What the Disability Determination Process Looks Like

If you can no longer work because of a disabling medical condition, you may be eligible for Social Security Disability (SSD) benefits. But even if you meet the criteria for SSD, getting approved for those benefits is easier said than done because of the lengthy and complicated disability determination process.

The Social Security Administration (SSA) uses this medical determination process for evaluating each application. Along with the help of a Social Security Disability lawyer, understanding this process can help you improve your application and increase your chances of getting approved.

What Goes Into Disability Determination?

The SSA must determine whether your medical condition is extreme enough to qualify you for Social Security Disability benefits. To do so, it will initially send your application to a network of Disability Determination Service (DDS) agencies, depending on the state you live in and local SSA field offices. 

The field offices receive your application and information about your impairments, treatment, and other relevant information about your disability. This is where non-medical eligibility requirements like your age, Social Security coverage, marital status, and employment are verified.

If you are denied coverage and appeal your application, that appeal may also go through a local DDS office.

Five Steps in the Disability Determination Process

After the field office has evaluated this information, they will send your case to your state’s DDS agency to assess your disability. Here, a medical consultant or claims examiner will look at your case and determine whether you’re medically eligible for benefits.

This process follows specific steps and only looks at the medical side of your eligibility, not the financial or legal factors. If your condition is determined to meet the criteria for disability benefits at any point in the process, the evaluation of your claim ends, and you are granted benefits. Here’s what each step of the disability determination process looks like.

Step 1: Checking for “Substantial Gainful Activity”

The first step of the Social Security evaluation process looks at whether or not you’re currently working or if you’ve worked at all since you sent in your application. If you are employed and make at least $1,220 per month as of 2019. This is typically considered “substantial gainful activity.” An exception exists for blind individuals, which amounts to $2,040 per month or more. 

Making more than the substantial gainful activity amount will consider you unqualified for Social Security Disability, even if you have a medical condition that fits the qualifications. However, if you are determined not to have any earnings or make less than the limit, your application moves to the next step.

Step 2: Severity of Your Impairments

Next, the DDS person looking at your application will determine how severe your impairments are. An impairment is only considered “severe” if it significantly limits the type of work you can do. Therefore, the examiner will be looking for impairments that impact your ability to mentally or physically function. 

If your condition limits your work, but you can have control, such as severe high blood pressure that you take medication to lower, it might not be considered severe. However, if you have impairments that get deemed more than “not severe,” the evaluation moves to step three.

Step 3: Impairment Criteria

During this step, the claims examiner or DDS medical consultant assigned to your case will use the SSA’s Listing of Impairments to determine if your disability is severe enough to meet requirements. If the DDS sees your condition is at or beyond the required level of severity, they would determine you cannot perform a substantial amount of work.

If you have an impairment that isn’t on the Listing of Impairments, it will need to be as severe as a listed impairment. You may also qualify if you have two impairments that are not severe enough alone but count as severe when combined. Suppose you don’t have impairments that are listed or equal to a listed item, the analysis moves to the next step.

Step 4: Ability to Do Prior Work

Suppose your conditions don’t meet the criteria of any listing. In that case, the person examining your application will determine whether or not your impairments are severe enough to keep you from doing the type of work you previously performed. 

If they aren’t severe enough to prevent this type of work, the DDS will assume you can continue doing your previous line of work and will deny your claim. However, if it is determined you can’t do your last type of work, the evaluation continues.

Step 5: Ability to Do Other Types of Work

The examiner or medical consultant will know if you can do other types of work despite your impairment. This does not mean they will try to find another job for you to do. They only have to decide that there is a sufficient amount of work available for you to do.

If the individual assessing your case does believe you can do another type of work, such as something that is less demanding, they’ll deny your claim on that basis. This is one of many places where the justification for denial can get murky and why it’s beneficial to have a Social Security Disability lawyer help you with your application or appeal.

As you can see, the disability determination process is lengthy and looks at several factors before accepting or denying your application. Even if the person evaluating your application has the best intentions, it’s easy for people who genuinely need help to fall through the cracks. 

If you need help with your SSD application or you’ve already gotten denied, don’t give up hope. A good attorney can help.

Disability Rejections From the SSA Happen Frequently 

The disability determination process often results in many rejections, even for those that legitimately do qualify. There are many reasons why the SSA may reject an application. You could be denied if: 

• You have too many past denials or appeals 
• You incorrectly fill out the application or have incomplete information 
• There is evidence that you don’t take care of your health 
• Your disability doesn’t qualify, or the SSA believes it doesn’t qualify 

Regardless of why your rejection happened, know that you have options available to ensure that you still receive your benefits. So, don’t throw in the towel just yet. If you don’t know where to begin or how to approach applying or appealing for benefits, please get in touch with one of our Social Security Disability attorneys today. 

Our Social Security Disability Lawyers Can Help 

While the disability determination process looks overwhelming, it is deceptively simple. However, mistakes can happen that lead to unnecessary delays and unfair rejections. Avoid these errors by partnering with a Social Security Disability lawyer. 

Our lawyers can help you in various ways, including: 

• Ensuring all your application materials are correct and you provide sufficient information and documentation of your disability 
• Guiding you through the appeals process 
• Representing you and your best interests at all times with any party involved in your application or appeal 

With no upfront fees and no obligation, don’t hesitate to contact us as soon as possible. We know you need your benefits, so time is of the essence. Don’t wait too long to get legal help today. Remember, if we can’t help you get your benefits, you owe us nothing in return. 

Talk to a Social Security Disability Lawyer for Free Today

At John Foy & Associates, we know how overwhelming the Social Security Disability determination process can look. Even for those with severe disabilities, it can take a strong application to get approved. That’s where we can help. 

Our lawyers understand the SSD process and know what the Social Security Administration is looking for before approving an applicant. Get help from one of our lawyers today, beginning with a free consultation. Call us or complete the quick contact form on this page to get started.