Front | Back |
5 Step Sequential Process
|
1. ARE you engaged in substantial gainful employment?
2. Do you have a severe impairment?
3. Does the impairment MEET or exceed LISTING?
4. Can you perform past relevant work?
5. CAN you perform any other work?
|
Define Disability
|
- can't do work you did before
- cannot adjust to other work because of condition
- disability lasted or will last > 12 months or death
|
What is Residual Functional Capacity (RFC)?
|
An assessment of what a claimant CAN do in a work setting in spite of functional limitations and environmental restrictions imposed by his or her medical determinable impairment(s).
|
What are the steps in processing a disability claim?
|
- Initial Determination
-Reconsideration
-ALJ Hearing
-Appeals Council
-District Court
|
Who may represent a claimant?
|
An attorney
A non lawyer
-The non-lawyer must be generally known to have a good character and reputation.
-The non-lawyer must be capable of giving valuable help to the claimant in connection with the claim.
|
Eligibility Requirements
|
Fully Insured
Currently Insured
5 full month Waiting Period
|
What is SSI (Supplemental Security Income)?
|
Title 16 provides for SSI payments to individuals, including children under age 18, who are disabled and have liminted income and resources.
|
Non Medical Eligibility Standards for
SSI
|
-Aged, Blind, or Disabled
-low income
-low resources
-US Resident (for 30 days)
-Citizen or "legal" qualified alien
-Truly the benefit of last resort
|
Non Medical Eligibility Standards for
SSDI
|
-Retired and/or Disabled Workers
-Recent work history (if under retirement age)
-Insured (worked and paid FICA taxes in specified number of past 40 calendar quarters, depending on age
-No Income/Asset Limits
|
SSA definition of Disability
|
"unable to engage in any substantial gainful activity be reason of any medically determinable physical or mental impairment(s) which can be expected to result in death, or ...has lasted or can be expected to last for a continuous period of not less than 12 months." (all 5 steps are actually listed)
|
Sequential Analysis of Disability
|
1. Substantial Gainful Employment? No, ALLOW.
2. Severe Impairment? If yes, step 3. No, DENY.
3. Meets or equals a listing. Yes-ALLOW No-Step 4
4. Can do prior relevant work? Yes-DENY No-Step 5
5. Can prior work skills be transferred to other jobs? Yes-DENY, No - ALLOW
|
2 Types of Favorable Disability
Determination (Allowances)
|
-Medical
-Medical/Vocational
|
Substantial Gainful Activity (SGA)
|
Substantial - perform significant physical or mental duties productive in nature
Gainful - work usually done for pay or profit, whether or not it;s realized, licit or illicit.
Significant Duties - have a degree of economic value
2010 - $1000
|
Severe Impairment
|
-if it substantially interferes with ability to perform basic work activities.
-If impairments are severe in combination, must consider all impairments together thoughout analysis.
-Claimant must have "severe" impairment(s) to be considered "disabled".
THINK: IMPAIRMENT, SYMPTOMS, LIMITATIONS...
|