Social Security

Published in 1992

This article is addressed at a few commonly asked questions about Social Security Disability and to provide the individuals as well as attorney whose practice involves personal injury, workers compensation and estate practice with a synopsis of the social security system.

There are a host of programs that are administered by the Social Security Administration and other related types of benefits including; disability insurance benefits(DIB), supplemental security income(SSI), spouse benefits, widow/widower's benefits, child's benefits and parents benefits to name a few. The more common type of questions that an attorney will field surround contested Social Security Disability Insurance Benefits(DIB) and therefore this article will focus primarily on common questions surrounding this program.

The definition of disability, 20 C.F.R. Sections 404.1505(a) & 416.905(a), which is applicable for both SSI and DIB is the inability to engage in any substantial, gainful activity by reason of any 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 continuing period of 12 months. This physical impairment must be severe and must prevent the worker from engaging in his or her previous work or any other Substantial gainful activity which exists in the national economy. In determining the ability to perform other work, the Social Security administration considers the age, education, previous work and residual functional capacity of the claimant.

To qualify for Social security benefits, a claimant needs to be insured in accordance with the Social Security program. Insured status means that an individual has 20 quarters of coverage in the past 40 quarter period prior to the onset of the disability. An individual who is disabled before age 31 needs less quarters to meet fully insured status. See, 20 C.F.R. Sec. 404.130(d).

The Social Security administration follows a five step sequential evaluation process for disability benefits at the administrative hearing level.

The first step is to examine whether the claimant engaging in substantial gainful activity. An often asked question was how much money would be considered too much and disqualify a claimant from entitlement. At the time of the writing of this article, more than $500.00 per months will generally mean the claimant fails at this step and less the $300.00 will generally be sufficient to demonstrate that the claimant is not performing substantial gainful activity.

Next, step two of the sequential evaluation process is whether the claimant has a severe impairment. This is defined as an impairment which significantly limits the claimant's physical and mental ability to perform basic work activities. See, 20 C.F.R. Sections 404.1521; 416.291.

Step three examines whether the impairment meets or equals the listed impairments. The listing are located at Appendix 1 to 20 C.F.R. Part 404, Subpart P. The listing of impairments describes, for each major body systems, impairments which are considered severe enough to prevent a person from doing any gainful activity. In order to competently represent a claimant, an attorney must have a thorough understanding of these listings and what medical proof will meet or equal the listings. This is the only step where a no answer will not result in a disqualification of benefits.

Step four looks at the impairment preventing the claimant from performing past relevant work. The Social Security administration examines the claimant's Residual Functional Capacity(RFC). In determining the RFC the Social Security Administration looks at the physical and mental abilities of the claimant in light of the demands of previous jobs. Jobs are classified as sedentary, light, medium, heavy or very heavy.

The final step is whether the impairment prevents the performance of other work existing in significant numbers in the nation considering the claimant's RFC, age, education and prior work experiences. It is not unheard of to have a vocational expert state that there are thousands of jobs your client could perform.

There are three aspects to examine when representing a Social Security Disability claimant, the medical records, durational requirements and vocational abilities. The cornerstone of proper representation is a thorough grasp of the medical impairments which effects your client. Just because the doctor has diagnosed your client with a large and difficult to pronounce ailment does not necessarily mean that the client will be entitled to benefits.

The Social Security administration looks at the signs, symptoms and laboratory findings that are submitted on behalf of your client. The signs must be shown by medically acceptable clinical diagnostic techniques. The key is to be prompt and thorough with the medical records.

The impairment must last or be expected to last for at least 12 months, or result in death. This is usually not difficult because by the time that a hearing occurs, the client most likely has applied for benefits well over a year ago.

The claimant has the burden of proof in establishing that their impairment(s) prevents them from performing past relevant work.

In sum, the social security practice will could provide great satisfaction from helping clients who are truly in need of obtaining benefits.