FACT SHEET 3

SSA s FIVE STEPS TO A DISABILITY DETERMINATION
FIVE STEPS TO A SOCIAL SECURITY ADMINISTRATION DISABILITY DETERMINATION The Myth of the Initial Denial: Social Security denies everyone s first application. That s so they can force you to go before a judge THIS IS INCORRECT! Many mistakenly think that Social Security policy is to deny all initial disability claims to force each of them through the appeals process. It is also believed that this helps sort out those claims that aren t serious. This is incorrect: All initial claims follow a five-step determination process. Passing or failing the requirements will determine the SSA decision. The steps are: 1. Working at SGA (Substantial Gainful Activity) Is the claimant currently employed and earning about $1,000 per month? If no, go to step two. If yes, the claim is denied. 2. Is the illness, injury or condition being reported medically determinable? Is there medical evidence with corresponding documented symptoms and the medical retreatment to support the claim? If yes, go to step three. If no, the claim is denied. 3. Does it meet Social Security s Listing of Impairment? The Social Security Administration has a directory of all qualifying diagnoses. It is called the Bluebook. If the diagnoses is listed in The Bluebook, then it is likely that the claimant will pass this test. However, if the effects of the illness are minimal a denial will be returned. 4. Residual Functional Capacity and Past Relevant Work Can the claimant do any work that he/she performed prior to the current illness, injury or condition that is prohibiting current employment? If no, go to step five. If yes, the claim will be denied. 5. Can the claimant perform any work as exists within the national economy? What exactly is work ? Showing up on time? Performing the required tasks to a level that satisfied management? Performing consistently throughout the prescribed workday?... workweek? work month? All of the above? Not all disabilities incapacitate the individual constantly; however episodic illness may prevent the employee from working for indefinite periods of time. Few employers can keep a person who s periodic absences make it impossible to remain in his/her position. For further information go to www.dhcs.ca.gov or call Pacific Clinics Benefits Establishment @ 626-254-5000

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