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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.

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