The five-step sequential disability evaluation process in SSDI claims
The DIB definition of disability is unique and complex.
When a person contributes to Social Security through payroll deductions, he or she is not only building eligibility for retirement benefits, but also for Disability Insurance Benefits or DIB. DIB provides monthly money benefits to an eligible person who has become disabled from working. However, DIB eligibility requirements and the definition of disability for purposes of the program are quite precise.
First, an DIB applicant must meet certain work history requirements involving how many quarters of coverage were earned over time by working as well as how recently the claimant worked. If these work requirements are met, the Social Security Administration or SSA analyzes whether the claimant is disabled from working.
Specifically, to be disabled for DIB, the claimant must have a severe medically determinable impairment (physical or mental) or combination of impairments that keep him or her from working and is expected to last at least one year or result in death.
The SSA has a history of taking a long time to decide DIB claims and of regularly denying claims at the initial application that are often approved later on review or appeal. (There are three levels of review and appeal before the agency followed by the option of federal court review.) In response to these problems, the agency has established two programs to speed the processing of the most medically serious claims: Compassionate Allowances and Quick Disability Determinations.
If an application is not fast tracked by one of these programs, the agency uses a five-step sequential evaluation process to analyze whether an applicant has a disability for purposes of DIB eligibility.
Step One: Is the claimant working? This means either not working at all or working so minimally that monthly earnings average less than $1,090 in 2015. (This monthly cap increases yearly with inflation.) If the claimant is working, then he or she is not considered disabled. If not working, then the analysis goes to Step Two.
Step Two: Is the impairment severe? This means that the medical condition interferes with basic work-related activities like lifting, standing, walking, sitting and other physical work activities as well as mental work activities like following simple instructions, making simple decisions, responding appropriately to direction and colleagues, and many more. If the impairment is not severe, the claim will be denied. If it is severe, then the analysis goes to Step Three.
Step Three: Does the impairment meet or equal one in the SSA’s listing of impairments? This list contains medical conditions that are so serious that the diagnosis means that the claimant will automatically be considered disabled and eligible. If a listing is not met, then the analysis goes to Step Four.
Step Four: Can the claimant do any past relevant work? The agency looks at the claimant’s residual functional capacity for full-time work, meaning after consideration of the limitations from his or her physical and mental conditions, whether he or she still retains the ability to return to previous work. If the claimant could do past relevant work, he or she is not disabled. If he or she could not do previous work, then Step Five is analyzed.
Step Five: Considering the impact of the impairment as well as age, education, work experience and training, could the applicant perform any work that exists in significant numbers in the economy? If he or she could, then the application will be denied. If no other work exists, the application will be approved.
The lawyers of William C Babut PC, with four offices in Southeast Michigan, regularly advocate for DIB claimants with a wide variety of physical and mental impairments.