How SSDI and SSI Claims Are Decided
Once you have applied for Social Security disability benefits, either through an SSDI claim or an SSI claim, depending on your situation, the Social Security Administration (SSA) sends your case file to be reviewed by your state’s Disability Determination Service (DDS). This review is the part of the SSA procedure that is intended to determine whether you are medically eligible for disability benefits; the SSA handles determining whether you are financially and legally eligible. The two agencies work together to go through a series of five steps in order in order to examine all three eligibility types.
Are You Working? How Much?
If you are currently working (or if you have worked at all since you applied for the benefits), the SSA will look at your earnings to decide if you are engaged in “substantial gainful activity,” that is, work. If your earnings are above the limit, which changes from year to year, you will not be financially eligible, even if you meet other requirements. If your earnings are below this line, your claim goes on to the next step.
What is the Severity of Your Impairment(s)?
A DDS claims examiner or medical consultant will examine your impairments limit and whether or not you can work. This information will be given on a range from “incapacitating” to “not severe.” The rating is specifically intended to express whether you can do work, not just whether you have an impairment at all, so the presence of medications, procedures or correctional devices for your impairment will move the rating farther towards “not severe.” If the impairments are rated anywhere above “not severe,” your claim goes on to the next step.
Is Your Disability Listed?
Federal regulations (specifically 20 C.F.R Part 404) include an official Listing of Impairments for SSA disability claims, including a degree of severity for each listed impairment. If any one of your impairments fills the criteria of the listing, both in type and severity, you will be considered legally disabled and eligible for disability benefits without any further steps. The same thing happens if you have an impairment that is not listed, but is determined by your case reviewer to be equally severe as a listed impairment, or if the combined effects of your impairments are equivalent to a listing. If none of these are true, your claim moves on to the next step.
Can You Do Something You Used to Do?
Next, the DDS claims examiner or medical consultant will decide whether your impairments prevent you from doing a job or type of work that you have previously done. If not, you will be considered able to go back to your past work. If you cannot do the types of work that you have done before, your claim moves on to the final step.
Can You Do Something Different?
The DDS next determines whether you can do other types of work that are currently available in the United States, usually work that is either less mentally or physically taxing. The agency does not actually need to identify a specific job, a job in your region or a job with similar wages to your previous jobs–it just needs to confirm that such work exists. If you are over 50 or 55 and have not had any recent job training or further education, you may still receive benefits. If not, the agency will proceed on the assumption that you can adjust to a different type of job and still be able to work and will deny your claim on that rationale.
Denied SSDI claims and SSI claims are not necessarily the end of the process. If your claim has been denied, you still have the option to appeal. You may want to seek legal advice to discuss your options and decide how to proceed with your case.