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How SSD Benefits Claims Are Evaluated

Serious woman evaluating disability claims benefit.

When you apply for Social Security Disability (SSD) benefits, you will go through a number of steps in the evaluation process. First, the Social Security Administration will receive your claim. Then, the SSA will send the claim to the state agency in charge of these evaluations, which is the Opportunities for Ohioans with Disabilities’ Division of Disability Determination. The DDD will determine whether you qualify for disability benefits under the federal guidelines.

The SSD benefits claim evaluation process is not perfect. People make mistakes when they review claims and make decisions. So, even if DDD denies your claim for disability benefits, you should not give up the fight. Instead, you should seek legal help right away.

With five offices located throughout northeastern Ohio, Heller, Maas, Moro & Magill, Co., L.P.A., can provide the legal assistance you need. Our dynamic team of highly skilled and experienced disability attorneys can assist you through every stage of the claims process, including appeals. We will bring more than 200 years of collective legal experience to your case. To learn more, contact us today for a free consultation.

Non-Medical Eligibility Requirements in SSD Benefits Claims

The two main types of SSD benefits that people in Ohio apply for are: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). To qualify for either type of benefits program, you must meet certain non-medical eligibility requirements.

For SSDI benefits, you must establish:

  • Work credits – You must have worked long enough to pay into the Social Security system. As of 2019, you will need to earn at least $1,360 in order to earn a single work credit. You can earn a maximum of four credits per year.
  • Length of work history – Because your eligibility is based on total work credits, you will also be evaluated to see if you have enough credits based on your age. As you get older, more work credits are needed to qualify for SSDI benefits.
  • Recent work – Some applicants may have plenty of credits. However, they may have earned them too long ago. Generally, you must have sufficient work credits within the last 10 years. If you have been out of the workforce for more than 10 years, you will likely not qualify for SSDI benefits unless an exception applies to your case.

If you do not qualify for SSDI benefits, you may still qualify for SSI. Your eligibility for SSI benefits will not depend on your work history. Instead, you must have a limited income and financial resources.

Many people get confused when they try to determine whether they meet the work credit requirements for SSDI benefits. Likewise, what counts as “income” and “resources” for SSI benefits can be challenging to determine as well. This is why you should consult with an attorney from Heller, Maas, Moro & Magill, Co., L.P.A. We can examine your circumstances and help you to determine whether you meet the non-medical requirements for the type benefits you want to receive.

The SSA’s Five-Step Sequential Evaluation Process

Regardless of which type of benefits you seek, you must meet the SSA’s medical eligibility requirements. In other words, you must show that you have a condition that fits the SSA’s definition of a “disability.” It may help you to understand the “five-step sequential evaluation process” that DDD uses to evaluate claims:

  • Substantial gainful activity (SGA) – The whole point of disability benefits is to compensate and assist those who cannot work. So, the government tests whether you are involved in earning income or not. The monthly limit on what you can make and still qualify for benefits in 2019 is $1,220. For those who are legally blind, it is $2,040.
  • Severe impairment – Next, DDD will review whether your condition is severe enough to justify a determination of need. A reviewer will look at things like your physician’s reports and any documentation of diagnostic work, testing and labs. The goal at this stage is to see whether the medical evidence clearly supports a finding of disability.
  • Finding a listed or comparable condition – The SSA lists certain conditions which are considered to be disabling. They are found in what is called the Blue Book. The conditions are divided into 14 categories of impairments. For each condition, the SSA lists certain criteria that your condition must meet. If you meet the criteria for a listed condition, or if your condition is similar and comparable to a listed condition, then you are considered to be disabled.
  • Residual functional capacity – If you do not have a listed or comparable condition, DDD will look at whether you can return to past work that you did prior to your injury or illness. The evaluation will focus on whether you can exert the same effort and physical or mental strain that you previously did. If you can do the work you did before, your claim likely will be rejected. If not, DDD will move on to the last stage of your evaluation: Determining whether you are physically and mentally capable of doing any other kind of work.
  • Other gainful employment – Even if you can never go back to working in your chosen profession, DDD will deny your claim if there is a likelihood that you could still work in some other field of employment. If you could find other suitable employment in or near your place of residence, then DDD will deny your claim. If not, then you will be considered to be “disabled” and eligible for benefits as long as you meet all other requirements.

Our Ohio SSD Benefits Lawyers Can Help You

Since 1985, our law firm has fought to protect the rights of disabled northeastern Ohio residents and their families. If you suffer from a serious and debilitating medical condition that prevents you from being able to work and support yourself and your family, don’t take chances. Contact Heller, Maas, Moro & Magill, Co., L.P.A. today.

Our team of compassionate attorneys has more than 200 years of combined experience. We are eager to put our experience and skills to work for you. We will charge no consultation fee, and we will charge nothing upfront. Instead, we will get paid if and only if we successfully help you to recover the disability benefits that you deserve.