How does the Social Security Administration determine if someone is disabled?

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The Social Security Administration social security benefitshas several thousand regulations regarding the proper way to determine whether a person is disabled.  A lot of factors go in to making that determination, but some of the main factors are a person’s age, education and work experience, as well as the extent of documentation that can be obtained regarding a person’s physical and mental condition.  Sometimes, but not always, the Social Security Administration will arrange for physical and/or mental evaluations to get more information about how a person is functioning, mentally or physically.

The Social Security Administration’s definition of disability is somewhat different from the way the term is used in general conversation or in other government or private programs.  The Social Security Administration only pays for total disability.  There are no benefits for partial disability, and no benefits for short term disability.  One either qualifies for benefits based upon total, long term disability, of one does not qualify for any Social Security Disability benefits.

To be meet the Social Security Administration’s definition of disability, the person must be unable to do the work that was done in the past.  The regulations, in general, look back at the work a person has done within the last fifteen years.  Jobs further back in time than that, as a general rule, do not count, because over time, the requirements of a job change, and frequently change quite a bit.      

The regulations also consider whether an individual has the ability to do other work.  This is a part that many people don’t understand when they come to see me.  Even if you can’t do the work you have done in the past, a person does not meet the definition of disability if there are other, full time jobs that the person can still do.  Many private policies of disability insurance pay benefits if a person can no longer do their most recent job.  SSA does not look at it that way, though.  If there are other full time jobs a person can perform, the person does not meet the definition of disability.

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Additionally, the person’s disability must either have lasted, or be expected to last, at least twelve consecutive months, or be expected to result in death.   One can file for disability without waiting for that 12 month period to end, and I generally encourage people to file if their disability is expected to keep them from working full time for at least twelve months.

There are many other provisions relating to SSA’s definition of disability, so each person’s case is unique.  I enjoy figuring out which regulations can help our clients, and getting the information together that proves a person meets the program’s complicated requirements.  My goal is to find a way to help our clients who are genuinely unable to work on a full time basis, by using the various regulations applicable to the specific circumstances of each client’s case.  I would like to speak with you and find out the specifics of your disability and how the disability law regulations can apply in your case. If you would like to set up a consultation to discuss the specifics of your case, please contact me.

New Cancer Listings

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The Social Security Administration utilizes a fairly complicated set of regulations in determining whether an individual meets its definition of “disabled”. These regulations cover many factors, including how much an individual can earn, how to classify one’s past work experiences, and how to categorize an individual’s age. In addition, there are regulations called “Listings” that describe certain health conditions and diseases that, if present, create a presumption of eligibility for benefits. As medical research and knowledge evolves regarding these medical conditions, the Social Security Administration’s regulations are modified to reflect current knowledge regarding these conditions, their treatment, and the effects on the individual’s ability to sustain employment.

The Social Security Administration has recently published final regulations concerning the medical criteria for evaluating Cancer (formerly referred to in the regulations as “Malignant Neoplastic Disease”). The new regulations go into effect on July 20, 2015. The listings were last revised in 2009, and are only in effect for the next five years. That is, these regulations expire on July 19, 2020, unless they are otherwise extended or modified.

The new regulations address specific cancers, including breast cancer, head and neck cancers, brain cancers, salivary gland cancers, rectal cancers, pituitary gland cancers, leukemia, as well as many other types of cancer. The requirements of the Cancer Listings are quite specific, and require medical documentation supporting the specific requirements of these Listings. Considerations include the treatment for cancer, and how long a person may be disabled as a result of the cancer and its treatment. The Listings for some cancers contain specific timeframe guidance, with the presumption that the individual will be able to return to work after that certain time. That presumption can, of course, be overcome by evidence specific to the individual’s care and treatment, as well considerations of other medical conditions, as well as the impact of other vocationally relevant factors.

Even if the specific medical information required by the Listings is not available, the regulations also provide that a finding of disability can be based upon medical equivalence. That is, if the medical condition is equal in severity to one of the Listed impairments, the individual is presumed to be disabled.

Additionally, in circumstances when a condition described in the Listings is not technically met or equaled, an individual can nonetheless be found “disabled” based upon other factors. These other factors may include other medical conditions. The regulations require that the Commissioner consider all of an individual’s various impairments, not just one condition. Further, when disability is not established by the medical evidence alone, the Commissioner is required, in many circumstances, to consider any adverse vocational factors, including the individual’s age, education and relevant work history, in determining whether an individual is eligible for benefits. In those cases, it is likely that one would need to appear and testify before an Administrative Law Judge.

The process of determining whether an individual meets all of the requirements under the regulation is a very complicated and technical process, and as the new Cancer Listings illustrate, the regulations are frequently revised. Thus, it is important to maintain a current knowledge of the various and multiple regulations that come into play in the context of an individual’s specific situation.

We stay current on these regulations. For a free initial consultation at either our Mobile or Pensacola office, contact us or call us toll free at 800-544-3568 to schedule an appointment with a disability lawyer.

Our New Site Has Launched!

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Welcome to our new Web site! We are very excited about getting our new site “live”!!! We hope our new site will be a useful tool for you. On it, you can find information about our Social Security Disability and SSI law practice.  We hope that both the client and the general public will benefit from access to forms that we frequently utilize.  We are constantly updating information about the disability claims of our clients.

We would like to extend our sincere thanks to Dot-Dot.com and Stand Still Designs in helping us to create a new, fully functional Web site. Dot-Dot.com specializes in search engine optimization, pay per click campaigns and social media, while Stand Still Designs focuses on Web design, Web development and graphic design.  Their assistance in seeing this project to completion has been invaluable.

We would love to hear your comments on the new site, so please feel free to use the comment link below to share your thoughts. We will be adding blog posts periodically, so we hope that you will check in frequently for helpful and interesting information.