: The SSA will initially want to determine if a claimant is currently working or engaged in what is referred to as substantial gainful activity (SGA). In most disability claims, applicants with earnings above the SGA threshold amount are denied on the grounds that their current earnings have indicated that they are not disabled.

Step 2: If a claimant is determined not to be engaging in substantial gainful activity (SGA) a medical screen is in place to determine if a claimant has any physical or mental impairments or combination of impairments of adequate severity making them unable to engage in substantial gainful activity (SGA). If the medical screen shows evidence of a “non-severe” impairment the DDS will determine that an applicant is “not disabled”.

Claimants can also be denied disability benefits if the impairments that have do not pass the SSA’s duration test. If a claimant’s impairment is not expected to result in either death or has not lasted 12 months and is not expected to last for a continuous period of 12 months their application will be denied.

Step 3: If the claimant passes Step 2, a medical screening is in place to further evaluate the claimants who are more severely disabled. The evidence from the medical screen on a claimant’s impairment is further assessed using specific clinical criteria from the “Listing of Impairments”, which has over 100 listed impairments. Claimants’ impairments that are found in the listings are awarded disability benefits with no further steps or evaluation necessary. If an applicant has an impairment that is not included in the Listing of Impairments, but is considered as a medical equivalent to any of the impairments listed, it is then stated that the impairment would “equal the listings” and the applicant would also be awarded disability benefits.

Step 4: At Step 4, the Disability Determination Service (DDS) considers if a claimant’s residual functional capacity (RFC) allows them to meet the requirements of his / her previous relevant work.

The DDS’s evaluation of an applicant’s Residual Functional Capacity (RFC) will determine if a claimant can perform work related activities that are associated with his / her previously held jobs. The DDS can go back 15 years to look at jobs that an applicant had held to determine if they can perform in any of these occupations.

Applicants that require a Residual Functional Capacity (RFC) score to continue their application will be examined. The DDS can determine what if any of the 5 Levels of work an applicant is capable of. There are 5 different levels of work:

Sedentary: work that requires a person to sit, stand, or carry objects less than 10 lbs.
Light: work that requires more frequent walking and standing, in addition to requiring you to be able to lift objects up to 10lbs.
Medium: work that can require lifting from 25 lbs up to 50 lbs.
Heavy: work that would require you to more regularly lift 50 lbs and up to as much as 100 lbs.
Very Heavy: work that would require you to regularly lift 50 lbs and also be able to list 100 lbs by yourself.

Claimants who are found able to perform past work will be denied. Claimants that are found not able to perform past work are moved on for further evaluation in Step 5.

Step 5: If a claimant is found not able to perform a previously held occupation the DDS will try to determine if they can successfully perform other jobs that are currently available within the United State’s economy. Residual Functional Capacity (RFC) is still considered during Step 5 along with other vocational factors such as: education, age, and previous work experience. These additional vocational factors will help determine whether the claimant can perform in jobs other than those that he / she previously held but that are consistent with his / her residual functional capacity (RFC). At the conclusion of Step 5 claimants are either awarded or denied disability benefits.

Let the team at Coastal Disability know if you have any questions regarding how to successfully navigate the disability determination process and get the money you are owed!

Filing a disability claim can be a frustrating process. Let us help. We don’t get paid unless you do.

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We often get questions at Coastal Disability about whether a claimant could qualify for Supplemental Security Insurance benefits.

First, let’s look at the difference between Social Security Disability Insurance (SSDI) benefits and Supplemental Security Insurance (SSI) benefits: SSDI is the program designed for claimants who have a fairly steady work record, and have paid into the disability fund through payroll deductions (FICA taxes). If you have not accrued at least 40 quarters of coverage during your career, or if you have not worked in the last five years, your coverage for SSDI may have lapsed. Your local Social Security field office can let you know what your date last insured is.

If you don’t qualify for SSDI, you should look into whether you qualify for SSI. A professional representative from Coastal Disability can help you with how to do this. SSI qualification is what is referred to as “needs-based”, meaning it is not based on your work record but rather on your financial need. So this means that having too much in the way of cash or bank accounts, or too much in the way of property (home, land, automobiles, etc.) can disqualify you from the SSI program. At Coastal Disability, we can show you how some of your assets may be excluded based on the Code of Federal Regulations. The maximum value of cash and property for an individual is $2000 dollars, and for a couple it is $3000 dollars.

The other difference between SSDI and SSI is that in an SSDI claim, the alleged onset date of disability can be back-dated as much as 17 months prior to the date of application; with an SSI claim, the date of the application will become the onset date of the disability if you win benefits, which can mean you may be entitled to less retroactive benefits.

Coastal Disability is experienced at helping clients file for and win both SSDI and SSI benefits, in fact, our success rate is 97%!

Filing a disability claim can be a frustrating process. Let us help. We don’t get paid unless you do.

Get Help Now