5 Steps To Determine Disability
The five-step sequential evaluation that Social Security uses to determine disability on every case. These five steps also have subcategories and definitions that are not addressed in these basic steps, as follows:
Step One: If you are working and earning monies that are over $1,310.00 (2021 standard) you will not be found disabled;
Step Two: You must have a severe medically determinable impairment that is expected to last 12 consecutive months or end in death;
Step Three: The impairment may meet or equal the severity found in the medical listings of impairments (Bluebook);
Step Four: Your limitations must prevent you from performing any of the work you have done in the last 15 years; and
Step Five: Your impairments must prevent you from performing any other work using skills you had derived from past work or any jobs you could perform in the national economy, consistent with your age, education, past work experience, and limitations/capacities.
As a basic framework, think of Social Security as two insurance policies that are named SSDI (Social Security Disability Insurance) and SSI (Social Security Income). Keep in mind that there are subcategories to these, such as disabled child’s benefits and disabled widow’s benefits, et cetera.
To get the better of the two benefits, Social Security Disability Income, you will have to have worked 5 out of the last 10 years; 20 of the past 40 quarters prior to the onset date of disability. The benefits include a monetary amount based on how much you have paid in in the past; could include payments that go back 1 year; and may pay benefits to your children that are under 18. SSDI also comes with Medicare insurance benefits.
Social Security Income is for persons who have not worked 5 out of the last 10 years and who do not have excess resources (defined as $2,000 in cash or other resources).
If you apply for SSI, there exists a presumption that you are also applying for SSDI. However, the opposite is not true. For instance, if you apply only for SSDI there is no presumption that you are also applying for SSI.
Getting a Representative or Not
There is no requirement to have a representative either before or at the time you present your case to an Administrative Law Judge. Representatives at the hearing level, under the law, can charge you 25% of any past-due benefits or $6,000, whichever is less. If your case does not win, your representative does not get paid.
When claimants discuss going in front of a judge on their own, I always ask them to pose the question “if you are capable of successfully presenting your case are you really disabled?” If the fee is going to be 25% of the past-due benefits at any level, why not get a representative early rather than wait until the last minute? It does not cost any more to get a representative early than late.
It is always good to remember that most limitations are caused by pain, and you have the duty to prove the level of pain you are experiencing is what is causing you to have limitations, so your testimony about your pain will rely on you “credibility.” I advise all my clients to be honest with Social Security and the doctors who treat and evaluate them.
Need Help Filing for Social Security Disability Benefits?
Social Security Claim Denied? Unable To Work?
You Can Rely On Us!
Dan McCaskell Ph.D., C.R.C., C.V.E., C.C.M.
Social Security Claimant Representative
Call (707) 528-4003