The Five Steps Social Security Uses to Decide if You Have a Disability

The Five Steps Social Security Uses to Decide if You Have a Disability

By Thomas Bothwell Social Security offers benefits to people who cannot work because of health problems. That sounds simple enough. But the qualifications for an official “disability” aren’t so simple. And winning benefits is downright hard.

Most people get denied when they first apply.

Then they face a multi­step appeal, including a hearing before a Social Security administrative law judge. After their hearings, people only win benefits 44 percent of the time, according to early 2017 numbers from the Social Security Administration.

If you or someone in your family is going through this process, it can help to learn the five steps Social Security uses to decide what counts as a disability .

At each step in the process – which Social Security calls the “Sequential Evaluation Process (SEP) for Assessing Disability” – claims examiners apply a different test to determine if you have a disability.

The basic definition of a disability is well known: • • • •

You cannot work because of your health.

You cannot do the work you did before.

You cannot adjust to other work because of your medical conditions.

And your disability has lasted or is expected to last at least one year or result in death.

But at every step in the determination process, Social Security examiners could accept or reject your claim based on that on factor, or decide to pass your case to the next step.

Your Disability Case One Step at a Time Here are the five steps Social Security puts your disability claim through: Step #1: Are you working?

In this step, Social Security checks any income you have from work.

For 2017 Social Security says earnings of more than $1,950 a month for those who are blind and earnings of more than $1,170 a month for other disability applicants disqualify your application.

If you’re not able to work enough to earn this much, then your application goes to the next step.

Step #2: Is your physical or mental condition severe?

In this step claims examiners consider the severity level of your medical condition.

Does it keep you from working? Does it meet the duration test of being expected to last 12 months? Is it expected to lead to death?

You will need medical records to confirm the severity of your condition.

Step #3: Does your condition meet the severity of an SSA Disability Listing?

The Social Security Administration maintains a “blue book” listing of impairments that qualify for Social Security Disability benefits.

If your impairment precisely meets the criteria for one of the conditions on the list, or is of equal severity, your benefits will be approved.

If not, the application goes to the next step, but regardless of what particular health condition you have, you’ll get a separate assessment of whether your health keeps you from working.

That is called a “Residual Functional Capacity” assessment. It considers your impairment­ related mental and physical limitations.

This includes factors such as how side effects of medications might reduce your alertness, affect your concentration or cause physical limitations to your ability to work.

Step #4: Can you do your past work?

Do you have the physical or mental ability to do what Social Security calls your “Past Relevant Work?”

Can you do the work as you performed it in the past? Can you do that work as it’s generally performed by others?

For steps one through four, Social Security says the burden of proof is on the applicant to submit evidence of the disability and how it prevents him or her from working.

In Step 5, the Social Security Administration shifts to deciding if your condition should prevent you from doing other work.

Step #5: Can you adjust to other types of work?

If you can make an adjustment to other work, Social Security will determine you don’t have a disability. If you cannot make an adjustment to other work, your case will be approved.

At every step of the process, medical evidence is crucial to your successful disability application.

This includes evidence from medical providers who have treated you. Social Security is looking for “objective medical evidence” that there is an impairment and the impairment keeps you from functioning in a work setting.

Economic Qualifications for Social Security Disability Benefits Aside from the type and severity of your medical impairments, Social Security has financial qualifications for different types of benefits.  

Social Security Disability Insurance pays benefits to those who worked long enough and paid Social Security taxes.

Supplemental Security Income pays benefits based on financial need for people with limited work histories, income and resources.

No matter what, putting together a strong disability application is important to getting benefits approved.

You’re not required to have professional representation, such as a lawyer. But having that representation makes sense. A professional who knows the judges, the doctors, and the local system gives you a greater chance of success.

Thomas Bothwell is a lawyer with Bothwell & Hamill, a law firm that focuses on helping injured and ill people with Social Security Disability and worker’s compensation benefits in Central Washington including Yakima, Kennewick, Walla Walla, and Ellensburg. Thomas specializes in disability cases, focusing on winning benefits for his clients while treating them with honesty, dignity, and respect.