When an injured or ill claimant applies for Social Security Disability Insurance or Supplemental Security Income based on disability, the Social Security Administration or SSA in most cases uses a five-step sequential evaluation process to determine whether the person is disabled under federal law.
What is disability?
For purposes of SSDI or SSI eligibility, the definition of disability is a unique creation of federal law. It differs from definitions for workers’ compensation or private disability insurance purposes.
To be disabled for Social Security purposes, the claimant must have a severe physical or mental “medically determinable impairment” or MDI (or combination of impairments) that is expected to last at least a year or end in death and that prevents the claimant from engaging in “substantial gainful activity” or SGA.
The five steps
For years, the SSA has used a five-step process to analyze disability:
- Is the claimant engaging in SGA? Monthly earnings must be zero or under the SGA limit. For example, monthly SGA for a nonblind claimant in 2019 is $1,220. If the claimant is earning at a monthly SGA level or higher, he or she is not disabled. If not, go to step 2.
- Does the claimant have a severe physical or mental condition? The claimant’s impairments or combination of impairments must be severe enough to limit “basic work-related activities” and either be expected to last at least a year or result in death. If these are not true, the claimant is not disabled. If true, go to step 3.
- Does the claimant’s impairment meet or equal a listing? The SSA has a Listing of Impairments that are so severe that if a claimant’s medical condition meets or equals a listing, the SSA presumes disability. If a listing is met, the claimant is disabled. If not, go to step 4.
- Can the claimant return to a past job? If yes, not disabled. If no, go to step 5.
- Is there other work in “significant numbers in the national economy” that the claimant could perform considering the limitations caused by the impairments as well as age, education and vocational experience? If yes, the claimant is not disabled. If no, the claimant is disabled.
Having been found disabled, the claimant will be eligible for benefits if he or she meets other requirements, which vary between SSDI and SSI. For SSDI, eligibility focuses on work history, while for SSI, on current levels of income and assets.