How the SSA Makes a Disability Determination

The Social Security Administration (SSA) is responsible for determining who receives disability benefits under Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). However, the process for determining who qualifies for SSDI or SSI can seem complicated or opaque. What, exactly, goes into a disability determination by the SSA?

There are two primary criteria to determining who can qualify for SSDI or SSI benefits. The first criterion is economic and is determined by whether someone has accrued enough work credits through payment of Social Security income taxes (for SSDI) or if they fall beneath a certain income threshold (for SSI). The second criterion is a medical determination about whether you suffer from a disability, and whether it is sufficiently disabling that you can no longer work. And while the economic criterion can cause some difficulties, it is often the medical criterion that causes problems.

For a person to qualify as disabled for the purposes of obtaining disability benefits, it is not enough for them to have a diagnosed medical or psychological condition, even one recognized as a disability (for example, for people who receive a permit to park in disabled spaces). After all, a combination of medical treatment and reasonable accommodations by employers can allow many employees with disabilities to work in their profession with minimal difficulty. Instead, a person can only obtain disability benefits if their condition is bad enough that they cannot work, even if they receive adequate medical treatment and are provided reasonable accommodations.

Also, it is not enough for your private doctor to decide you have a disability. After all, there is a risk that an unscrupulous doctor could certify someone as being disabled when they would not normally qualify. Instead, your disability determination is made, appropriately enough, by your local Disability Determination Services (DDS) office. DDS offices are operated by the state, not the federal government, but they employ medical professionals who are certified by the SSA to determine if you qualify for SSDI or SSI benefits.

Once you apply for disability benefits, you will make an appointment with DDS to be examined by their on-staff medical examiners, who are typically licensed physicians or psychologists trained to make these determinations. The medical examiner will conduct the examination, then compare the symptoms you have experienced to the “Blue Book,” which is the official list of conditions recognized by the SSA. If your condition matches the criteria for a condition listed in the Blue Book, you are likely to have a much easier time obtaining disability benefits, but even if your condition does not, you may still qualify for SSDI or SSI.

The primary factor the medical examiner is looking for is how much your disability negatively impacts your ability to function, and particularly its effect on your ability to work. If there is a reasonable likelihood that you will be able to work, whether in your current field or in another field, you will likely not receive disability benefits. This is a somewhat subjective determination, and is dependent on your training, education, and work experience.

For example, if you lose the use of your legs in an accident, you have a high school diploma, and you have worked your entire life in construction, it is unlikely that you will be able to find employment in another field, and so you would qualify for disability benefits. However, if you are college educated, work as a paralegal and suffer the exact same injury as the construction worker, that is unlikely to have a significant impact on your ability to do your job, and so you would likely be denied benefits. These situations are not always clear cut, however, and sometimes disputes occur. When that happens, you should seek legal representation to help secure you the benefits you deserve.

If you or a loved one need assistance applying for SSDI or SSI benefits, it is important that you seek the guidance of an experienced Social Security Disability benefits lawyer. The lawyers at Sullivan & Kehoe, LLP have over 50 years of combined experience between its attorneys and are available to you or your loved one in obtaining Social Security Disability or Supplemental Security Income benefits. To schedule a consultation with our New York Social Security Disability benefits lawyers, call (631) 823-7155.

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