There are two forms of disability payments through Social Security. One is SSDI or Title 2, which is disability insurance. In order to qualify for this, you have to be disabled and have earned enough work credits. In other words, you have paid into the system. The second is SSI or Title 16, which is supplemental security income. In order to receive this, you have to be below an income threshold and disabled. The key in each of them is that you have to show that you are disabled, and cannot participate in your former work or in any type of work on a substantial gainful basis considering not only your disability or impairments, but also your age, education, and experience.
In determining this, SSA will walk through a five step sequential evaluation process to determine if the individual and his/her disabilities prevent one from obtaining and maintaining “substantial gainful activity” (SGA).
STEP ONE: Is the claimant currently engaged in “substantial gainful activity” (SGA)? In other words is the claimant working? And if so, does the income earned rise above the set allowance for determining what is substantial gainful employment? Currently for 2019, the amount for non-blind individuals as $1,220. Thus if the claimant is making that amount, then the claimant would be denied as SSA would find that they are engaging in SGA. If the claimant is currently not working or earning less than $1,220/month, then SSA would move to step two.
STEP TWO: Whether or not the claimant has a severe disability and how that may or may not effect the claimant’s ability to function? Thus at this level, SSA would list out the disabilities of the claimant and determine, based on the medical evidence, if the claimant’s disability is severe or not. If the disability is severe, SSA will move to the third step.
STEP THREE: Does claimant’s severe disability equal a listing of impairments? SSA has a list of impairments, which are enumerated and defined in detail. If the claimant’s disability meets the impairment on the list, not just by name, but by the definition as found in the list, the claimant will be found disabled. If the disability does not equal a listing although found on the list, then one moves to the fourth step.
STEP FOUR: Here SSA determines how much a claimant is actually able to do on a day-to-day basis such as sit, stand, walk, lift, grip, bend, focus, listen, and climb. There are many other variables, but those are only a few examples. The goal at this step is to determine the claimant’s residual functional capacity (RFC). SSA will look at both physical and mental demands. Once determining the claimant’s RFC, SSA asks if the claimant is able to return to his previous work with whatever limitations are determined? If the claimant is able to return to his or her previous work, then the case is closed and the claimant is not disabled. If the claimant is not able to return to his previous work, then one moves to the fifth step.
STEP FIVE: Are there other jobs in the national economy which can be performed by claimant based on his RFC? Thus taking into account all limitations of claimant to include medical as well as education, age, and prior employment skills, SSA determines if there are any other jobs in the market. Looking at all those aspects, sometimes a claimant may meet a grid listing, which is the Medical-Vocational Guidelines. In the grid rules, one looks at the characteristics of the person (age, education, skill level for employment), and may determine if one is disabled based on those factors alone. If the claimant is unable to transfer their skills from the prior job to another job; or if their RFC prevents them from SGA, the claimant would be disabled.
This is merely an overview of the sequential process that SSA has established. It is important to not only get the medical treatment that you need, but also to find a lawyer who will advocate for you. Thus if you have been denied benefits, call our office so that we may begin working for you immediately. Note that generally one has only 60 days to appeal a decision by SSA. Therefore it is important to call someone who can fight for you.