Social Security Appeal and Evaluation Process

The Appeal Process

1. Application – If you are denied, you may file a Request for Reconsideration.
2. Request for Reconsideration – If you are denied, you may file a Request for Hearing.
3. Hearing – If you are denied, you may Request a Review of the Judge’s Decision by the Appeals Council.
4. Appeals Council – Your claim may be approved, sent back to the judge for another hearing, or denied.
5. Federal Court – If you are denied again by the Judge or Appeals Council, you can file a lawsuit.

To continue with your claim, ALL APPEALS MUST BE FILED WITHIN 60 DAYS OF THE DENIAL DATE. (If you let the appeal deadline lapse and/or re-apply, you may lose back pay benefits.)

The Evaluation Process

This is the process that Social Security goes through to decide whether you are disabled.

Step One: Are you working at the SGA level? If you have worked since claiming disability and the work constitutes substantial gainful activity (you are earning more than approximately $980 per month – this amount changes each year), you will be ineligible for disability benefits. There are some exceptions to this rule, depending on the type of work you are performing.

Step Two: Do you have a severe impairment? You must have either a severe impairment or several impairments when combined would be severe. This step requires that you MUST suffer from substantial physical or mental problems rather than simple, minor problems. To be considered severe, the medical problems must significantly limit your ability to perform basic work activities such as sitting, standing, walking, lifting, or concentrating. Severity is a threshold issue and few claims are denied at this step.

Step Three: Do you meet Social Security’s requirements to be “automatically” disabled? SSA has determined certain diseases are, per se, disabling. These diseases are called the “Listings of Impairments.” Consequently, if you suffer from one of these conditions, SSA will award disability benefits. These conditions are very specific. There are criteria in the Listings of Impairments for 14 different body systems which affect the health of claimants. A review of the Listings for these disorders indicates the type of specificity required to establish that you meet the criteria for a listing. You can also be found disabled for a condition which does not exactly meet the criteria, but is so similar it equals a listing.

Before step four, SSA will determine the maximum level of work you can perform considering their exertional ability. This is referred to as “Residual Functional Capacity” (RFC), (i.e., your ability to sit, stand/walk, and lift). SSA will determine the maximum level of work you can perform, considering you physical impairments, as either sedentary, light, medium, or heavy work. Mental impairments have an RFC process as well.

Step Four: Can you go back to your prior work? If, based on you RFC, you are able to perform any of the jobs which you performed on a full-time basis in the last 15 years, then you will be found not disabled.

Step Five: Can you perform any other kind of work? If you cannot perform work which you have done in the last 15 years, then SSA determines whether there is any other work in the National Economy which you can do. Social Security considers your Residual Functional Capacity and your age, education, and work experience.

If you need any legal help navigating the appeal process, please call our office at 725.777.7777.