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Social Security Disability Insurance: the five-step process

While it seems that it would be a straightforward question whether someone is disabled from working, for purposes of eligibility for Social Security Disability Insurance, the federal government uses a five-step process to answer that question.

What is SSDI?

SSDI is the disability insurance portion of the federal Social Security programs. Many people are not aware that not only do their payroll deductions qualify them for Social Security retirement benefits, but also for a monthly support payment under SSDI should they become disabled from working before reaching retirement age.

Assuming a person meets SSDI financial requirements of having worked long enough and recently enough, the question becomes whether he or she is disabled under the federal definition.

Social Security definition of disability

The Social Security Administration is the federal agency that administers the Social Security programs. SSA has a very specific definition of disability based on the Social Security Act and regulations for purposes of SSDI eligibility:

A claimant is disabled from working if he or she has a serious physical impairment or mental impairment or combination of impairments that is expected to last at least one year or result in death that prevents him or her from engaging in substantially gainful activity (work).

The five-step process

SSA asks a series of five questions to determine whether the definition of disability is met.

  • One: Is the claimant working or earning over a certain low threshold amount monthly? If yes, then not disabled. If no, then go to step two.
  • Two: Is the claimant’s medical condition severe, meaning significantly limiting his or her ability to do basic physical and mental work activities for an expected year (or if the condition will cause death)? If no, then not disabled. If yes, then go to step three.
  • Three: Is the claimant’s physical or mental impairment on the official Listing of Impairments or does it or all of claimant’s impairments in combination equal the severity of a listed impairment? If yes, then disabled. If no, then go to step four.
  • Four: Can the claimant return to previous work? If yes, then not disabled. If no, then go to step five.
  • Five: Can the claimant do another kind of work considering his or her medical impairments, age, education, work experience and skills? If yes, then not disabled. If no, then disabled.

Several levels of review

The SSA does not always correctly determine whether someone is disabled and eligible for SSDI benefits at the initial application stage, so there are three levels of review before the agency, followed by the right to appeal the final decision of the SSA to the federal courts. It is not unusual for a claimant to be found disabled at levels beyond the initial determination.

Because the determination of disability is not always simple and because some medical impairments are difficult to assess from the standpoint of the ability to work, it can be a tremendous help for a claimant to retain an attorney with specific SSDI experience.

A skilled SSDI lawyer can assist with an initial application or can become involved at any stage of the review process. Legal counsel can assist with developing the medical record, meeting deadlines, communicating with SSA on the claimant’s behalf, representing the claimant at the administrative hearing if necessary and appealing the matter to federal court if required.