No one wants to find themselves needing Social Security Disability benefits. But if you or a loved one have or are considering filing for disability benefits; you should become familiar with the basics of social security disability rules and law. Disabilities can be mental, physical, or a combination of both, and can occur from slowly over time as with a deteriorating condition, or immediately, such as getting injured in a car accident.
Applicants can file for disability benefits in person, online, or over the phone with the Social Security Administration (SSA). Applicants will need to provide information about past work, limitations, activities of daily living, and medical providers (for requesting medical records). Once the SSA has all the information they need, they will issue an initial determination.
If you fail to complete all the necessary paperwork or provide all the information, you will likely be denied benefits. In that instance, depending on where you live, you may request reconsideration of the decision or immediately request a hearing before an Administrative Law Judge (ALJ).
You have a right to representation at your disability hearing. If you’re denied after the hearing, the you can appeal the decision to the Appeals Council. If denied at the Appeals Council, you will have exhausted all administrative remedies, and can then appeal the decision in federal court.
Medical versus Non-Medical Guidelines
To be eligible for Social Security Disability benefits, you must meet both the medical and non-medical guidelines. The non-medical guidelines determine which kind of disability benefits you can apply for. There are Social Security Disability Insurance benefits, which are based on whether the applicant has worked and paid into the system and is therefore insured. Disabled Widow/Widower Benefits looks to a deceased spouse’s work credits where the surviving spouse is over the age of 50. Disabled Adult Child benefits look to whether a child of a deceased or disabled parent with enough work credits is found to be disabled before age 22. Supplemental Security Income (SSI) is based on your household income and resources.
The medical guidelines are set out in a five-step analysis and are determined based on your medical records, your own reports of medically based limitations, and even possibly a medical examination requested by Social Security.
The Five-Step Analysis
The first step is determining whether the applicant is performing “substantial gainful activity,” meaning whether they are working and earning money. Though non-income earning work can be considered, typically the threshold for this amount is $1,260 for non-blind disabled applicants in 2020. If the applicant is earning more than the threshold through work (not by passive income), then the applicant will be considered not disabled and the analysis ends there.
The second step in the analysis is determining whether the applicant has a “severe” medically determinable impairment. The impairment must be medically determinable, meaning there must be some medical diagnosis of a condition. If the applicant cannot afford medical treatment, social security may send the applicant for an independent medical examination to determine if a diagnosis is appropriate, and if so, how severe it is. The test for severity is low, requiring only that the condition imposes any more than a minor limitation in someone’s ability to work.
The third step is applying the Listing of Impairments to the severe medical impairments. There is a separate set of listings for adults and children. The Listings are descriptions of certain medical conditions and testing requirements to conclude that the impairment is severe enough to conclusively end the analysis. If none of the applicant’s impairments meet or equal a Listing, then the analysis continues.
Before the fourth step is reached, the decision-maker determines the applicant’s “residual functional capacity” (RFC) based on the medical evidence, any medical provider’s opinions in the file, and the applicant’s own statements. The RFC is the most physical and medical capabilities of the applicant based on what the applicant could do over the course of a typical workday and workweek.
The fourth step is applying the RFC to the applicant’s past relevant work, or work that had been performed long enough to learn the job in the last 15 years. If the decision-maker determines that the applicant can perform past work, then the evaluation ends there, and the decision-maker will find the applicant not disabled. However, if the decision maker determines that the applicant cannot perform past work, the decision-maker will move to the final step.
The fifth step is determining whether there exists any other work that the applicant could perform in the national economy, given their limitations, education, age, and past work experience. Often the decision-maker will consult with a vocational expert to make this determination.
In determining whether the applicant can perform other work, the decision-maker will also apply the grid rules. The grids consist of a chart for sedentary, light, and medium exertion levels. Starting at age 50, the applicant can be found disabled if they could perform other work but are limited to the sedentary level. The grid level changes to light at 55 years old, and medium at 60. These rules recognize that as a person ages, they are less likely to get work.