David G. Schiller represents North Carolina employees in a wide range of employment law cases — including social security disability.
The Social Security Administration (SSA) pays benefits to individuals who have a disability and meet medical criteria. Social Security Disability Insurance pays benefits if you are “insured,” meaning that you worked long enough and paid Social Security taxes.
The Social Security Disability Evaluation Process
The SSA reviews your application to make sure you meet some basic requirements for disability benefits. The SSA checks whether you worked enough years to qualify and evaluates your current work activities.
The SSA office will ask your doctors for information about your medical condition. 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.
The SSA also will ask your 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. In some cases, the SSA may ask you to go for a special examination with another physician who is not your regular treating physician.
How the SSA Decides Whether you are Disabled
The SSA uses five-step process to decide if you are disabled.
- Are you working?
If you are working and your earnings average more than a certain amount each month, we generally will not consider you disabled. The amount changes each year. For the current figure, see the annual SSA Update (current as of January 1, 2013). If you are not working, or your monthly earnings average the current amount or less, the state agency then looks at your medical condition.
- Is your medical condition “severe”?
To be considered 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, you are not considered disabled. If your condition is that severe, the evaluation continues to step 3.
- Is your medical condition on the List of Impairments?
The SSA 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 SSA 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 SSA goes on to step four.
- 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 SSA goes on to step five.
- Can you do any other type of work?
If you cannot do the work you did in the past, the SSA 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.
The SSA’s Decision
The SSA will inform you of its decision by 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.
Appealing the SSA’s Decision
If you disagree with a decision made on your claim, you can appeal it. You have the right to be represented by an attorney.
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