Eligibility

Return to Step One. In this article, Ocala disability lawyer CJ Henry will explain the next step in the sequential evaluation process, the so-called severity step. Step 2: Do You Have a “Severe” Medically Determinable Impairment? If you’re not engaged in any substantially gainful activity, the Social Security Administration will then determine whether you suffer from a “severe” impairment. If your impairment is slight, then the Social Security Administration will consider it to be “non-severe,” and you will be determined not to be disabled. Almost any decrease in your residual functional capacity (which is the work that you can still do despite your impairment) will satisfy Step 2. The Social Security Administration will look at all evidence, even your subjective…Read More

Return to overview. Step 1: Are You Engaged in Substantial Gainful Activity? The first step in the sequential evaluation process is determining whether you’re engaging in substantial gainful activity. To fall into this category, the work must be both “substantial” and “gainful.” It entails doing “significant physical or mental activities.” Meaning of “substantial” Work you do is not considered to be substantial when: You do not have the capacity to perform “ordinary or simple tasks satisfactorily without more supervision or assistance than is usually given other people doing similar work”; or You are engaging in work that requires “minimal duties that make little or no demands” on you and is actually of “little or no use” to either your employer…Read More

General Overview of the Sequential Evaluation Process If you apply for Social Security disability benefits, the Social Security Administration will undergo a five-step sequential evaluation process in order to determine whether you’re disabled and thus qualified for disability benefits. If, at any step, the Social Security Administration determines that you’re either disabled or not disabled, then it stops the evaluation, and there’s no further proceeding to the next step. The five steps for determining disability are: You are not doing any “substantial gainful activity” (SGA); and You suffer from a “severe” medically determinable impairment; and This impairment meets or “equals” an impairment that is listed in Social Security’s “Listing of Impairments”; or Taking into account your “residual functional capacity” (RFC),…Read More

Imagine going out on disability, losing all your benefits – health insurance, life insurance, maybe even your job –only to find out you do not qualify for disability benefits under your insurance policy. This could lead to financial disaster. Every year millions of people purchase disability insurance, negotiated by their employer, without ever reading the policy. Because they didn’t read the policy they didn’t realize that there are preexisting clauses that may disqualify them from collecting benefits or that the policy limits or denies coverage for the medical condition that they have, or that the benefits offered under the policy are not enough to replace their loss of income. Not only do they have one of these worthless policies, but…Read More

Is There a Conflict of Interest If the Party Paying Benefits Is The Same Party Who Decides Eligibility? On Thursday, the Supreme Court answered this question with a resounding YES! The Court found, what every plaintiff ERISA practitioner already knew, that when a company determines eligibility and pay benefits out of its own pocket there is an inherent conflict of interest. Recognizing this conflict of interest, the Court went on to state that a reviewing court should consider an insurance company's conflict of interest when reviewing the denial of an employee's health or disability benefits claim. While the court did not provide much guidance on how much weight should be given to the conflict, it provides that the reviewing court…Read More

Whether or not you still qualify for disability benefits depends on how much you’re working, how much you’re making, and the specific disability program you are enrolled in. The restrictions on what you can earn are stricter if you are enrolled in the Supplemental Security Income program. Assuming that you have no other sources of income besides your job and SSI, your Supplemental Security Income benefits are reduced by a dollar for every two dollars you earn over $85 in a month. It is entirely possible to earn so much at a job that your benefits stop altogether. If you earn enough to receive no benefits for an entire year, you will have to reapply for the program if you…Read More