This practice area covers claims for “Social Security Disability,” Disability Insurance Benefits and Supplemental Security Income (SSI), including assistance with benefit denials, filing appeals and completing paperwork.
Two Types of Social Security Disability Claims
There are two basic types of Social Security disability benefits. They have many similarities, but several distinctions. One is an insurance claim and the other is a welfare program.
The insurance claim is called Disability Insurance Benefits, commonly shortened to DIB. The welfare program is Supplemental Security Income, or SSI. The medical and vocational qualifications are the same for each, but the financial qualifications are completely different.
To qualify for DIB, a person must have worked and paid in, through payroll deductions, to the Social Security system for at least five of the past 10 years. To qualify for SSI, the person must have extremely low household income and assets, but does not have to show any record of paying into the system.
Another major difference between the two types is that people who qualify for DIB benefits receive Medicare coverage. People who qualify for SSI benefits receive Medicaid coverage.
Medical and Vocational Qualification
Once the financial determination is made, and the claimant meets the test for either DIB or SSI, the claimant must then qualify medically and vocationally for a finding of disability. In Social Security disability cases, the claimant must be determined to be totally disabled and unable to be gainfully employed. There is no percentage finding, as in veterans service-connected compensation claims. Social Security is an all-or-nothing system. However, an award of benefits does not require a finding of permanent disability. A person can receive benefits if he or she is disabled for a minimum of 12 months.
These medical and vocational determinations are made in a series of decisions referred to as the Five-Step Disability Determination Process. A claimant must pass each stage in order, move on to the next stage, and finish out the process. If the claimant fails any stage, the process stops and the claimant will be denied benefits. Each step is in the form of a question.
The Five-Step Disability Determination Process
Step 1: Is the person engaging in substantial gainful activity?
If the answer to this question is yes, the person is not disabled. Substantial gainful activity means physical or mental activity performed full-time or part-time for an amount of money in excess of the amount defined as acceptable by the Social Security Administration. That amount for nonblind persons in 2011 is $1,000 per month. A person who is working and earning more than $1,000 per month is not disabled by law.
Step 2: Does the claimant have a severe impairment?
A severe impairment is defined by the Social Security Administration as an impairment or a combination of impairments expected to last more than 12 months and/or result in death, and that significantly limits the claimant’s physical or mental ability to perform work activities
Step 3: Does the claimant have an impairment or combination of impairments that meets or medically equals a listed impairment?
The Social Security Administration listings are a complex compilation of age-factored medical conditions and symptoms. The listings can be found at the Social Security Administration’s website. The listings include both exertional and nonexertional matters. If a claimant’s condition meets or equals the requirements of a listing, the claim is approved. If a claimant’s condition does not meet or equal the requirements of a listing, the claim proceeds to step 4.
Step 4: Can the claimant perform his or her past relevant work?
This question is normally answered by using a medical finding referred to as residual functional capacity. Evidence may come from the claimant’s treating doctors and from a medical expert hired by the Social Security Administration. The claimant can also offer testimony on this point.
If a claimant can still do his or her past relevant work, the claim is denied. If a claimant cannot do his or her past relevant work, the claim proceeds to step 5.
Step 5: Is there any other work in the national economy, given the claimant’s age, education, past relevant work, and residual functional capacity that the claimant could perform?
Vocational testimony is used to make this determination based upon information in the Dictionary of Occupational Titles. At the ALJ hearing there will frequently be a vocational expert who will present evidence regarding jobs available that fit the claimant’s residual functional capacity. It is the duty of the claimant’s lawyer to rebut this vocational evidence.
If a claimant makes it through these five steps, he or she should be declared disabled. Of course, as with any bureaucracy, this does not always happen. In those cases, an appeal may be in order.
The Procedural Stages
There are five stages at which a person may be declared disabled:
- Initial Application
- ALJ Hearing
- Appeals Council
- Federal Court