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How the SSA Determines Disability Claims

For all people applying for Social Security Disability Insurance (SSD) and Supplemental Security Insurance (SSI) benefits, the definition of disability is the same. The Social Security Administration defines disability as “the inability to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. 42 U.S.C. § 423(d).”

 

In everyday language that means:  in order for you to be considered disabled by the Social Security Administration, you cannot perform any work because of a serious medical condition that is diagnosed by a doctor.  The condition will last for at least a year or, in all likelihood, will cause your death.  The Social Security Administration needs to have more than your word that you cannot work.  They need to hear it from a doctor and usually want test results that back up the doctor’s claim.

 

Most disability claims are initially processed through local Social Security field offices. SSA representatives in the field offices receive initial applications for SSD and SSI benefits, either in person, by telephone, by mail or via an online application process.  At this stage, the SSA will attempt to verify the information submitted in the application by having its representatives contact claimants for more information.

 

When an initial claim is denied, you can appeal the denial. If SSA also denies the appeal, the case moves to a hearing office within the SSA called the Office of Disability Adjudication and Review (ODAR). Here, the case is scheduled before an administrative law judge for a hearing. The judge issues a decision on the case after receiving additional medical evidence and holding a hearing with you present.  The entire application process- from filing the initial application through the hearing- takes approximately one year to complete. The key to obtaining your disability benefits as soon as possible is to have continuing medical treatment and an experienced Social Security attorney by your side.