When applying for Social Security Disability Insurance (SSDI) benefits, understanding the evaluation process is key. The Social Security Administration (SSA) follows a structured five-step process to determine whether an individual qualifies for disability benefits. This process assesses your ability to work, the severity of your condition, and whether you can adapt to new work environments. Below, we’ll walk you through these steps, so you’ll know what to expect when navigating the system.
Step 1: Are You Currently Working?
The first step in the evaluation process is determining whether you are currently working and, if so, whether your work activity qualifies as “substantial gainful activity” (SGA). In 2024, if you earn more than $1,550 a month, or $2,590 if you’re blind, the SSA will typically determine that you are not disabled. This threshold is meant to distinguish those who are unable to work due to their medical conditions from those who can still engage in work activities.
If your earnings fall below this amount, or if you are not working at all, the SSA will send your application to the Disability Determination Services (DDS) office for further review.
Why It Matters: This step ensures that only individuals who are unable to earn a livable income due to their disability are eligible for benefits. If you’re still working but not earning enough, you could still qualify depending on the severity of your condition.
Step 2: Is Your Condition “Severe”?
The second step looks at whether your medical condition significantly limits your ability to perform basic work-related activities, such as lifting, standing, walking, sitting, or remembering. To pass this step, your condition must interfere with these activities for at least 12 months.
If your condition is not severe, your claim will be denied. However, if your condition does significantly impact your ability to work, the evaluation moves to the next step.
Why It Matters: This step ensures that only those with conditions that seriously impact their day-to-day abilities can move forward in the evaluation process. The SSA wants to be certain that the applicant’s limitations are substantial and prolonged.
Step 3: Is Your Condition on the List of Disabling Conditions?
The SSA maintains a comprehensive list of medical conditions that are considered severe enough to prevent substantial gainful activity. This is often referred to as the “Listing of Impairments.” The list includes conditions that affect major body systems such as neurological disorders, cancers, and musculoskeletal issues.
If your condition matches or is equivalent to a condition on this list, the SSA will generally approve your application for benefits. If your condition is not on the list, the SSA will determine if it is as severe as one that is listed. If your condition is not equivalent to any listed impairments, the process moves to the next step.
Why It Matters: Listing your condition here can speed up the approval process. However, even if your condition is not listed, you could still qualify if it’s proven to be equally disabling.
Step 4: Can You Perform the Work You Did Previously?
If your condition isn’t listed, the SSA will evaluate whether your impairment prevents you from doing any of the work you’ve done in the past. The agency will review your work history and determine if your medical condition stops you from performing tasks you used to handle.
For instance, if you previously worked as a construction worker, but your physical condition now prevents you from lifting heavy objects, the SSA will consider this a valid limitation. If your condition doesn’t prevent you from performing your past work, your application may be denied. However, if it does, the process continues to the final step.
Why It Matters: This step aims to assess whether you can return to any of your previous jobs. If you can no longer perform the same work, you’ll move to the next step.
Step 5: Can You Do Any Other Type of Work?
The final step of the process involves determining whether you can adjust to any other type of work. Even if you cannot perform your previous job, the SSA will assess whether there is other work you could do despite your condition. They will consider factors like your medical condition, age, education, past work experience, and any transferable skills you may have.
If the SSA determines that you are capable of adjusting to other work, they will likely deny your claim. However, if they find that your medical condition prevents you from performing any kind of work, they will approve your application for disability benefits.
Why It Matters: The SSA will take a broader view of your capabilities at this stage. If there is no other work that you can reasonably do given your limitations, your claim is likely to be approved.
What If You’re Denied?
Even if your application is denied at one of these steps, it’s important to know that you have the right to appeal the decision. Many people are initially denied but win their cases during the appeal process. It’s crucial to gather all necessary medical documentation and consult with a disability lawyer who can help you navigate the complexities of the appeals process.
Special Circumstances
In addition to the standard five-step process, there are special rules for certain individuals. For example, individuals who are legally blind have different income thresholds for SGA. Additionally, people with terminal conditions or severe disabilities, such as ALS or certain cancers, may qualify for expedited processing through the Compassionate Allowances or Quick Disability Determinations programs.
Conclusion
Understanding the five-step disability evaluation process is crucial if you are considering applying for Social Security Disability benefits. Each step is designed to ensure that only individuals who genuinely cannot work due to a severe, long-lasting condition receive benefits. If you’re unsure whether you qualify or need help with your application, consulting a disability attorney can be an essential step in ensuring your claim is properly evaluated.
At Collins Price, our experienced disability lawyers are here to guide you through every step of the process. If you’ve been denied benefits or need assistance with your application, contact us today for a free consultation.
This blog post not only outlines the five steps involved in the SSA’s disability evaluation process but also provides potential applicants with insights into what they can expect and how they can improve their chances of approval.