Social Security’s five-step process to determine disability

The Social Security Administration uses a five-step disability determination process for SSDI applications.

The federal Social Security Administration or SSA administers the benefit programs established under the Social Security Act, including Social Security Disability Insurance. Some Americans do not know that when they contribute to the Social Security fund through payroll deductions, not only are they paying toward retirement benefits, but also toward the disability insurance component of the program: SSDI.

The nature of SSDI

SSDI works much like private disability insurance. Basically, a claimant must work enough quarters over time and recently enough to meet specific work history requirements. If the work requirements are met, a claimant will be eligible for SSDI monthly payments if he or she meets the federal definition of disability: a worker is disabled if he or she has a severe medical impairment or combination of impairments expected to last at least one year or result in death that prevents him or her from working.

SSDI application

While this sounds simple enough, applications for SSDI can take many months to be correctly processed, which may include denials and appeals, especially when the medical evidence is complex, or symptoms are subjective (like pain or fatigue) and harder to prove.

Fast-track processing

For the most severe of impairments, the SSA has two fast-track application processes: Compassionate Allowances or CAL, which approves applications for disability based on devastating medical conditions on the CAL list as soon as they are confirmed by the medical evidence, and Quick Disability Determinations or QDD, which uses a computer program to quickly identify applications likely to be favorably decided.

The five steps

For applications not on either fast track, the SSA in partnership with state disability determination agencies (for example, the Michigan Disability Determination Service), uses a five-step process to analyze whether an applicant is disabled for SSDI purposes:

  • Is the claimant working (defined as of this writing as making more than $1,070 per month)? If yes, then not disabled. If no, then continue.
  • Is the claimant's medical condition severe (meaning does it interfere with basic work activities)? If no, then not disabled. If yes, then continue.
  • Does the claimant's impairment meet or equal one on the official Listing of Impairments (meaning that it is included on or equals one on an official SSA list of disabling impairments)? If yes, then disabled. If no, then continue.
  • Can the claimant return to previously performed work? If yes, then not disabled. If no, then continue.
  • Can the claimant perform any other type of work considering medical impairments, age, education, experience and skills? If yes, not disabled. If no, disabled.

Seek legal counsel for SSDI claims

The law and procedure that apply to an SSDI claim are very complicated and can be confusing to a layperson. It can make all the difference in the processing of an SSDI application, especially if appeals are necessary or if the medical conditions are complex, to have the representation and advice of an experienced SSDI attorney to guide the claimant, communicate with the SSA, be sure deadlines are met and appeal negative decisions.

Keywords: Social Security Disability Insurance, SSDI, disability, definition, five-step process, application, fast track, Compassionate Allowances, Quick Disability Determinations, impairment