Social Security Disability Guide
Answers to some common social security disability questions. If you have other questions, please contact us anytime at (800) 573-9503 or e-mail Client Services.
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Eligibility Standards
A social security disability claimant must establish 3 things before s/he can receive Social Security Disability Compensation. All three of these things must be established. Any one of these things alone will not be enough.
The three things which must be established for a claimant to receive Social Security Disabilities are:
- That the claimant is disabled
- The claimant’s disability meets the durational requirements
- The claimant has disability insured status
Disability Standard
Under Social Security a claimant is “disabled” and entitles to benefits if s/he cannot work. The term used is whether the individual is capable of “substantial gainful activity.”
The fact that the claimant cannot work must be the result of one or more medically determinable physical and/or mental problems. If one problem alone does not prevent a claimant from working, but two or more problems combined do, the claimant will be considered “disable.”
The Social Security Administration, in considering whether a claimant is “disabled” will consider both medical impairments and claimant’s vocational ability to work.
The problem which causes a claimant to be disabled does no have to be the result of work. However, if a claimant is disabled due to work, s/he can still receive Social Security Disability, as long as the requirements are met. (There may be an offset if the claimant is also receiving workers’ compensation benefits.)
Durational Requirement
The “durational requirement” means that the disability must be of a certain length or severity before Social Security Disability will be paid.
A disabled claimant meets the durational requirement for Social Security Disability benefits if the medical impairment which causes the disability has either (1) lasted for longer than 12 months; (2) is expected to last longer than 12 months; or (3) can be expected to result in death.
Disability Insured Status
A claimant is not eligible for Social Security Disability unless s/he has what is known as “disability insured status.” If the individual does not have “disability insured status”, s/he cannot receive Social Security Disability – even if disabled. [Such an individual may qualify for Supplemental Security Income.]
The requirements for achieving “disability insured status” are complex and cannot be fully discussed on this page. You can get the requirements from the Social Security Administration.
The central requirements for disability insured status is that the claimant must have worked five out of the last ten years in covered employment. Employment is considered covered if it results in payments being made to the Social Security Administration. However, in some cases [such as individuals just starting to work] another rule may apply, so check with the Social Security Administration for the rules.
Claim Procedure
The process is started by filing the initial claim application. The should be filed at the local district office of the Social Security Administration closes to the claimant’s residence. After the initial claim application is filed, an initial decision is made.
If the claim is disallowed by the initial decision, a request for reconsideration can be filed. The request for reconsideration must be filed within 60 day of the date the denial was received. Additional evidence may be filed at this stage.
If the claim is again disallowed, the claimant can request a hearing. The request for hearing must be filed within 60 days of the date the reconsideration disallowance was received. The hearing will be held before an Administrative Law Judge. New evidence may be submitted before the Administrative Law Judge.
In the Administrative Law Judge decides against the claimant, appeal may be had to the Appeals Council. An appeal to the appeals council must be filed within 60 days of the date the Administrative Law Judge’s decision was received. New evidence may be submitted at this stage, but it must be related to the time before the Administrative Law Judge’s denial.
If the Appeals Council refuses to review the cases or affirms the Administrative Law Judge’s denial, the claimant may appeal to the Federal District Court for the District where the claimant lives. An appeal to the federal court must be filed within 60 days of the decision of the Appeals Council. No new evidence may be submitted at this stage.
Vocational Evidence/The Grids
The last step of the sequential evaluation process required a consideration of the ability to work if a claimant cannot return to his/her prior employment. The ALJ must consider vocational evidence of this issue.
The Social Security Administration has adopted a set of regulations, known as the “grids” to help make these determinations. The grids apply age, education, work history, and physical ability to work and automatically reach a conclusion on whether the claimant could work. [You can find more information about the grids on the Social Security Administration’s Web Site].
If the ALJ determines that a claim fits within the grids, the AALJ will just look at the grids and reach the result they compel. No further evidence is required.
However, if the claimant does not fit within the grids, the Administrative Law Judge may also have a “vocational consultant” present to testify as to what work, if any, the claimant might be capable for doing.
The vocational expert’s role is to clarify issues concerning the claimant’s work experience. This expert is asked by the judge to classify the claimant’s past job(s) in term of skill and exertional level. Skill level may range from unskilled to semi-skilled to skilled. Exertional levels include sedentary, light, medium, and heavy.
The vocational expert is also asked whether the claimant has obtained job skills in his previous work experience that are transferable to other jobs. Frequently, and Administrative Law Judge will ask the vocational expert a hypothetical question. Careful attention should be paid to this question to insure that it correctly states the facts in the claimant’s case. The vocational expert should ask “Assuming the disabilities are restriction testified to by the claimant at the hearing are true, are there jobs available that the claimant is capable of doing?”