How does the Social Security Administration determine if you are Disabled?
If you are making a claim to collect Social Security Disability Insurance, the Social Security Administration must first determine that you are actually disabled. There is a five-step process for determining eligibility for benefits:
The first step in applying for disability is for you to submit a claim with the local Social Security Administration field office.
Claims can be filed in person, by phone, by mail or by applying online, but your local office will be the first to process your claim. There they will verify any non-medical prerequisites such as your age, employment and marital status.
If you are applying for Social Security Disability Insurance, they will see if you are engaged in “substantial gainful activity”. There is no income cap for eligibility, if you have passive investment income that does not get counted. However, your earnings must be under $1,170/month as of 2017. If you earn more than that the Social Security Administration will determine you are able to work. Otherwise, your application proceeds to the next step. If you are applying for Supplemental Security Income, then you will face more stringent income requirements. The method for calculating income is complex as it can include your spouse’s income as well as food and shelter family provides to you as “income”. Your income (as calculated by the SSA) must be under $2,000/month to qualify for SSI.
The second step is managed by Disability Determination Services or the DDS, a federally-funded state agency whose main function is to find whether or not Social Security claimants are disabled.
While non-medical eligibility requirements differ between the Social Security Disability Insurance and Supplemental Security Income programs, medical evaluations are made using the same process. The applicant must prove they have a severe disability. The disability must be documented by health care professionals and confirmed by medical records. The DDS will often require the claimant to see a physician for an evaluation.
The third step is to determine if your disability is one of the impairments listed in the Disability Evaluation under Social Security, commonly referred to as the “blue book” or “the listings”.
The listings are a list of every condition eligible to receive benefits. Each condition has a particular set of criteria for determining the presence and severity of the condition.
The fourth step is evaluating capacity for past work. The DDS will evaluate the claimant’s ability to perform tasks associated with their previous jobs.
The level of ability to perform previous work is termed “Residual Functional Capacity” or RFC. If it is judged the claimant has full capacity to complete job-related tasks, they will be denied benefits.
The fifth step evaluates if the claimant is capable of doing any work.
A complex vocational table is used which factors in education, language ability, and age. The table determines if the applicant has capability for doing any work. After this step benefits may finally be approved.