ssdi-help.com | Claim Evaluation

How does the Social Security Administration Evaluated Your Claim?

Sequential Evaluation

Social Security takes your claim through a decision process called a “sequential evaluation.” Think of the “sequential evaluation” as five questions asked in a specific order. Depending on each answer, Social Security decides if your claim is approved, denied or moves to the next step.

The five steps of a sequential process consider each of the following topics in the order listed.

1.current work activity?

2. any severe impairment(s)?

3. any impairment(s) which meets or equals the medical listings?

4. ability to do past work?

5. ability to do other work-considering age, education, training and work experience?

Step 1 – Current Work Activity

If you are not working then your claim goes directly to Step 2. If you are working then Social Security will want to verify your income. If after expenses you are making more than the SGA, sustained gainful activity, then your claim will be denied. Each year the SGA changes, for 2009 it is $980 a month. If you make less than the SGA your claim progresses to Step 2.

Step 2 – Any Severe Impairments

Your disability claims examiner reviews your application to determine if there a “severe” impairment, which is a medical condition that has more than a mild affect on your ability to work. If you don’t have a “severe” impairment, your claim is denied. If you do have a “severe” impairment your claim goes to Step 3. For more information severity of impairments see Definition of Disability

Step 3- Any impairment(s) which meets or equals the medical listings

Social Security maintains a listing of impairments which are described and defined in what is called the Bluebook. This is a list of mental and physical conditions with certain medical findings considered bad enough to prevent a person from doing any significant work activity. If your disability matches listing then your claim is automatically approved. If you do not mach or closely match a listing your claim moves to Step 4.

You can view the adult medical listings at www.ssa.gov/disability/professionals/bluebook/AdultListings.htm.

Step 4 - ability to do past work

26.2% of claims are denied because Social Security determines the claimant is capable of doing past work. The basis for this determination comes from a medical-vocational profile which matches skills and job tasks from the “Dictionary of Occupational Titles” with the medical condition of the claimant (person submitting the application).

The medical-vocational profile includes reports called a Mental or Physical Residual Functional Capacity Assessment Report completed by your doctor or the adjudicative team (a caseworker or a medical consultant). These forms can be found at link Social Security Forms The result of assessment is a set of limitations caused by your current medical condition.

The residual function report describes your limitations as represented by your answers to the application’s questions. The caseworker then compares the report to the description of physical and/or mental abilities required for jobs you did in the past fifteen years.

If the caseworker determines you can still do them despite your current limitations, your claim is denied. If you can’t do past jobs based on your residual capacity then the claim proceeds to Step 5.

Step 5 - ability to do other work-considering age, education,
training and work experience

The largest percentage of claims, 30.7%, are denied at this step. Social Security decides that a claimant is capable of doing any kind of work. Just because you can’t do your past work does not mean you can’t do other work. The determination is made by looking at your past work experience and finding past skills that are transferrable.

It might sound discriminatory but a less educated, older person or someone who doesn’t speak English has a greater chance of being approved than a younger claimant with higher education that speaks fluent English. The basis for these considerations is the ability to adapt to new work environments.

If you are found disabled at step 5, your file is returned to your local Social Security office, and you are sent a letter telling you about your benefits. If you are found “not disabled,” Social Security will send a letter telling you why your claim was denied.