Let’s face it: Getting the SSA to approve your claim for benefits is not easy. You may have a major illness and be unable to do your job anymore. Your impairments may be severe. You may already be receiving benefits under a short-term or long-term disability policy. None of this guarantees you will be approved for SSDI or SSI benefits, because Social Security has set a high bar for approval, and they approve benefits only for total disability. In this post, our St. Louis disability attorney reviews key aspects of the Social Security decision-making process, to help you better understand how the process works and what you need to establish to gain benefits.
The Compassionate Allowance
A relatively small number of people will be approved quickly through the Compassionate Allowance, which expedites the claims process for those with medical conditions so severe there is no doubt they meet the SSA’s definition of disability. These conditions include acute leukemia, Huntington disease, amyotrophic lateral sclerosis (ALS),aplastic anemia, early-onset Alzheimer’s Disease, Ewing Sarcoma, heart transplant wait list, kidney cancer, pancreatic cancer, and many more. The list is long and offers some qualifiers for the allowance for some of the diseases.
The Definition of “Disability”
For most people, however, the disability process is a long, arduous, “hurry up and wait” situation. Even though the time frame from initial application to hearing can be several years, the SSA’s criteria for determining disability are fairly simple and straightforward:
• You cannot do your prior work.
• You cannot do other work because of your medical conditions
• Your medical conditions have lasted 12 months, or are expected to last 12 months or result in death.
How you prove you are disabled can be the difficult part. Social Security uses a five-step process to determine if you meet their definition.
Step One: Are you currently working?
If you are currently working and making more than $1,130 a month, you will be denied from the get-go, as you are performing what they call “substantial gainful activity.” The thinking is that if you make that much money, you could probably work a full-time job. If you are not working or making that much per month, then you go on to step two.
Step Two: Do you have one or more severe conditions?
To have your disability claim progress, your condition or conditions must be severe enough that they interfere with basic work activities. It is critical that you have established yourself with one or more doctors and have consistently gone to office visits and been compliant with treatment. Your medical records will indicate whether your impairments are severe. Some claimants may be disabled, but they don’t have the medical records to prove it, so they are denied. SSA will often order a consultative mental or physical exam for claimants whose medical records are inconclusive or unclear.
Step Three: Does your medical impairment meet a listing of disabling conditions?
Social Security maintains a list of medical conditions that are so severe they automatically qualify for benefits. (This list is different than the Compassionate Allowance mentioned above.) The listings correspond to major systems of the body, as well as some medical disorders. They are grouped according to musculoskeletalsystem, respiratory system, skin disorders, mental disorders, etc. The various listings will include criteria necessary for meeting that listing. If your medical impairment is not on the list, Social Security will decide if it is equal in severity to a condition on the list. Your St. Louis Social Security Disability attorney will figure out if you meet or equal a listing. If you do not meet a listing (and many claimants don’t), you will go on to step four.
Step Four: Can you do your previous work?
If your conditions do not meet a listing, Social Security will determine whether they are severe enough to interfere with your past work. If you have developed problems with walking, sitting, standing, lifting, carrying, handling or other functionalities, you might not be able to do your previous work anymore. Supportive medical evidence from your treating physicians is critical for showing the severity and duration of your impairments and that they would preclude your past work. Letters from employers as to reduced hours, absences, discipline, and any accommodations given you are helpful to prove your
Step Five: Can you perform other work?
If Social Security determines you cannot do your prior work, the next decision is if you can do any other work. Say you worked in a factory, but because of back issues, you can’t lift as much weight anymore,
ruling out going back to the factory job. But you might be able to do assembly, call center, or mailroom work, for example. To help make their determination, SSA will consider your age, education, work experience, and if you have transferable skills from your prior work. If you are over 50 years of age, and particularly over 55, it may be easier to get your benefits as SSA considers that the older you are, the harder it is to adjust to other work. Again, a thorough medical record is critical to proving your limitations for other work to the administrative law judge.
Contact a St. Louis Disability Attorney
Building a case and proving you are disabled can be difficult (and, sometimes, exhausting), but your disability attorney will guide you through the process and explain the steps. Having a knowledgeable and experienced St. Louis disability attorney on your side is your best chance of getting the benefits you deserve. For a free claim evaluation contact us today, at 888.588.0001, or complete our email form on this page.
Title: Overcoming SSA’s High Bar for Approval of Disability Benefits / St. Louis Disability Attorney