As a majority of initial disability benefits petitions are denied by the Social Security Administration (SSA), the question of whether one is actually disabled is of critical importance. Many believe that they are entitled to benefits because they can longer hold a particular job, or have not recovered from an injury. However, the SSA follows a specific five step process when determining if disability benefits are appropriate for any given individual. It is important to understand the process before applying for disability.
If you are seeking disability benefits, you must have first have worked in a job covered by Social Security (one where Social Security taxes are paid through regular wages) and earned credits for disability insurance. Then you must have a medical condition that meets Social Security's definition of disability. Essentially, you must have a qualifying condition that prevents you from doing your previous jobs, prevents you from adjusting to other jobs and your condition has lasted (or is expected to last) for at least 12 months.
To reach this determination, the Administration inquires into:
Your current work status - If you are currently employed and earning more than $1000 per month in wages, you are generally not considered disabled. If you earn less than $1000, or are unemployed, the inquiry continues.
The severity of your condition - Your condition must interfere with the basic functions of your job. For instance, if you cannot walk, stand for certain periods of time or compete certain tasks, the inquiry continues. If you can perform the essential tasks for the job, you are generally not considered disabled.
Comparative conditions - The Administration maintains a list of impairments that automatically qualify for benefits. If your condition is not on the list, the Administration must evaluate whether it is of equal severity to a condition that is currently listed.
Previous work - The Administration reviews your relevant work history and assesses whether you can still perform those jobs. This includes jobs you have held in the past 15 years. It compares how you performed the specific tasks in the past with how they are generally performed in the current industry to determine if you are mentally or physically able to do any of your past work.
Other jobs - If you cannot perform your previous jobs, the Administration then determines whether you are able to perform other jobs. It considers your medical condition, along with your age, education level, experience, and any relevant, transferable skills you may have. If you cannot adjust to other work, your claim will be approved. If you can adjust to other work, your claim will be denied.
Necessary Information
It is important to have detailed reports of your injuries. This could include narrative reports from your treating physician, and second opinions from doctors you were referred to for further evaluations. It is also critical that you provide activity recommendations which explain how much you must lift in your employment, how long you are required to stand and/or how long you will be unable to work at all. It is estimated that 60-70 percent of initial claims are denied because information regarding the severity of an injury, or the inability to work, is not properly documented.
In documenting your employability, it is vital to provide information detailing how you performed your previous jobs, including the tasks you performed, how often you worked and any accommodations you received. It is also important to demonstrate that your medical condition altered your ability to work, or your qualifications for the job.
The Appeals Process
A denial during the initial review is not terminal, and it is not a declaration that you will never receive disability benefits. The petition process allows for several levels at which you may appeal a denied disability claim. First, an individual seeking benefits may ask for his or her petition to be reconsidered by someone who was not part of the initial review. If reconsideration is unsuccessful, the petitioner is entitled to a review hearing before an administrative law judge. In this setting, additional information such as medical reports, statements from physicians and documents from employers regarding employability are considered as evidence to prove (or disprove) your disability as a matter of law.
If you have questions or need assistance in petitioning for Social Security disability benefits, an experienced attorney can help.
