The Social Security Administration (SSA) provides benefit payments to millions of Americans each year. While some of these individuals collect benefits after retirement after paying into the Social Security system during their working years, others collect Social Security disability benefits after sustaining severe injuries or developing medical conditions that prevent them from working. The amount received in Social Security disability benefits and the time frame that payments will continue fluctuate based on numerous factors. Additionally, the SSA enforces very rigid policies regarding the agency’s determination of disability for most claimants.
To qualify for Social Security disability benefits, a claimant must meet the SSA’s criteria for eligibility. The SSA determines eligibility for benefits using a five-step Sequential Evaluation process. If you are preparing to file for SSA benefits or have already done so and need to appeal a denied claim for benefits, it’s essential to know these five steps and what they entail so you can make informed decisions as you navigate the system.
Step One: Determining Substantial Gainful Activity
The first step the SSA takes in evaluating a claimant’s eligibility for Social Security disability benefits is reviewing any “gainful activity” the claimant currently performs. The term “gainful activity” is intentionally broad and generally applies to anything the claimant does for an income. For example, suppose the SSA evaluates a claimant’s finances and determines they are performing any work that generates pay or profit. In that case, they may decide the claimant does not qualify as disabled and will deny their claim for Social Security benefits. However, if the SSA sees that the claimant has not been performing any substantial gainful activity, they will proceed with the next step of their evaluation process.
Step Two: Assessing “Severe” Medically Determinable Impairment
A claimant seeking Social Security disability benefits must prove they have a medical condition or combination of medical conditions limiting their ability to perform basic work activities. SSA generally considers any condition “severe” if it causes any interference with the individual’s ability to perform basic work functions, and the SSA evaluates all related symptoms, including fatigue and pain, in evaluating a condition’s severity. Step two of the determination process also pertains to the anticipated duration of the claimant’s impairment. For example, suppose their condition and the related effects it has on their ability to work is expected to persist for more than one year or result in death. In that case, the SSA will likely qualify the condition as a severe medically determinable impairment.
Step Three: Listing Determination
The SSA eligibility rules uphold a catalog of “listings” that describe various disabilities. Therefore, the third step in the eligibility determination process is for the SSA to determine which listings apply to the claimant’s condition. If a specific impairment or combination of impairments fills the definition of a listing, the SSA will likely determine the claimant to be disabled and approve benefits. Some of the possible listings are very detailed, and an experienced attorney can help their client determine which listings are most likely to apply to their condition or conditions. Additionally, an attorney can be very helpful in gathering the evidence necessary for proving a claimant’s condition or conditions meet the definition of a particular listing.
It’s possible to qualify for multiple listings depending on the scope of your medical impairment and whether you struggle with multiple medical conditions. The SSA will likely want to review relevant documentation from your medical care teams and records that prove your medical condition or conditions have interfered with your ability to perform your previous job duties and secure alternative work.
Step Four: Past Relevant Work
Once a claimant has completed the first three steps of the sequential evaluation process, the SSA will then review the past work the claimant performed and determine whether they possess any “residual functional capacity” to perform those job duties. If the SSA determines that the claimant’s condition prevents them from resuming their previous job duties, the sequential evaluation process will proceed to Step Five. If the SSA determines the claimant retains the ability to perform their previous job duties, the SSA will deny the claim for disability benefits.
Step Five: Alternative Work Review
Social Security disability benefits are meant to support those who cannot work at all. If Step Four of the sequential evaluation process determines that the claimant can no longer perform their previous job duties, the SSA will then coordinate with a vocational expert who can determine whether the claimant can do any other work in any capacity. If Step Five of the sequential evaluation process determines the claimant cannot perform any alternative work, then the SSA will likely consider them disabled and approve disability benefits, potentially including back benefits applicable to the time they developed their condition and stopped working until the SSA approved their claim.
Approach the Sequential Evaluation Process With Confidence
Steps Four and Five of the SSA’s sequential evaluation process are the most likely to lead to a denial. Additionally, there is always a possibility of clerical or administrative issues leading to a denial, and a claimant may not know how to approach these demanding situations. Having an experienced Social Security attorney guide you through each step of the claim process will make it much easier for you and your family to secure the benefits you need when you are unable to work. Legal counsel for your initial claim will eliminate the chance for administrative errors delaying your claim or causing a denial. In addition, your attorney can help you gather the documentation you will need to prove the full extent of your medical conditions and prove they qualify under the SSA’s Listings.
Legal counsel from an experienced attorney will be essential if the SSA denies your claim for any reason. The appeal process is arduous and complex, and your legal team will help you gather all evidence you require to compel the SSA to reevaluate their decision to deny your claim. Finding the right attorney early in the claim process will prove to be an invaluable asset as you work toward securing the Social Security disability benefits you need.