Understand the Steps in the Process & How to Qualify For Benefits

Once an application has been filed, what happens next?

Social Security takes the application information and sends it to a State Agency called Disability Determination Services (DDS) where a case analyst reviews the applicant’s medical evidence and makes a determination as to whether or not they qualify for benefits under their rules. The Social Security rules of what deems someone disabled is very different from any other governmental or social services agency. The rules are very specific and the burden of proof is quite high.

Determining Total and Ongoing Disability

Social Security does not pay benefits for temporary disability; they determine whether or not a person meets the requirements for total disability. More than 66% of individuals who apply for disability are denied upon the first attempt. Disability Determination Services (DDS) goes through a 5-Step Sequential Evaluation Process in order to determine whether an individual meets the requirements for total disability. This essentially equates to an individual who cannot engage in Substantial Gainful Activity (see more about SGA below) in any job that exists in the United States of America. That is to say, they are not just looking at whether a person can return to the work they have performed in the past, but if there is ANY JOB that exists in the national economy that they could perform on a full-time basis.

Stages in the Disability Process

If denied at the Initial Application Level, an appeal is filed to request that Social Security reconsider their decision. If denied again at the Reconsideration Level, an appeal is filed to request a disability hearing in front of an Administrative Law Judge. Each stage takes approximately 6 to 9 months, sometimes longer, to receive a decision. The whole process from first application to a hearing can take 2 years or more; this is a common occurrence and should be taken into consideration at the outset.

How does Social Security determine whether someone is disabled?

They go through a process called the 5-Step Sequential Evaluation.

Step 1: Financial Eligibility

If an individual earns what Social Security determines to be Substantial Gainful Activity (SGA), then they do not consider that individual to be disabled. SGA for non-blind individuals in the year 2022 was $1,350 in gross wages per month, meaning the amount of earnings before taxes are taken out. SGA for non-blind individuals in 2023 is $1,470 in gross wages per month. In order to pass this first step, if an individual is earning over SGA, they will not qualify for disability benefits, despite the severity of their impairment(s). If an individual is not earning over SGA, then the disability evaluator will go on to Step 2.

Step 2: At Least One Severe Impairment

At Step 2, the evaluator considers the severity of an individual’s impairments. First, an individual must have a medically determinable impairment, meaning a formal diagnosis from a qualified medical provider and/or objective medical evidence that substantiates the individual’s complaints. Second, that impairment must be considered severe. For an impairment to be considered severe, it must interfere with at least one basic work-related activity (physical or mental). Third, to meet the duration requirement the impairment(s) must be expected to last 12 months or to result in death. If the impairment(s) are not considered severe or do not meet the duration requirement, then the individual is found not disabled. If the impairment(s) are severe and meet the duration requirement, the evaluator goes on to Step 3.

Step 3: Impairment Criteria

If an individual meets the requirements for the first two steps, the evaluator will review the individual’s medical records to determine whether the severe impairment(s) match any of the conditions included in the SSA’s Bluebook Listing of Impairments. If there is a match, there are very specific requirements detailed under each Medical Listing. Even if an individual’s impairment is not included in the listings, they may still qualify through an equivalent condition. If an individual has an impairment that “meets or equals” one of the listings and meets the duration requirement, they are found to be disabled. If an individual does not have an impairment that “meets or equals” one of the listings, then the evaluator goes on to Step 4. Before moving to Step 4, the evaluator has to assess the individual’s functional capacity. This functional capacity is then used at Step 4 and Step 5. See link below for complete Listing of Impairments.

Step 4: Individual’s Past Work

At Step 4, based on a review of the objective medical evidence, a non-examining doctor will make a determination as to the most activity the individual can do despite their limitations. This is called the Residual Functional Capacity (RFC). The RFC breaks down how much a person can engage in physical and/or mental activities in a regular 8-hour work day. Next, based on the RFC, the evaluator will determine whether or not the individual can return to any of the work they have done in the past. If they determine that any of the past work can still be performed, the individual is found not disabled. If they determine the past work cannot be performed, the evaluator goes on to Step 5.

Step 5: Capacity to Perform Any Other Type of Work

If an individual cannot perform their past work, the final determining assessment is whether or not there is any other work that individual can perform based on their age, education, career experience, and set of limitations outlined in the Residual Functional Capacity (RFC). Can the individual make an adjustment to any other type of work? If the answer is yes, then the individual is found not disabled. If the individual cannot make an adjustment to any other type of work, they are found disabled under Social Security regulations.

Special Medical-Vocational Rules

There are other special rules that come into play when an individual turns 50 years old and again at 55 years old. It is critical to obtain a qualified representative who understands these rules and regulations in order to build the best case possible.

Get in Touch

Understanding the rules is critical when applying for disability benefits. Jenny knows what it takes to win a case through years of experience, strategy, and know-how. Don’t go through this process alone. Take the next step and reach out to Jenny for a free consultation.

It is free to obtain representation and no payment is collected directly from the applicant. The representative is only paid if the case is WON and Social Security owes the applicant past due benefits, meaning payment back to the date they determine the applicant is eligible. By the time an individual wins their case, there can be months to years of backpay owed. The representative is then paid a one-time, lump sum percentage of the backpay amount.