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Qualifying for Social Security Disability and Supplemental Security Income

Qualifying for Social Security Disability and Supplemental Security Income

To get qualified for Social Security Disability (SSD) or Supplemental Security Income (SSI) you need to understand what you’re up against.  The Social Security Administration’s qualification process is designed to deny you.  Even people with career ending medical conditions are denied.

One of my clients was on the “inside” of the SSA doing claims work, she advised me that her manager would constantly ask about her “numbers" (that is SSA code for claim denials).  No one said this was going to be easy; you need to be equally tenacious on your end.

When you apply for SSD and or SSI, there are four levels of appeal to either grant or deny your benefits.  If your claim is denied, you can request Reconsideration, if that request is denied; you can request a hearing before an Administrative Law Judge (ALJ).  If you are not happy with the ALJ’s decision, you move up to the Appeal’s Counsel, then the 9th Circuit Federal Court of Appeals.  The trick is to keep appealing and never give up!

Also, pay careful attention to this: You have sixty days (+ five for mailing) to file appeals with the SSA.  Failure to timely appeal could result in you having to apply all over again.

Like State Disability Insurance, SSD is driven by your work record.  In a SSD claim, you need to have worked five of the last ten years to be insured under the system.  You will automatically qualify for Medicare two years after you qualify for Social Security Disability.

As far as SSD goes, if you do not have the work record, you’ll be out of luck.  The only remaining benefit is Supplemental Security Income (SSI)That is why it is so important to file early while you are still insured!  If you qualify for SSI, then you will automatically qualify for MediCal.  Not the best place to be as SSI is an income based benefit.  So, if a spouse or a member of the household is making a significant income or you have more assets than allowed by the program, you won’t qualify.

I can state categorically that to be qualified for the benefit, you normally need to have your medical condition well-documented and have the appropriate facts on your side.  If you are under 49.5 years of age you will have to demonstrate that your residual functional capacity (RFC) is that of a sedentary occupational base that is significantly eroded.  This would be someone that can only sit or stand comfortably for 15 minutes.  If you older than 49.5, things get a lot easier as your RFC can be greater and you can still qualify. 

Qualifying for SSD or SSI will be based on the “Sequential Evaluation Process.”  Understanding this process is like discovering the Colonel’s secret blend of “11 herbs and spices.”  The Sequential Evaluation Process is the SSA’s recipe for denying or qualifying someone for SSD.

The Sequential Evaluation Process:

  • The first decision node concerns determining if you are involved in “Substantial Gainful Activity” (earned income).  Check the SSA website for current limits, for 2013 it is $1,040. If you are earnings are not above this amount then you get to go to step 2.
  • Do you have a Severe Impairment?  Normally this is a condition that will keep you from working for a year or more or result in death.  If the answer is yes, you get to go to step 3.
  • Does your medical condition meet or equal an impairment described in SSA’s “Listings of Impairments”?  If so, you can stop here--you win!  If not, go to step 4.
  • Can you perform the easiest job you did in the last 15 years (past relevant work)?  If so, you just got denied.  If not, go to step 5.
  • Can you do other work existing in the national economy considering your residual functional capacity (RFC), age, education and work experience (the “Grids”)?  If you fit into one of the slots on the Grids, you are approved!

Sounds easy, doesn’t it?  Sometimes it is.  Some people luck out and get some reasonable evaluator in the SSA and they are qualified.  In other cases, it is like pulling teeth and you get your claim through all of the levels of appeal. 

The good news is that if you have the facts on your side, you can win one of these claims. However, this is very upper division stuff and this is not an area to “go it alone.”  If you are denied benefits on the initial evaluation, then you seriously need to consider getting a competent advisor to help you.

Thomas Ledgerwood
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Proprietor Ledgerwood Law Group