What the Disability Determination Process Looks Like

If you are no longer able to 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, actually getting approved for those benefits is easier said than done because of the lengthy and complicated disability determination process.

The Social Security Administration 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.

This article will cover what you need to know about the disability determination process.

There Are 5 Steps in the Disability Determination Process

To determine whether your medical condition is extreme enough to qualify you for Social Security Disability benefits, the Social Security Administration (SSA) will initially send your application to a network of Disability Determination Service (DDS) agencies, depending on the state you live, and local SSA field offices. If you are denied coverage and appeal your application, that appeal may also go through a local DDS office.

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.

After the field office has evaluated this information, they will send your case to your state’s DDS agency to evaluate 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”. (For blind individuals, that amount is $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.

If you are determined to not have any earnings or you make less than the limit, your applications 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. The examiner will be looking for impairments that impact your ability to mentally or physically function. If your condition limits the work you can do but you can have controlled, such as severe high blood pressure that you take medication to lower, it might not be considered severe.

If you have impairments that are 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 aren’t able to 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 an impairment that is listed. You may also qualify if you have two impairments that are not severe enough alone but counts as severe when combined.

If 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

If your conditions doesn’t meet the criteria of any listing, the person examining your application will determine whether or not your impairments are serious 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.

If it is determined you can’t do your previous type of work, the evaluation continues.

Step 5: Ability to Do Other Types of Work

The examiner or medical consultant will know consider if you’re able to do other types of work despite your impairment. This does not mean they will try to actually 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 truly need help to fall through the cracks. If you need help with your Social Security Disability application or you’ve already been denied, don’t give up hope. A good attorney can help.

Talk to a Social Security Disability Lawyer for Free Today

At John Foy & Associates, we know how overwhelming the Social Security Disability application process can be. Even for those with clear severe disabilities, it can take a strong application to actually 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 they will approve an applicant. To get help from one of our lawyers today, beginning with a FREE consultation, call us at 404-400-4000, or complete the quick form on this page to get started.