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How Does the Social Security Administration Determine If You Are Disabled?

In a previous post, we outlined, the disability process. But how does the Social Security Administration (SSA) define disability and determine if someone meets the criteria of being disabled?

Disability is defined as "the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. To meet this definition, you must have a severe impairment, which makes you unable to do your previous work or any other substantial gainful activity which exists in the national economy."

That's a long definition.

In brief, disability is:

(1) Inability to do any substantial gainful activity

(2) Because of a physical or mental impairment

(3) Which is expected to last for at least 12 months, or even result in death.

The SSA uses a 5-step process to determine if someone is disabled:

(1) Is the person working?

If the person is earning more than $1,220 per month, then he/she is not disabled.

(2) Is the condition severe?

This is the 12 month requirement noted above in the definition of disability. If the condition isn't expected to last for more than 12 months, it's not considered severe and the person won't meet the definition of disabled.

(3) Is the condition found on the list of disabling conditions?

In essence, the SSA is determining if your condition prevents you from completing substantial gainful activity (SGA).

(SGA is an important concept which is discussed in detail below).

(4) Can you do work that you did previously?

If so, then you likely are not disabled.

(5) If you can't do previous work, is there other work you can do despite your impairment?

At this point, the SSA looks at your age, education, work experience, and any transferrable skills to determine if there is any other job you could do. If not, then you will meet the criteria for being disabled.

Substantial Gainful Activity

This is an important issue and determines whether someone qualifies for disability.

SGA is defined as work that:

(1) Involves doing significant and productive physical or mental duties; AND

(2) Is done for pay or profit.

Again, as noted above, if someone can do SGA, then he/she is not disabled.

There are a few factors the SSA looks at to determine if the work constitutes SGA:

(1) The nature of the work: Do the person's duties contribute substantially to the operation of the business? If so, then it's probably SGA.

(2) How well the person performs: Can the person actually perform the duties? It's one thing to have a job and be assigned various duties that might qualify as SGA, but if the person can't perform the duties, then that person isn't working at a SGA level.

(3) Is the work performed under special conditions? If so, the SSA may find that the person does not have the ability to do SGA. At the same time, the special conditions may also show that the person actually has the necessary skills to work at a SGA level.

Here are some things to consider for special conditions: (a) does the person receive special assistance from other employees? (b) Is the person allowed to work irregular hours or take frequent breaks? (c) Was the person assigned special equipment or have a unique work environment tailored to the impairment? (d) Can the person get to/from work only because of a special arrangement? (e) Is the person allowed to work at a lower standard of productivity?

(4) Self-employed: If the person is self-employed and supervises or manages other people, then that likely shows he/she can perform SGA.

(5) Time spent at work: Not definitive, but if he/she spends more time at work than those without an impairment, then likely can perform SGA.

This is a long post and there is quite a bit to digest, particularly when it comes to SGA.

But this is a reminder that the SSA disability evaluation process is a very thorough and that the SSA does not make simple and quick determinations (except in a few circumstances).

It's for that reason you want to have a qualified attorney that can guide you through the complicated process and ensure that you obtain the benefits you deserve.

Contact our office today for a free consultation.

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