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 HOW SOCIAL SECURITY DECIDES YOUR CLAIM

 

They will review your application to make sure you meet some basic requirements for disability benefits. They will check whether you worked enough years to qualify. Also, SSA will evaluate any current work activities. If you meet these requirements, they will send your application to the Disability Determination Services office in your state.

This state agency completes the disability decision for SSA. Doctors and disability specialists in the state agency ask your doctors for information about your condition. They will consider all the facts in your case. They will use the medical evidence from your doctors and hospitals, clinics or institutions where you have been treated and all other information. They will ask your doctors:

• What your medical condition is;
• When your medical condition began;
• How your medical condition limits your activities;
• What the medical tests have shown; and
• What treatment you have received.

They also will ask the doctors for information about your ability to do work-related activities, such as walking, sitting, lifting, carrying and remembering instructions. Your doctors are not asked to decide if you are disabled.

The state agency staff may need more medical information before they can decide if you are disabled. If more information is not available from your current medical sources, the state agency may ask you to go for a special examination. SSA prefers to ask your own doctor, but sometimes the exam may have to be done by someone else. Social Security will pay for the exam and for some of the related travel costs.

How we make the decision

SSA uses a five-step process to decide if you are disabled.

1. Are you working?

   If you are working and your earnings average more than a certain amount each month, they generally will not consider you disabled. The amount changes each year. For the current figure, see the annual Update (Publication No. 05-10003).

   If you are not working, or your monthly earnings average the current amount or less, the state agency then looks at your medical condition.

2. Is your medical condition “severe”?

   For the state agency to decide that you are disabled, your medical condition must significantly limit your ability to do basic work activities—such as walking, sitting and remembering—for at least one year. If your medical condition is not that severe, the state agency will not consider you disabled. If your condition is that severe, the state agency goes on to step three.

3. Is your medical condition on the List of Impairments?

   The state agency has a List of Impairments that describes medical conditions that are considered so severe that they automatically mean that you are ­disabled as defined by law. If your condition (or combination of medical conditions) is not on this list, the state agency looks to see if your condition is as severe as a condition that is on the list. If the severity of your medical condition meets or equals that of a listed impairment, the state agency will decide that you are disabled. If it does not, the state agency goes on to step four.

4. Can you do the work you did before?

   At this step, the state agency decides if your medical condition prevents you from being able to do the work you did before. If it does not, the state agency will decide that you are not disabled. If it does, the state agency goes on to step five.

5. Can you do any other type of work?

   If you cannot do the work you did in the past, the state agency looks to see if you would be able to do other work. It evaluates your medical condition, your age, education, past work experience and any skills you may have that could be used to do other work. If you cannot do other work, the state agency will decide that you are disabled. If you can do other work, the state agency will decide that you are not disabled.

Special rules for blind people

There are a number of other special rules for people who are blind. For more information, ask for If You Are Blind Or Have Low Vision—How We Can Help (Publication No. 05-10052).

We will tell you our decision

When the state agency reaches a decision on your case, SSA will send you a letter. If your application is approved, the letter will show the amount of your benefit and when your payments start. If your application is not approved, the letter will explain why and tell you how to appeal the decision if you do not agree with it.

What if I disagree?

If you disagree with a decision made on your claim, you can appeal it. The steps you can take are explained in The Appeals Process (Publication No. 05-10041), which is available from Social Security.

You have the right to be represented by an attorney or other qualified person of your choice when you do business with Social Security. More information is in Your Right To Representation (Publication No. 05-10075), which is also available from Social Security.