Who Determines If I’m Disabled?

POSTED BY Jon Corra . April 23, 2018

We’ve been helping people get their Social Security disability benefits since 1994. That means we’re approaching our 25th year in business. In these 25 years, we have been asked many questions.  For instance, “Who determines if I am disabled?” This is a good question any individual pursuing Social Security disability should ask.

Although your treating physician may indicate that you are disabled, it’s not a guarantee that the Social Security Administration (SSA) will agree.  SSA will consider the information and determine the amount of weight they feel the doctor’s statement should have on the decision.

So, who does determine if you are disabled?  There is not a simple black and white answer to this question. Instead, there are infinite shades of grey that will eventually determine if you’re disabled or not. The SSA uses a five-step process to determine if an individual is approved for disability benefits.

The first step in the process is simple: they will ask if you are currently working at the current SGA level. For those who may not be aware, SGA stands for Substantial Gainful Activity. The SSA states that SGA is as follows:

A person who is earning more than a certain monthly amount is ordinarily considered to be engaging in SGA. The amount of monthly earnings considered as SGA depends on the nature of a person’s disability. The Social Security Act specifies a higher SGA amount for statutorily blind individuals; Federal regulations specify a lower SGA amount for non-blind individuals. Both SGA amounts generally change with changes in the national average wage index.

So, if you’re engaging in SGA, you will likely be denied at step 1 in the SSA process without SSA even looking at your medical evidence

If you’re not engaging in SGA, your claim will proceed to step 2 in the process: do you have a severe physical or mental impairment or combination of severe impairments?  SSA defines a severe impairment as an abnormality that causes more than a minimal effect on your ability to work.  SSA also requires that your impairment will cause such effect on your ability to work for 12 months or longer.

If SSA deems your impairment(s) to be severe, your claim will proceed to step 3: do you meet or equal a medical listing?  The SSA maintains a listing of medical criteria that are considered to be so severe that an individual is found to be disabled if his or her medically determinable physical or mental impairment(s) matches them.

If an individual has an impairment that meets or equals one of the listings and meets the duration requirement, he or she is found to be disabled. If an individual does not have an impairment that meets or equals one of the listings or the duration requirement is not met, the adjudicator goes to step 4.

Social Security considers many factors when determining if you’re disabled.

In step 4, the SSA will examine your prior work history. Do the limitations associated with your disabilities keep you from doing the type of work you’ve performed in the past 15 years? This is where your doctor’s input becomes very important.  SSA is looking for more information than your doctor’s opinion that you are disabled and can no longer do your past work.  It is beneficial for your doctor to note what limitations you have because of your disabilities.  For example, how long can you sit, stand, walk, lift, and concentrate?  Would you need to elevate your legs and how often/for how long?  Can you interact with the public or with supervisors?  Would you need to be frequently retrained due to problems with concentration or memory loss?  Would you need extra breaks throughout the day and how often/for how long?  If your doctor does not note these types of limitations, the agency adjudicator will determine your limitations based on the information noted within your medical records.  Your doctor, who has probably evaluated you many times, is going to better know and understand your limitations than an adjudicator who is merely reading your medical records.  If it’s decided that your disability does keep you from working in the field you were formerly employed, the SSA will go on to the 5th and final step: can you do any other type of work?

At this point, the SSA wants to know if you will be able to work and achieve the SGA level in a field that differs from any of previous fields in which you were employed in the past 15 years. This can get very complicated.  Your limitations, along with other vocational factors such as age, education and work experience, will be used to determine if you can work in jobs you haven’t done before.  If it is decided that you cannot do your past work or any other type of work, you will be deemed disabled by SSA.

If you believe you may be disabled and need some help with your claim, call us today for a free consultation. Our toll-free number is 1-877-526-3457. If you can’t talk now, fill out this form so we can contact you at a better time.

How Does the RFC form Impact Your Disability Claim?

POSTED BY Jon Corra . December 11, 2017

Anyone who has even considered applying for Social Security Disability will tell you that there are a lot of acronyms. An individual pursuing Social Security Disability or Supplemental Security Income will quickly learn that DDS is an abbreviation for Disability Determination Section. They also quickly find out that ALJ means Administrative Law Judge, and DE is short for Disability Examiner. Even Social Security Administration is typically abbreviated to SSA. But one acronym that many Social Security applicants may not be aware of is RFC.

RFC is short for residual functional capacity. Now that you know what the letters stand for, you’ll likely want to know what it means. Here is how the SSA explains RFC:

“Residual functional capacity assessment. Your impairment(s), and any related symptoms, such as pain, may cause physical and mental limitations that affect what you can do in a work setting. Your residual functional capacity is the most you can still do despite your limitations. We will assess your residual functional capacity based on all the relevant evidence in your case record.”

Essentially, SSA is determining what limitations you may have due to your conditions. For instance, back pain may limit your ability to stand for longer than 4 hours out of an 8 hour day or social anxiety may limit your ability to work with the general public.  SSA will be looking to see if there are still jobs within the national economy that you can do despite the limitations defined within your RFC.

If you have multiple disabilities, SSA will consider the combined limitations established for all of them to determine your ability to work. For instance, your back pain may limit you to only performing sedentary type jobs but your mental health diagnosis also limits your ability to concentrate for longer than 30 minutes at a time.  The physical & mental limitations combined would further reduce the jobs you could perform than only one limitation by itself. That’s why it’s important to list ALL of your disabilities when you apply for benefits. Or, if you’re working with an attorney, you’ll want to make sure they’re aware of all of your disabilities, as well as the ways in which they limit you.

[youtube url=”https://www.youtube.com/watch?v=YOK7KTjXhVs” width=”500″ height=”380″]Now that you understand the basics of RFC, you may be curious as to who determines your RFC. Actually, it’s a combination of people. Disability Determination Services is a state agency, and is the first level of determining disability benefits. DDS has individuals called Disability Examiners who work with a medical consultant to determine your RFC. These individuals consider limitations your doctor has assigned you, such as the inability to stand more than 10 minutes or lift more than 10 pounds. This is why it is extremely important to have your doctor document the limitations along with your symptoms within your medical records.

The RFC is first used to determine if you can do the type of work that you’ve done for the past 15 years. If you’ve done sedentary work for the past 15 years and your RFC states that you can do light work, which is above sedentary work, they will likely suggest that you return to your previous type of work. If the Disability Examiner determines you can’t do your prior job, they will then determine whether, given your RFC, your age, your education, and your skills, you should be able to learn another job.

This can be a difficult process to understand and navigate. That’s why so many people turn to the team at Jan Dils, Attorneys at Law to help them get the benefits they deserve. If you’d like to know more about the services we offer, or if you’d like a free consultation, give us a call today. Our toll-free number is 1-877-526-3457. If you can’t talk to us now, fill out this form so that we may call you at a better time.

SSA Warns of Fraudulent Text Message Scheme

POSTED BY admin . December 02, 2014

According to an announcement from the Social Security Administration, a phishing scheme has launched via suspicious text messages that appear to be related to individuals’ Social Security claims.

These text messages request that people call a number under the guise that they’ll find out information regarding their benefits or claims. These supposed government officials then try to obtain personal information.

If you are a Social Security Disability applicant or beneficiary and your phone displays something of the effect of, “Disability Alert: Please call 253-xxx-xxxx regarding your recent disability benefits application,” you can report the incident to the Social Security Administration at 1-800-772-1213 to verify the validity of any communication.

As a general rule, never provide information such as your address, Social Security number or bank account information to an employee who hadn’t been validated by the SSA. Any suspicious activities like this text message can be reported via the Social Security Fraud Hotline (1-800-269-0271, open from 10-4 EST).

If you have questions about benefits, the Social Security Disability attorneys of Jan Dils, Attorneys at Law, have years of proven experience for every step of the process. You can schedule a free initial consultation by calling toll-free 1.877.526.3457 or by sending us an e-mail.

SSA Warns of Fraudulent Text Message Schemes

POSTED BY admin . November 28, 2014

According to an announcement from the Social Security Administration, a phishing scheme has launched via suspicious text messages that appear to be related to individuals’ Social Security claims.

These text messages request that people call a number under the guise that they’ll find out information regarding their benefits or claims. These supposed government officials then try to obtain personal information.

If you are a Social Security Disability applicant or beneficiary and your phone displays something of the effect of, “Disability Alert: Please call 253-xxx-xxxx regarding your recent disability benefits application,” you can report the incident to the Social Security Administration at 1-800-772-1213 to verify the validity of any communication.

As a general rule, never provide information such as your address, Social Security number or bank account information to an employee who hadn’t been validated by the SSA. Any suspicious activities like this text message can be reported via the Social Security Fraud Hotline (1-800-269-0271, open from 10-4 EST).

If you have questions about benefits, the Social Security Disability attorneys of Jan Dils, Attorneys at Law, have years of proven experience for every step of the process. You can schedule a free initial consultation by calling toll-free 1.877.526.3457 or by sending us an e-mail.

Can I Receive Disability Insurance If I’m Eligible for SSI?

POSTED BY admin . November 18, 2014

Many of our clients ask us if they can receive Social Security Disability Insurance (SSDI) once they are deemed eligible for Supplemental Security Income (SSI).

Most of the time, the answer is no. You must be insured for SSDI and meet several stringent qualifications in order to receive those benefits. It’s also imperative that you have worked and paid payroll taxes for five years of the last decade before you became disabled.

Even if you receive SSI and suffer from disabilities but don’t qualify for SSDI, you still have valuable benefits in the SSI program such as better prescription coverage through Medicaid. For more about the differences between SSI and SSDI, you can check out our FAQ page by clicking here.

If you have questions about benefits, the Social Security Disability attorneys of Jan Dils, Attorneys at Law, can guide you based on years of proven experience. To contact us for a free initial consultation, please call toll-free1.877.526.3457 or send us an e-mail for a prompt response.

The Trial Work Period for Social Security Disability Insurance

POSTED BY admin . October 24, 2014

The Social Security Administration can test a Social Security Disability Insurance (SSDI) recipient’s ability to work through what’s known as a Trial Work Period (TWP). This allows individuals to ease back into the workplace if they are able without risking their eligibility for benefits.

Specifically, a Trial Work Period lasts for nine months (across a span of sixty rolling months) in which the individual can test their ability to work while keeping full SSDI benefits. The amount earned during this period does not affect benefits, but in order for a month to count toward the nine, the worker must have earned a gross income greater than $750, or 80 hours of self-employment.

If a recipient completes a successful Trial Work Period, he or she then moves on to an Extended Period of Eligibility, which determines if he or she can work at a rate of $1040/month, the Substantial Gainful Activity level.

Once this level is achieved, SSDI benefits will cease unless the individual’s income dips below that mark during the Extended Period of Eligibility. If the recipient is unable to earn above $1040 after a period of 36 months, he or she will receive benefits until reaching that threshold or until medically declared able to resume work responsibilities.

If you have questions about benefits, the Social Security Disability attorneys of Jan Dils, Attorneys at Law, can guide you based on years of proven experience. To contact us for a free initial consultation, please call toll-free1.877.526.3457 or send us an e-mail for a prompt response.