Applying for Social Security Disability benefits involves more than showing that you have a medical condition. The Social Security Administration (SSA) follows specific rules and evaluates medical, work, and other relevant information to determine whether an applicant meets the requirements for disability benefits.
Understanding the general decision-making process can help you know what information may be important when applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
What Does Social Security Consider a Disability?
For adults, the SSA generally evaluates whether a medically determinable physical or mental impairment prevents a person from performing substantial work and meets the agency’s duration requirements. Social Security’s definition of disability may differ from definitions used by employers, insurance companies, or other benefit programs.
The SSA reviews each claim individually based on the evidence available and the rules that apply to the particular benefit program.
The SSA’s Sequential Evaluation Process
For many adult disability claims, the SSA uses a multi-step evaluation process to determine whether an applicant meets its disability requirements.
1. Are You Working?
The SSA first considers your current work activity. Earnings and the nature of the work being performed may affect whether a claim can proceed under the disability evaluation process.
2. Is Your Medical Condition Severe?
The SSA considers whether your medical condition or combination of conditions significantly limits your ability to perform basic work-related activities. Medical evidence can be particularly important at this stage.
3. Does Your Condition Meet or Equal a Listed Impairment?
The SSA maintains criteria describing certain medical impairments and their required severity. If a condition meets or medically equals the applicable criteria, the applicant may be found disabled, assuming other program requirements are satisfied.
Not meeting a listing does not automatically mean that a disability claim will be denied. The evaluation may continue to additional steps.
4. Can You Perform Your Past Work?
The SSA may evaluate your remaining ability to perform work-related activities despite your medical limitations. This is commonly referred to as residual functional capacity, or RFC.
Your RFC may then be compared with the physical and mental demands of relevant past work to determine whether you can still perform that work.
5. Can You Perform Other Work?
If the SSA determines that you cannot perform relevant past work, it may consider whether you can adjust to other work. Factors such as age, education, work experience, transferable skills, and functional limitations may be considered under applicable SSA rules.
Medical Evidence Can Be Important
Medical documentation helps the SSA understand the nature and severity of an applicant’s condition. Relevant evidence may include treatment records, diagnostic testing, clinical findings, information about medications, and statements concerning functional limitations.
Applicants should provide accurate information about their healthcare providers and treatment so that the claim can be properly evaluated.
SSDI and SSI Have Additional Eligibility Requirements
Meeting the SSA’s disability standard is only part of the eligibility determination. SSDI generally has work-related eligibility requirements, while SSI has financial and other non-medical eligibility requirements.
As a result, two applicants with similar medical conditions may have different eligibility outcomes depending on their individual circumstances.
What If Your Disability Claim Is Denied?
A denied initial application does not necessarily mean that the process is over. Applicants may have the right to appeal an unfavorable determination. Depending on the stage of the claim, the appeals process may involve additional review and potentially a hearing before an Administrative Law Judge.
Deadlines can apply to appeals, so it is important to carefully review correspondence received from the Social Security Administration.
Have Questions About a Social Security Disability Claim?
Social Security Disability rules can be difficult to understand, particularly when a claim involves extensive medical records, past employment, or an appeal after a denial.
If you are applying for disability benefits or dealing with a denied claim in Arizona, you can request information about connecting with an independent Social Security Disability attorney who can discuss your situation and available options.
Have questions about your disability claim? Complete our contact form to learn more about getting assistance with the Social Security Disability process.
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