How Are Decisions on SSDI and SSI Disability Claims Made by SSA?

by May 17, 2018General

Home » Blog » Frequently Asked Questions (FAQs) » How Are Decisions on SSDI and SSI Disability Claims Made by SSA?

The Social Security Administration (SSA) uses a variety of medical and non-medical criteria to make decisions on claims for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).

When you apply for SSDI or SSI, your application goes to a disability examiner, or DE, for review. The DE reviews your application along with supporting documentation, such as your medical records and work history, to determine if your condition falls under the SSA’s definition of disability.

The DE also seeks to verify that you meet the SSA’s non-medical qualifications for your chosen program, whether SSDI or SSI. Non-medical criteria include those related to your income, assets, and work history.

A Social Security lawyer from the Disability Advantage Group, can help you put together a strong disability claim that makes a compelling case to the SSA. We offer a free case evaluation to new clients. To schedule a meeting with a member of our legal team to discuss decisions on SSDI and SSI disability claims made by SSA, call 865-566-0800 today.

Social Security Disability Medical Qualifications

When the SSA denies a claim for SSDI or SSI, it is usually because the applicant failed to demonstrate that they met the medical standards of the program. To qualify on a medical basis, you must meet the criteria of a Blue Book listing or meet the medical-vocational allowance Social Security disability or SSI cases.

Blue Book Listing

The Blue Book is a master list of conditions for which the SSA grants automatic approval. The catch is, you must meet all criteria listed under a given situation. The requirements are known for being rigorous and highly specific, with very few applicants qualifying on this basis. If you fail to meet even one out of sometimes dozens of listed criteria, you do not satisfy a Blue Book listing.

Your attorney from the Disability Advantage Group, can evaluate your medical records and other evidence through the framework of the Blue Book listing for your condition and help you determine if it is worthwhile to try to qualify on this basis. Otherwise, you can receive benefits by requesting and being granted a medical-vocational allowance.

Medical-Vocational Allowance

The SSA grants medical-vocational allowances to applicants who do not meet the criteria for a Blue Book listing but are otherwise able to demonstrate that their condition limits them to the degree that they cannot work and earn a living for themselves.

You must demonstrate to the SSA that your condition prevents you from doing Substantial Gainful Activity (SGA). The SSA defines SGA as work that you can do on a consistent basis and earn above a certain level of income. This level changes from year to year. In 2018, the SSA set the SGA threshold at $1,180 per month for a nonblind individual and $1,970 for a blind individual. If you make more than this amount, your application will likely get denied.

To prove your functional limitation, we can have you undergo a Residual Functional Capacity (RFC) test, administered by your doctor. This evaluation provides the closest thing available to objective evidence of the specific functional limitations presented by your condition.

Social Security Disability Non-Medical Qualifications

The SSA also evaluates your claim for non-medical factors, most of these involving your income, assets, and work history. The non-medical criteria differ significantly for decisions on SSDI and SSI disability claims made by SSA.

SSDI Non-Medical Qualifications

SSDI runs like an insurance program. With insurance, you cannot file for benefits unless you have paid premiums. The “premiums” for SSDI come from your payroll taxes. Accordingly, you must have a sufficient work history to qualify for SSDI. Generally speaking, as long as you have worked steadily and full-time for several years leading up to your disability, you should have enough work credits for SSDI and thus not have any issues qualifying on a non-medical basis.

SSI Non-Medical Qualifications

SSI is a benefit program for the needy. To qualify on a non-medical basis, your monthly income and total assets must remain below certain thresholds. For 2018, the maximum allowed monthly income is $750 for an individual and $1,125 for a couple. Total assets must not exceed $2,000 for an individual and $3,000 for a couple.

Your attorney can review your financial statements to determine if you are eligible for SSI on a non-medical basis. Some forms of income and types of assets are excluded from calculation toward the cap.

Call 865-566-0800 Today to Schedule a Free Disability Claim Evaluation at the Disability Advantage Group

The attorneys at the Disability Advantage Group, want to help you win your Social Security disability claim. We understand all the nuances of the SSA and can help you put together a robust application. To schedule a free case evaluation, call our office at 865-566-0800.