Social Security Administration

What Does The Social Security Administration Look For?

To receive an initial disability determination, there are a series of consideration steps/questions involved in the process.  When an examiner receives your case from the DDS, they will use the information provided in the application to determine if an applicant meets predetermined criteria for receiving benefits.

The considerations steps/questions are as follows:

1. Is the applicant working at Substantial Gainful Activity (SGA)? Even if you work a small amount, it does not keep you from claiming disability.  However, you will be denied benefits if the examiner determines you are able to support yourself through working.  To move on from this step, the examiner must determine that your impairment keeps you from earning enough money through your vocation to financially support yourself.

2. Is the condition listed in your claim so severe that even doing basic work is not possible?

3. How does your specific condition(s) compare with the list of impairments? Does your condition meet the ‘meet or medically equal’ definition?  To move forward past this step and still be considered you must be able to show that your condition(s) meet the required threshold.  If you fail to meet this threshold and this definition your claim will be denied.

4. What is the applicant’s past line of work? Can the applicant return to their last line of work with their condition(s)?  In this step the applicant must show that they are unable to return to their past line of work due to their conditions.

5. The last step and threshold that will have to be met by an applicant at this stage is for the SSA and experts to determine whether the applicant is able to do another type of work. This process is a slight modification from the previous step and seeks to determine whether there is a type of vocation the applicant can perform given the condition(s).

In some cases, more medical information is needed and you may be asked to do a Consultative Exam (CE).  This option allows for new or missing information to be obtained through a SSA contracted physician to assist the examiner ultimately in making a determination on the application.

A CE exam is paid for by the SSA and can be critical to a final determination. When enough medical information is obtained your application will be approved or denied. After the last step the application is returned to the SSA to proceed with the action required. For applicants who are approved, the SSA will then calculate the appropriate benefits to be paid out and will begin paying that amount. Applicants who are rejected will have the opportunity for appeal.