The Social Security Administration generally offers two types of benefits for the disabled, Social Security Disability Insurance Benefits and Supplemental Security Income.
SSDI (Social Security Disability Insurance) is based on the credits from the work you have done in your life. You must be found disabled before your date last insured (DLI) to be found eligible for Social Security Disability Insurance. Simply put, you must have worked 5 years of the last ten years (in general).
SSI (Supplemental Security Income) is a need-based program and you must meet income/asset standards in addition to being found disabled under the five steps above. In 2023, SSI is $914.00 per month for an individual and $1,371 for an eligible couple. SSI will be reduced by 1/3 if you are receiving financial help from others. In NC, SSI recipients are also entitled to Medicaid.
Before you are entitled to either benefit, you must be found disabled under SSA’s Five Step Sequential Evaluation. Social Security will ask these five questions at every step of the below mentioned disability process.
Social Security’s Five Step Sequential Evaluation
Step 1 – Are You Working? The Social Security Administration defines work as “Substantial Gainful Activity” (SGA). SGA is roughly defined as work from earnings that average more than $1,470 (2023) a month. If you are making that amount you generally will not qualify for Social Security Disability or SSI.
Step 2 – Is Your Condition “Severe”? Severity is key when it comes to what qualifies as a disability. Severe is defined by the Social Security Administration as: your condition must interfere with basic work-related activities for your claim to be considered.
Step 3 – Is Your Condition on the List of Disabling Conditions? The Listings are very hard to meet in most cases and not always interpreted as a common reading would suggest. If you meet a listing you are gravely ill. The listings are found here.
Step 4 – Can You Do the Work You Did Previously? The Social Security Administration will look at your past work and determine if it was sedentary, light, medium, or heavy. They also will evaluate the skill level: unskilled, semi-skilled and skilled. For instance, an attorney would be sedentary skilled work. The Dictionary of Occupational Titles is found here.
Step 5 – Can You Do Any Other Type of Work? If the Social Security Administration finds that you cannot do what you used to do, they then look to see if you can do anything else. This is where the “grids” come into play. The grids are the Medical-Vocational Guidelines. The grids are only for exertional impairments. Non-exertional impairments are not considered by the grids. If you are found to be capable of any other work, you will be found not disabled. Read The Grids and Your Social Security Disability Case.
The Disability Process
The disability process starts with an application filed for disability benefits online or with your local SSA office at 3315 Poole Rd, STE 100, Raleigh, NC (phone: 800-772-1213). In NC, initial disability cases are evaluated by Disability Determination Services (DDS’ phone number is 866-542-8113). If you are denied at the initial level by DDS, you will have to appeal by requesting a “reconsideration.”
At the reconsideration level, your case will be sent back to DDS for another disability examiner to review your claim. The initial and reconsideration levels can take 6+ months depending on DDS’ backlog and the examiner that is assigned to your case.
The best things that you can do for your case at the initial and reconsideration level is to return the forms that DDS sends you as soon as possible, report to any medical appointments that DDS’ schedules for you and to continue to receive medical treatment from you own doctors.
Despite doing the above, most claimants are denied benefits at both the initial and reconsideration level.
If you are denied at reconsideration, you will have to request a hearing before an Administrative Law Judge (ALJ). The hearing with the Administrative Law Judge is your best chance to tell the Social Security Administration why you should be found disabled. The importance of proper preparation and presentation at the hearing can not be overstated.
If you are denied by the Administrative Law Judge, you will have to appeal to the Social Security Appeals Council which is in Falls Church, Virginia. If the Appeals Council denies your request for review, you must file a case in Federal District Court.
Do you need a Social Security Disability Lawyer?
While no attorney can guarantee a win, a Social Security Disability Lawyer can help your case immensely. Gathering medical records and presenting that evidence to the Social Security Administration in a clear and logical way will ensure all of your evidence is evaluated when SSA is making a decision on your claim. Also, pointing out relevant medical record evidence to the agency can make the difference between winning and losing your claim.
There are different ways that SSA can find you disabled: the grids, the listings or on the combination of your impairments. In some instances, specific information is needed from a medical professional for the SSA to find you disabled. Your attorney can ask the right questions to obtain the information that the agency needs to make the correct decision.
Hearings can cause anxiety for a claimant as they do not know what to expect. An attorney who knows the process can give you a preview of what the hearing will be like and what information SSA needs to know from you. The last thing that a claimant wants to do is make an Administrative Law Judge’s job more difficult. Gathering all evidence and pin-pointing to evidence that supports an argument for approval are important tasks an attorney can help you with.