Social Security Disability Insurance (SSDI) – Evaluating Claims

Whenever I meet with a potential Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) client, again prior to his or her hearing, I find it helpful to discuss how the Social Security Administration (SSA) evaluates claims for disability.  In terms of meeting the medical requirements, the SSA utilizes the same process for Social Security Disability Insurance (SSDI) claims as it does for SSI claims.  The SSA calls the process the five-step sequential evaluation.  The evaluation is done in order and if a decision to approve or deny can be made at any step then the evaluation stops.

1. Is the claimant working and performing substantial gainful activity? Substantial gainful activity is defined as work that involves significant and productive physical or mental duties and is done or intended to be done for pay or profit.  Work activity and actual pay must both be considered. Part-time work can classify as substantial gainful activity.  The regulations state that SSA should consider the nature of the work, how well it is performed, whether the work is done under special circumstances, and the time spent doing the work.

2. Does the claimant have a severe medical impairment or combination thereof? An impairment or combination of impairments is severe if it limits the workers’ ability to do basic work activities.  If the claimant receives regular medical treatment for a condition or several conditions, then this hurdle should be overcome.

3. Does the claimant’s impairment(s) meet or equal a listed impairment? The Code of Federal Regulations contains a list of impairments that should the claimant meet or equal a listed impairment than he or she is automatically found disabled. The impairments are considered so severe per se that it is assumed the claimant is prevented from doing any substantial gainful activity.

4. Do the impairments prevent the claimant from performing his or her past relevant work? The regulations allow consideration of work performed within the past 15 years.  The work is defined as heavy, medium, light or sedentary, and skilled, semi-skilled, or unskilled and the Dictionary of Occupation Titles and the Selected Characteristics of Occupations from the Dictionary of Occupational Titles provides the SSA with this information about past relevant work.  This is also the first step that really looks at Residual Functional Capacity (RFC), which signifies what a claimant can do despite his or her physical and/or mental limitations.

5. Do the impairments prevent the claimant from performing any other work? At this step, the statute and regulations require the SSA to consider all “vocational factors,” including age, education, and past work experience.  Additionally, the burden of proving that work is available shifts to SSA until jobs are shown by using the medical-vocational guidelines or “Grids” and then the burden shifts back to the claimant.

If work is identified that the claimant could perform considering age, education, past work experience, and impairments, then the claim will be denied. If no jobs exists, then he will be found disabled.

For FAQs about SSD and SSI, click here.

If you need more information about a Social Security Disability/SSI, personal injury, EEOICPA, long or short-term disability, VA disability, Railroad Retirement Board disability, or a workers compensation matter, please contact the Law Offices of Tony Farmer and John Dreiser for a free case evaluation. We can be reached at (865) 584-1211 or (800) 806-4611 or through our website. Our office handles claims throughout Tennessee.




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