To be approved for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), you must submit a claim to the Social Security Administration (SSA). The SSA reviews it and determines if you are eligible for benefits. If the decision is not in your favor, you have access to a multi-step appeals process to try to get it reversed.

You must follow a sequence of steps to be approved for Social Security Disability or SSI. Here is what happens during the initial application review as well as the two main levels of the appeals process.

What Is the First Step in the Process?

The first in the sequence of steps to get approved for disability benefits is to submit an application to the SSA, along with supporting documents that lend evidence to the statements on your application. Good supporting evidence includes your medical records, lab test results, work history, physicians’ statements, and a personal statement.

Upon receiving your application, the SSA forwards it to a disability examiner for review. In reviewing your application, the disability examiner seeks to answer the following questions.

Are You Substantially Gainfully Employed?

If the disability examiner finds that you are able to work and earn a living, they will probably consider you ineligible for benefits. The SSA uses an income threshold to determine whether or not you are capable of working. As of 2018, this substantial gainful activity limit is $1,180 per month. If your gross monthly income from work is higher than this amount, the SSA considers you able to work and ineligible for benefits. If you are applying for SSDI and not SSI, this limit only includes your unearned income. Investment income, dividends, and capital gains will not impact the SSA’s decision on an SSDI application.

Is Your Condition Severe?

SSDI and SSI are for fully disabled applicants. If the SSA judges you to be partially disabled, you will most likely receive a denial. It is critical to prove to the SSA that your condition is severe. How the SSA defines severe is subjective. The best way to demonstrate severity is to offer evidence that your condition:

  • Keeps you from working;
  • Impacts your activities of daily living;and
  • Has lasted or is expected to last for at least one year.

Do You Meet a Blue Book Listing? 

The SSA’s Blue Book lists the medical conditions that qualify for benefits as long as you meet the listed criteria. If you do, you might get approved quickly. Otherwise, the SSA will evaluate your work capacity.

Can You Do the Work You Did Before?

If you do not meet a Blue Book listing, the SSA evaluates your residual functional capacity (RFC) to determine how your condition affects your ability to work. What the SSA first wants to know is whether you can return to your previous employment or any job you have done within the past 15 years. This is why the SSA requires you to submit such a substantial catalog of your work history with your initial application. If you cannot return to the job you just left or any job in your employment history, you might be approved for disability benefits.

Can You Do Any Other Work?

Aside from your work history, the SSA also asks for your educational background, skills, and experience. This is so it can match you up with an internal database of available jobs. The SSA is looking to see if you might be qualified for any job, including those you have not done before. If your condition prevents you from working at any job, the SSA may approve your application.

What Are the Steps of the Appeals Process?

If the SSA denied your initial application, you have two main appeals options. The first is a request for reconsideration. If that is unsuccessful, you can schedule a hearing in front of an administrative law judge (ALJ).

The Request for Reconsideration

This is the first stage of the appeals process. You resubmit your application, plus any additional evidence or documentation that you can produce, for review by a second disability examiner. This will not be the same person who reviewed and declined your initial application.

The ALJ Hearing

If you received a denial on a reconsideration appeal, you can appeal the SSA’s decision face to face with an ALJ. You can even have your attorney present for this process. At the ALJ stage, you have much higher chances of winning disability benefits.

How Can I Schedule a Free Claim Review With a Disability Lawyer?

The Social Security Disability attorneys at the Disability Advantage Group, want to help you fight for the benefits you deserve. Call us at 865-566-0800 today to schedule a free disability claim evaluation.