The disability claims process begins by starting down the path of the 5 evaluation steps. These 5 evaluation steps are about you, your work history, and your disability.

5 step disability eval

But all five steps may not be needed in your case. The disability decision may be made with a denial of your claim at Step 1, 2, or 5, or an award of benefits at step 3 or step 5.

Evaluation Step 1STEP 1: Are you working? If you are working, and your earnings averaged more than $1,000 a month last year, that is considered Substantial Gainful Activity, and Social Security probably won’t consider you to be disabled. Social Security Regulations explain “substantial gainful activity” and whether work activity is not gainful activity, or is done under special conditions or is an unsuccessful work attempt. The “Substantial Gainful Activity” Monthly Earnings Amount for 2017 is $1,170.


$1,070
1980 – 1989
$300
1990 – 1998
$500
1999
$700 (2nd 1/2 of year)
2000
$700
2001
$740
2002
$780
2003
$800
2004
$810
2005
$830
2006
$860
2007
$900
2008
$940
2009
$980
2010 – 2011
$1,000
2012
$1,010
2013
$1,040
2014
$1,070
2015
$1,090
2016
$1,130.

 

The POMS has a discussion and helpful examples of how Social Security decision makers apply the regulations for substantial gainful activity. POMS also discusses special employment situations that are not considered SGA. and explains how Social Security Disability looks at fringe benefits like health insurance and employee bonus plans. Social Security Program Policy Statement talks about whether a person has the ability to engage in SGA.

Evaluation Step 2STEP 2: Is your condition severe? Your impairments must interfere with basic work-related activities for you to be considered disabled. Your physical and/or mental impairment must be determined (proved) by medical evidence. There is a “duration requirement” that says your impairment(s) must have lasted or be expected to last for a continuous period of at least 12 months, or be expected to result in your death.

 

Evaluation Step 3STEP 3: Is your condition found in the list of disabling impairments? Social Security has a listing of impairments for each of the major body systems.  Links to Listings.
If your disability is described in the listing, that automatically means you are disabled. If your condition is not on the list, Social Security has to decide if it is of equal severity to an impairment on the list. If it is, your claim is approved. If it is not, we go to the next step.

Evaluation Step 4STEP 4: Can you do the work you did previously? If your condition is severe, but not at the same or equal severity as an impairment on the list, then Social Security must determine if it interferes with your ability to do the work you did in the last 15 years. If it does not, your claim will be denied. If it does, your claim will be considered further.

 

STEP 5:Evaluation Step 5 Can you do any other type of work? If you cannot do the work you did in the last 15 years, Social Security looks to see if you can do any other type of work. They consider your age, education, past work experience, and transferable skills, and they review the job demands of occupations that were determined by the Department of Labor in a Dictionary that was last updated in 1991. If you cannot do any other kind of work, your claim will be approved.

To answer the 5 questions, Social Security has to review the reports from all of the doctors, hospitals, and clinics that have treated you. Information about any medication you are taking is also important. The law requires Social Security to consider all of the evidence, and all of your impairments, when makes a disability decision. Social Security must look at the combined effects of every impairment. We will explain to Social Security how the combined effects of your impairments prevent you from working.

The person who decides your claim must use the logic of a doctor, a lawyer, and a rehabilitation counselor to decide if you are eligible for benefits. The decision combines your medical records and your work history, and Social Security’s complex regulations and policies.

Getting the medical evidence delivered directly to the person who is deciding your claim is an important part of the service that we provide to you when you become a client. Your disability decision will be made properly as soon as Social Security gets the evidence it needs to answer all 5 questions in your favor. Call (413) 567-5600 for a free case evaluation.