Introduction to the Social Security Disability Insurance claim process
There are significant appeal rights for denied applications. At least for now, we retain our right to collect federal disability insurance benefits if we become disabled and unable to work. We pay into this program through our Social Security payroll deductions and many people do not realize that they have earned federal disability insurance coverage.
Work-history eligibilityIt is important that we all understand the circumstances under which we may become eligible for Social Security Disability Insurance, often called SSDI. First, there are work-history requirements that an applicant has worked recently enough and historically enough over time. Basically, every quarter we work goes into our work-history record with the Social Security Administration or SSA, the federal agency that manages the program. If work-history requirements are met, the SSA looks at whether the claimant meets the definition of disability, which is unique and different than what workers’ compensation or a private disability insurance policy might require.
Disability definition for SSDITo be eligible for SSDI, the claimant must have a serious medically discernable impairment or combination of impairments expected to last at least one year or result in death that prevents the claimant from engaging in substantially gainful activity or SGA (a very low bar measured monthly). Realistically, many applicants are not able to earn anything because of their impairments.
Application processThe application process can be arduous, and most people are denied at the initial application stage. The agency offers a program called Compassionate Allowances, known as CAL, in which SSA flags applications involving certain very serious medical conditions early in the process for quick approval. These conditions are so devastating that the agency has determined that applicants suffering from them can be automatically approved. CAL conditions include rare diseases, fatal cancers, brain disorders and similarly serious impairments. If the applicant does not have a CAL or qualify for another program for fast processing, if he or she is denied, there are several more steps for review of the application:
- Administrative hearing before an administrative law judge or ALJ
- Review by Appeals Council
- Appeal to federal court system
SSA analysisThe SSA analyzes disability using a five-step process:
- Is the claimant engaging in SGA (more than minimal work)? If yes, not disabled. If no, continue.
- Is the physical or mental impairment severe? If no, not disabled. If yes, continue.
- Does the claimant’s impairment meet or equal a condition in the SSA’s Listing of Impairments? (A list of impairments so severe that anyone who meets or equals one of them is disabled.) If yes, disabled. If no, continue.
- Considering the limitations on work activities from the claimant’s impairments, can he or she perform past relevant work or PRW? If yes, not disabled. If no, continue
- Considering the limitations of the claimant’s impairments, age, experience and education, are there jobs in significant numbers nationally that the claimant could adjust to? If yes, not disabled. If no, disabled.