5 TESTS FOR SOCIAL SECURITY DISABILITY ELIGIB ILITY
By Gregory Forsythe
1. Are you working while applying for Social Security disability benefits?
Social Security disability benefits are meant for persons who are not able to work. If you are working and earning enough to support yourself, you are probably not eligible for a disability benefit. In 2020, you are considered working at substantial gainful activity if you work and earn at least $1,260 per month.
2. Do you have a severe medical impairment that has lasted or is expected to last at least 12 straight months?
A severe impairment is one which affects at least one essential work-related function. In simple terms, you must have a medical condition that makes you unable to work. This condition must have lasted at least 12 straight months or be expected to last at least 12 straight months. A short-term condition is not covered by Social Security. Any condition expected to result in death meets the 12-month condition.
3. Do you meet one of the published Listings?
Listings are medical conditions of a severe nature, along with a specific list of very severe symptoms that must be met. If a claimant has one of the listed condition and all of the severe symptoms listed, approval is automatic. Note: Most claimants will not meet a listing. They might still be approved but not at Step 3.
4. Are you unable to perform any of the jobs you performed during the last 15 years (called "Past Relevant Work" or PRW)?
If Social Security finds that you can still perform any of your past relevant work, you will not be eligible for a benefit. They only look at full-time jobs you have held during the most recent fifteen year period. So, in 2020, they will be looking at full-time jobs you have held since 2005.
5. Can you perform any other job which exists in significant numbers in the national economy?
Even if you can't perform any of your past work, there may be other work that you can perform. Your past work may have involved a lot of standing, walking, stooping or lifting. You can't perform that work but you could perform a job with less standing, walking, stooping and lifting. Therefore, you may be denied at Step 5. Persons age 50 and over may avoid Step 5 if they fall under a grid rule (medical-vocational guideline). Older claimants may have their case decided at Step 4 if they can prove they can't do any of their past relevant work. However, persons under age 50 will wind up at Step 5 for the "other work" question.
Everyone who enters my office to file a disability claim or appeal believes that they are unable to work. However, Social Security will be very skeptical of this and will require serious medical evidence. It isn't enough to believe that you are disabled. We must provide doctors records and other medical evidence to prove disability. Without the evidence, Social Security will not pay a benefit.
The burden of proof is on the claimant. This means that you, the person applying or benefits, must submit proof of your disability. If you fail to do this, you lose your case. It is not Social Security's burden to provide evidence.
In most cases, Social Security will deny the original claim. This is true in about 75 percent of cases. The first appeal is called Reconsideration and it has a 95 percent denial rate. The second appeal takes you before an administrative law judge (ALJ) for a hearing. The approval rate averages almost 50 percent here and represents the best chance for approval. This is especially true if you have an experienced representative who knows how to build and present your appeal case before the judge.
1. Are you working while applying for Social Security disability benefits?
Social Security disability benefits are meant for persons who are not able to work. If you are working and earning enough to support yourself, you are probably not eligible for a disability benefit. In 2020, you are considered working at substantial gainful activity if you work and earn at least $1,260 per month.
2. Do you have a severe medical impairment that has lasted or is expected to last at least 12 straight months?
A severe impairment is one which affects at least one essential work-related function. In simple terms, you must have a medical condition that makes you unable to work. This condition must have lasted at least 12 straight months or be expected to last at least 12 straight months. A short-term condition is not covered by Social Security. Any condition expected to result in death meets the 12-month condition.
3. Do you meet one of the published Listings?
Listings are medical conditions of a severe nature, along with a specific list of very severe symptoms that must be met. If a claimant has one of the listed condition and all of the severe symptoms listed, approval is automatic. Note: Most claimants will not meet a listing. They might still be approved but not at Step 3.
4. Are you unable to perform any of the jobs you performed during the last 15 years (called "Past Relevant Work" or PRW)?
If Social Security finds that you can still perform any of your past relevant work, you will not be eligible for a benefit. They only look at full-time jobs you have held during the most recent fifteen year period. So, in 2020, they will be looking at full-time jobs you have held since 2005.
5. Can you perform any other job which exists in significant numbers in the national economy?
Even if you can't perform any of your past work, there may be other work that you can perform. Your past work may have involved a lot of standing, walking, stooping or lifting. You can't perform that work but you could perform a job with less standing, walking, stooping and lifting. Therefore, you may be denied at Step 5. Persons age 50 and over may avoid Step 5 if they fall under a grid rule (medical-vocational guideline). Older claimants may have their case decided at Step 4 if they can prove they can't do any of their past relevant work. However, persons under age 50 will wind up at Step 5 for the "other work" question.
Everyone who enters my office to file a disability claim or appeal believes that they are unable to work. However, Social Security will be very skeptical of this and will require serious medical evidence. It isn't enough to believe that you are disabled. We must provide doctors records and other medical evidence to prove disability. Without the evidence, Social Security will not pay a benefit.
The burden of proof is on the claimant. This means that you, the person applying or benefits, must submit proof of your disability. If you fail to do this, you lose your case. It is not Social Security's burden to provide evidence.
In most cases, Social Security will deny the original claim. This is true in about 75 percent of cases. The first appeal is called Reconsideration and it has a 95 percent denial rate. The second appeal takes you before an administrative law judge (ALJ) for a hearing. The approval rate averages almost 50 percent here and represents the best chance for approval. This is especially true if you have an experienced representative who knows how to build and present your appeal case before the judge.
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