If you experience an illness or medical condition that prevents you from being able to work, you can apply for Social Security Disability (SSD) coverage. SSD is a type of insurance provided by the government to those who can’t continue working because of an injury, illness, or medical condition. However, there are certain criteria that determine how Social Security Disability is decided for each applicant.
Most workers in the United States have paid into SSD their entire lives. The purpose of SSD is to provide assistance for those who need help paying bills and supporting themselves and their families because of their disability. Unfortunately, 70% of SSD claims are denied for various reasons. To prevent this from happening to you, it’s best to:
- Get help from a Social Security Disability lawyer and
- Understand each step in the application review process, which is how acceptance or denial is decided.
5 Steps in How Social Security Disability is Decided
Each Social Security Disability application is sent to and initially processed by the Social Security Administration (SSA). The SSA has local offices as well as state agencies called Disability Determination Services (DDS). If an applicant is denied and appeals it, those are reviewed and determined by either an administrative law judge or a DDS.
Once the application is received, the SSA asks a series of five questions when deciding if you qualify for Social Security Disability.
1. Are You Currently Working?
First, the Social Security Administration (SSA) will look to see if you are working in the current year. If you are indeed employed and making more than an average of $1,220 per month, your application is usually get denied.
If the SSA determines you are not currently working, they will send your application on to the Disability Determination Services (DDS) to handle steps 2-5 in evaluating your medical condition.
2. Is Your Condition Considered “Severe”?
The DDS will look at the condition that has kept you from working. This medical condition must have greatly limited you from performing basic actions like standing, sitting, lifting, walking, and remembering for at least 12 months.
If you do not meet these criteria, the DDS will not consider you disabled. But if you do, they will proceed to the next step.
3. If Your Condition Listed as a Disabling Condition?
The SSA maintains an official List of Disabling Conditions they reference during this step. If your medical condition is on this list, it has been considered severe enough to keep someone from performing “substantial gainful activity.”
There are also certain conditions that can qualify someone for disability as soon as they’re diagnosed. These are known as “compassionate allowances” and include conditions like Lou Gehrig’s disease (ALS), acute leukemia, rare childhood diseases, and adult brain disorders. Other serious conditions can go through a fast-track process where granting disability is decided faster than usual.
If the condition that disables you from working does not appear on the medical conditions list, your application moves to the next step.
4. Are You Able to Perform Past Work?
The SSA now determines whether they think your condition prevents you from performing any past work you used to do. If they decide you can still complete in a past field of work, your application will be denied.
If they determine you can’t do past work, the process moves to the last step.
5. Can You Perform Another Type of Work?
If the SSA agrees you can’t perform work at your most recent job or past work, they will look to see if there’s any other type of work you can perform with your condition. Factors beyond your condition are considered here, including your age, education level, and job skills.
If you’re found to be able to complete other types of work, your application will be denied. But if it’s determined you can’t do any other type of work, it’s decided you qualify for SSD.
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Other Situations That May Qualify
There are certain rare situations where Social Security Disability is decided based on criteria beyond what’s mentioned above. Those include:
- Being blind or having low vision
- Disabled children
- Workers’ widowers or widows
- Wounded veterans and warriors
Each of these follows different rules in terms of how benefits are awarded. If you follow into any of these categories, talk to your Social Security Disability lawyer or local SSA office for eligibility details that apply to you.
What If My Social Security Disability Application Was Denied?
If you received a denial, don’t give up hope. We find many denied applications result from a lack of documentation or not enough information to back up the claim. Just because you were denied doesn’t mean you don’t deserve to receive benefits or have lost your chance. You can appeal—and we can help.
Whether you’ve been denied or need help with your first Social Security Disability application, John Foy & Associates can assist you in the process. We’ve been helping SSD applicants for more than 20 years, and we understand how the system works. We’d love to give you a FREE consultation to talk about details. To schedule your free consultation today, call us at 404-400-4000 or fill out the form on this page.