The Decision Process

Standards Used to Determine Eligibility
Social Security Administration field offices receive applications for disability benefits in their offices and begin the decision process. First, they will verify all non-medical eligibility requirements that include Social Security coverage information such as age, employment, and marital status. Secondly, that the person is legally disabled, supported by medical evidence.

They will ensure that these two primary concerns of eligibility are substantiated, and will, to an extent, help claimants get medical reports from their own medical sources when the claimants give SSA permission to do so. This medical evidence generally comes from sources that have treated or evaluated the claimant for his or her condition. Once this is completed, the file will go to State Disability Determination Services (called DDS).

There is an initial process to determine disability. A step-by-step process is used by DSS, involving five main questions. The amounts in these may change every year. Each of these needs to be answered for eligibility before moving onto the next one. These questions are:

1. Are you working?
If your 2006 earnings average more than $860 a month, generally you cannot be considered disabled. If your 2007 earnings will average more than $900 a month, you generally cannot be considered disabled. If you earn less than these amounts, are not working, or are unable to work, you are qualified to go to the next question.

2. Is your condition "severe"?
Basic work-related activities must be hindered by your condition for your claim to be considered. The Social Security field office will find that you are not disabled if they are not. If your medical condition does interfere with basic work-related activities, go to question 3.

3. Is your condition found in the list of disabling conditions?
The Social Security Administration maintains a list of medical conditions for each of the major body systems. These are so severe, if you have one of these, it will automatically mean that you are disabled. If your condition is not on the list, the DSS has to decide if it is of equal severity to a medical condition that is on the list. If it is, we will find that you are disabled and that your are qualified for benefits. If it is not, they will then go to question 4.

4. Can you do the work you did previously?
The DSS must determine if your condition is severe but not at the same or equal level of severity as one on the list medical conditions. They will then determine if the condition interferes with your ability to do the work were accustomed to. If not, your claim will be denied. If it does, proceed to question 5.

5. Can you do any other type of work?
DSS reviews your history and will find that if you cannot do the work you did in the past, seeks to find if you are able to adjust to other work. Your medical condition, age, education, past work experience and any transferable skills you may have are all taken under consideration. If it is not possible that you can adjust to other work, your claim will be approved. However, if your may be able to adjust to other work, your claim will be denied, but your file may be sent on to Social Security's rehabilitation agency.

The Social Security Website has additional details in regard to these questions and more. Processing your application is very detailed and complex. Qualified Social Security Disability lawyers are competent in assisting you in covering any contingencies that you are not able to foresee, avoiding unnecessary delays in approving your claim.

Appeals

Nearly 64% of all initial Social Security Disability claims are denied. When this happens, you have the right to appeal this decision. These statistics are obtained from the Social Security website and based on the numbers of denials per 100 cases. The next step is to go to the hearings and appeals program for the Social Security Administration (SSA), which is administered by the Office of Disability Adjudication and Review (ODAR). These are conducted by Administrative Law Judges (ALJs).

From there, the Appeals Council considers appeals from hearing decisions, and acts as the final level of administrative review for the Social Security Administration. At this point, there is about a 20% chance of having a claim approved according to 2005 case averages. The last resort is appealing to the federal courts. Of the 64 of 100 case average denials, only 25 of the 64 cases denied are appealed, and 68% of these are eventually approved. Social Security Disability attorneys experienced with your specific type of case will be able to guide your through all levels of the appeals process with the least amount of delays.