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So You've Submitted Your Claim for Disability Benefits. What Happens Next?

“How Will Social Security Evaluate My Claim?”

When the Social Security Administration’s Disability Determination Bureau receives your claim, they use a 5-step sequential evaluation in order to determine if an individual is disabled or not disabled. Each step can be presented in a question format asked by an adjudicator regarding the individual applying for disability. If the adjudicator finds that the claimant is disabled or not disabled at a step, they make a decision and do not go on to the next. If they cannot make a finding, they proceed to the next step.

Step 1 - Is the Claimant Engaging in Substantial Gainful Activity?

  • For 2016, if you are earning more than $1,130 a month, your claim is denied. For statutorily blind individuals, the limit is $1,820.
  • If you are working full time (40 hours or more) a week continuously, the claim is also denied.

Step 2 - Does the Claimant Have a Medically Determinable and Severe Impairment?

  • To be severe, an impairment or impairments must interfere with basic work-related activities. For example, physical activities such as lifting, carrying, standing, sitting, and walking. Mental activities such as making simple, work-related decisions and dealing with changes in a workplace setting.
  • There is a durational requirement- the impairment(s) must have lasted or be expected to last 12 months or longer, or to result in death.

Step 3 - Does the Claimant’s Medical Impairment or Combination of Impairments Meet or Equal a Listed Impairment?

  • The SSA maintains a listing of medical criteria that are considered to be so severe that if the claimant meets the language which SSA has set forth, they will be found disabled. A claimant’s impairment(s) can be found to meet the listed criteria exactly, or they can be equal in terms of severity.
  • If an individual doesn’t meet or equal a listed impairment, the claimant’s residual functional capacity (RFC) is assessed, which is then used at Step Four and Step Five. An RFC basically summed up- What can the claimant still do, given their impairments? Special note: the RFC does not consider factors such as sex, age, natural body build, or physical conditioning.

Step 4 - Given the Claimant’s RFC, Can They Do Any of Their Past Relevant Work (Work They Did in the Past 15 Years that Was GSA)?

  • Past relevant work is work that the claimant 1) performed at SGA 2) performed in the past 15 years and 3) performed long enough to learn it (reach average performance).
  • At step four, the burden of proof lies on the claimant to submit evidence proving that they cannot perform past relevant work due to their impairment(s).
  • A function-by-function assessment of the claimant’s RFC and past relevant work is done at Step Four. If an individual has the mental and physical capacity to perform any of their past relevant work, they are not disabled. If they cannot or if the individual has no PRW, the claim moves to step 5.
  • Step 4 has two parts: Does the individual retain the capacity to perform PRW as he or she actually performed it? AND Does the individual retain the capacity to perform PRW as generally performed in the national economy?

Step 5 - Given the Claimant’s Age, Education, Work Experience, and RFC, Are There Jobs That Exist in Significant Number that the Claimant Could Sustain on a Full Time Basis? If So, Denied. If Not, Approved for Disability Benefits.

  • Here, the burden of proof shifts to the SSA to show that work, other than the PRW, exists in the national economy in significant numbers.
  • “Significant numbers” are defined as follows: 200 for unskilled sedentary work, 1400 for light work, and 900 for medium work.

Disability Claims Can Be Complex and Difficult, but an Experienced Attorney on Your Side Will Help Your Claim

As you can see, there is a lot of information Social Security needs to gather in order to properly evaluate a claim. If they do not receive all the information they deem necessary to make a decision, they can deny you! Hiring the law offices of Keller & Keller to represent you in your disability claim can make a massive difference. We know what Social Security is looking for and how to get it to them when they need it. We are here to help. Give us a call today to see how we can aid you in your application for benefits.

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