Social Security Disability: Financial and Medical Eligibility Requirements
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Social Security Disability: Meeting the Financial and Medical Eligibility Requirements

July 10, 2018

By Linay L. Haubert

social security benefits

Being diagnosed with a potentially disabling medical condition and not being able perform the work you used to do is not a guarantee that you will be entitled to Social Security Disability benefits. There are stringent rules and requirements, both financial and medical, which must be met in order to be approved for Social Security benefits.  Applying for benefits without both knowing these rules and seeking the assistance of a professional experienced in Social Security Disability could lead to an initial denial of your claim and then a lengthy appeals process.

Social Security evaluates claims in a five step sequential process.  First, when you submit an application for disability benefits, the field office will determine whether you are financially eligible for benefits.  If you are engaged in “substantial gainful activity” or “SGA” your claim will be denied.  SGA is “work that involves doing significant and productive physical or mental duties and is done for pay or profit”.  In 2018, if you earn $1,180 per month (non-blind applicants) or $1,970 per month (blind applicants),  you will be considered gainfully employed and not eligible for benefits.  The fact that your monthly earnings are zero or less than SGA does not establish disability, but will move you to the next step of the evaluation.

During Step 2 Social Security will evaluate your claim under the  “duration test”. In order to be disabled, your medical disability must have lasted for one year, or be expected to last for at least one year, or must be expected to result in death. If the medical evidence does not establish one of these requirements, your claim will be denied at Step 2.

Step 3 is designed to allow for the most severely disabled applicants to be approved.  Social Security has a Listing of Impairments for physical and mental conditions.  Each Listing contains codified clinical criteria that must be met in order for Social Security to find you disabled at this step.  The Listings provide very specific standards that must be met for diagnostic studies, objective findings on evaluation, and subjective symptoms documented within the medical evidence.  The Listings are extremely difficult to meet.  If you have not treated with medical providers that have performed all of the necessary diagnostic testing and documented all of the pertinent abnormal findings on examination, you will not meet a Listing and will not be approved at this step.

If you did not meet a Listing, your case will move on to Step 4, which examines whether or not you can perform the basic skills and requirements of your past jobs.  Social Security will look at what types of work you have performed over the last 15 years and determine from the medical evidence if you could now meet the physical and/or mental requirements of those jobs.  If Social Security determines that you can perform any of these past jobs, your claim will be denied at this step.  If Social Security determines that your physical and/or mental capacities have decreased to the extent you can no longer perform your prior jobs, your claim can move forward to Step 5.

Step 5 evaluates whether you are capable of performing other work in the national economy other than what you have done in the past. The evaluation takes into consideration what Social Security has determined are your residual functional capacities, which include ability to sit, stand, walk, lift, carry, use of hands/feet, reaching, bending, etc. and the length of time these activities can be performed in an eight-hour work day.

At this step, Social Security also examines your prior work to determine if you have transferrable skills which would allow you to do similar work in a less physically or mentally taxing position. Social Security also looks at whether you could be trained to perform work different than your past work that would be within your residual functional capacity. Your age, level of education and vocational history are part of this analysis. The disability examiners use the “medical-vocational guidelines” which is often referred to as “the grid”. It is extremely difficult to be found disabled under the “grid” if you are a high school graduate under the age of 50 and can perform light duty work.  In most instances, an applicant that falls under this category will be considered capable of performing entry level work or capable of being retrained to perform different work. Many factors that you think should be considered in reaching the determination of whether or not you can perform work are not given much weight at this step in the evaluation. For example, driving restrictions, lack of access to public transportation, lack of availability of work in your general area do not factor into Step 5.

Although we strongly recommend getting professional advice during the application stage of the process, most people do not seek counsel until their application has been denied by Social Security. If it is your intention to appeal the Social Security’s unfavorable determination, you should obtain counsel as soon as possible.  At the present time, you may not be able to have a hearing before an Administrative Law Judge (ALJ) until 18 to 24 months after denial of your disability application. If you come to a hearing without legal representation, the ALJ will usually advise you that you have a right to an attorney and that in general it is recommended that you have one present with you at the hearing. The ALJ will often allow you to reschedule your hearing to allow you to seek an attorney.

An attorney experienced in Social Security Disability will be able to help you develop a strong medical and legal argument as to why you meet the requirements of the Social Security Administration to get your benefits. They will be able to examine your full evidentiary file to determine where your application and medical evidence fell short and assist you in putting your best case before an ALJ and/or through a request for reconsideration of your claim. In general, attorneys practicing Social Security Disability are not paid hourly. Attorneys are paid on a contingency fee basis and only if they are able to get you past due benefits. Most attorneys will perform an initial evaluation of your case in person or through a telephone conference.

If you have questions regarding your entitlement to Social Security Disability benefits or need assistance in applying for benefits or filing an appeal, please contact me at 215-345-8888 or lhaubert@highswartz.com. As a registered nurse, I also have the medical knowledge and experience to navigate you claim through the rigorous medical requirements of the disability application and appeal process. Our attorneys see clients in both our Bucks County and Montgomery offices and have the knowledge and experience in all facets of disability issues.

The information above is general: we recommend that you consult an attorney regarding your specific circumstances.  The content of this information is not meant to be considered as legal advice or a substitute for legal representation.

 

About the Author: Linay Haubert

Linay L. Haubert focuses her practice in the areas of workers’ compensation and Social Security Disability. She represents employers in workers’ compensation matters at the trial and appellate level in Philadelphia and the surrounding area. With 15 years of experience as a registered nurse, Linay brings a unique perspective that is especially beneficial in handling medically complex workers’ compensation cases.

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