How Does The Social Security Administration Determine Disability?


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How does the Social Security Administration determine disability?

Published on June 6th, 2019 by Eric Slepian

When you apply to the Social Security Administration for Social Security Disability Insurance, it can seem mysterious what the agency is doing behind the curtain to decide if you are disabled and eligible for SSDI.

Remember, disability for this purpose is different from disability for workers’ compensation or private disability insurance. SSDI is essentially public disability insurance that does not pay for partial or short-term disability. Eligibility depends on the presence of a physical or mental medical impairment (or impairments) expected to last at least a year or result in death and that is severe enough to prevent meaningful work.

The SSA has a five-step process for evaluating whether a claimant is disabled for purposes of SSDI:

1. Is the claimant engaging in substantial gainful activity or SGA?

SGA is a low level of average monthly earnings that the agency does not consider financially significant for purposes of SSDI eligibility. The 2019 SGA amount for a claimant who is not blind is $1,220 ($2,040 if blind). If the claimant earns SGA, he or she is not disabled. If not, go to step 2.

2. Is the medical condition (or combination of conditions) severe?

To be severe, the impairment must be medically determinable, restrict basic physical or mental work-related activities and be expected to last at least a year or result in death. If the impairment is not severe, the claimant is not disabled. If severe, go to step 3.

3. Does the impairment meet or equal a listing?

The agency has a list of especially serious impairments that are so devastating that it makes an automatic finding of disability if the claimant’s impairment meets or equals one of them. If a listing is met, the claimant is disabled. If not, go to step 4.

4. Can the claimant return to previous work?

The SSA determines the claimant’s residual functional capacity or RFC, an assessment of the person’s ability to work full time considering restrictions and limitations of his or her physical and mental impairments. Considering the RFC, if the claimant could return to a previous job, he or she is not disabled. If not, go to step 5.

5. Can the person adjust to other work after weighing the impact of the RFC, education, age and experience?

If yes, the claimant is not disabled. If no, the claimant is disabled.

An SSDI attorney can answer questions about the SSA’s definition of disability and the five-step process.

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