The Social Security Disability application and appeals process can be very confusing. The language, terms and acronyms you’re asked to understand are not words you use every day.
Below is a list of helpful definitions as related to Social Security Disability claims, aimed to help you better understand the disability application and appeals process.
Activities of Daily Living (ADLs) – These are the basic activities people do every day, such as eating, bathing, dressing, toileting, and transferring. When a person cannot perform these tasks, they need help in order to cope. SSA will probably ask you to complete an ADL questionnaire. Your ability to do these tasks will be considered by the SSA in determining your ability or inability to work.
Administrative Law Judge (ALJ) – Comparable to a trial judge, the ALJ reviews disability case files, hears testimony, examines evidence and makes decisions about a claimant’s entitlement to disability benefits.
ALJ Hearing – The most important level of appeal before the Social Security Administration is what is known as an ALJ Hearing. The hearing is conducted by an Administrative Law Judge, whose job is to issue an independent decision. This means the ALJ’s decision is not to be influenced by the fact that your case was previously denied.
Appeal – If a claim for SSDI benefits is denied at any level, you have the right to appeal the decision. An appeal is an official review of the decision to deny your claim. There are four levels of administrative appeals for SSDI claims:
- Reconsideration (of the initial application)
- Requesting a hearing with an ALJ
- Appealing the ALJ’s decision with the Social Security Appeals Council
- Bringing an appeal (lawsuit) in Federal Court
You must always appeal to the next level. If all administrative appeals are exhausted, you may file a lawsuit in a local Federal Court for a review the claim.
Appeals Council – If you disagree with an unfavorable decision of the Administrative Law Judge, you may file a request for review with the Appeals Council. The Appeals Council will act as the final level of administrative review for the SSA. The Appeals Council review process generally begins after an application for benefits has been denied at the initial determination, reconsideration, and ALJ hearing levels. The Appeals Council is located in Falls Church, VA.
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Back Pay – Also referred to as back benefits, retroactive benefits and past due benefits. After you win your SSDI or SSI claim, you are entitled to past due benefits that began to accrue 5 months after the onset of your disability. Back pay is limited to 12 months before the date of the application. Due to the length of time involved in processing claims, most claimants who win benefits are owed back payments, which can add up to a significant amount of money.
Blue Book – The SSA explains their complex disability determination process in what is referred to as the “Blue Book.” This is a detailed listing of the 14 impairments which the SSA considers severe enough to prevent SSDI claimants from performing substantial gainful activity. These impairments are generally considered permanent or are expected to eventually result in death. The Blue Book is also an online publication officially entitled Disability Evaluation Under Social Security.
Credits – Also referred to as Work Credits or Quarters of Coverage (QC). As you work and pay taxes, you earn credits that count toward your eligibility for Social Security benefits. In 2013, you receive one credit for each $1,160 of earnings. You can earn up to four credits each year. The number of credits required to be eligible for disability benefits depends on how old you are when you become disabled.
Date of Filing – The date you actually file for SSDI benefits. This date helps establish the date at which your disability began.
Dictionary of Occupational Titles – The SSA and most vocational experts use a publication known as the Dictionary of Occupational Titles (DOT) to determine the Residual Functional Capacity (RFC) requirements and skill level of your past jobs. The DOT lists thousands of jobs and their requirements including their strength level and skill level.
Disability – There are two components to the definition of disability under the Social Security Act: a medical component and a vocational component.
Medical component: the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment, which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.
Vocational component: a claimant will be found disabled only if his impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education and work experience, engage in any other kind of substantial gainful work that exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work.
Disability Claim – A claim for disability benefits from the Social Security Administration.
Disability Examiner – The disability claims examiner reviews applications and makes recommendations to the SSA regarding whether or not you are eligible to receive Social Security Disability benefits. Examiners are employed by the Disability Determination Services (DDS). Examiners do not make the final decision on whether your claim is approved or denied. That decision is made by the SSA.
Department of Disability Services (DDS) – Federally funded state agencies through which initial claims for Social Security disability are processed. DDSs are responsible for developing medical evidence and rendering the initial determination on whether the claimant is or is not disabled under the law.
Five Step Sequential Evaluation – A five-step inquiry, with questions asked in a specific order, until a question is answered affirmatively or negatively in such a way that a decision can be made that a claimant is either disabled or not disabled. We have a step-by-step infographic of the Five Step Sequential Evaluation here.
Normal Retirement Age – Normal retirement age varies, depending on when a person was born. Normal retirement age ranges from age 65 for older workers to 67 years of age for those born in the year 1960 or later. Also referred to as Social Security Normal Retirement Age (SSNRA).
Office of Disability Adjudication and Review (ODAR) – The SSA office responsible for holding hearings and issuing decisions for determining whether or not a claimant may receive benefits. When you file a Request for Hearing, your file will be sent to your local Office of Disability Adjudication and Review, or ODAR. Your case will be assigned to an Administrative Law Judge (ALJ).
Visit our ODAR information center to learn more about the process, get facts about your state or city’s ODAR, and know the decision rates of the AJLs.
Past Relevant Work – As a claimant, your impairments must prevent you from doing past relevant work. If SSA cannot make a decision based on your current work activity on medical facts alone, and if you have severe impairments, SSA will then review your residual functional capacity and the physical and mental demands of the work you have done in the past.
To determine this, the SSA should normally only address previous work that meets the following criteria:
- You performed the work in the prior 15 years;
- The work lasted long enough for you to learn to do it
- The work was substantial gainful activity.
Quarters of Coverage or QC – See Credits
Request for Hearing – If your Request for Reconsideration is denied, your next step is to file a Request for Hearing with an administrative law judge (ALJ). It is at this level where your claim has the greatest chance of being approved.
Request for Reconsideration – If your initial application has been denied, your next step is to file a Request for Reconsideration by a claims examiner at Disability Determination Services (DDS). Some states do not observe this step in the appeals process, so those claimants would appeal for an ALJ hearing following an initial denial (see Request for Hearing above). Your paperwork from SSA will tell you which appeal to file in your state.
Residual Functional Capacity (RFC) – The maximum remaining ability you have in order to do sustained work activities in an ordinary work setting on a regular and continuing basis. A regular and continuing basis means work done for eight hours a day, for five days a week, or an equivalent schedule. Your RFC is expressed in terms of the exertional classifications of work. These classifications are described as sedentary, light, medium, heavy, or very heavy work. Residual Functional Capacity is determined in steps four and five of the five-step sequential evaluation.
Res Judicata – If a claimant receives a final denial, then the claimant may not reapply for benefits under the same set of facts. This is called the doctrine of res judicata (a legal doctrine meaning you cannot litigate the same issue twice.)
Self-employment income – SSA considers you to be self-employed if you operate a trade, business or profession, either individually or as a partner, and have net earnings of $400 or more in a taxable year.
Social Security Administration (SSA) – Established in 1935, the SSA is the federal government agency that administers the social insurance programs for retirement, disability, SSI, Medicare, and survivors’ benefits.
Social Security Disability Income (SSDI) – A wage replacement program set up under the SSA. It is designed to help eligible workers who are unable to work due to a long-term disability obtain their social security benefits before their normal retirement age. Claimants cannot be able to engage in any substantial gainful activity for at least 12 months and they must have paid into the social security system for approximately five out of the last 10 years to be fully insured under the system.
Social Security Listing of Impairments – See Blue Book.
Substantial Gainful Activity (SGA) – Work which involves significant physical or mental activities and that is typically done for pay or profit, whether or not a profit is actually realized. Further, the level of income deemed to reach SGA status is different for blind and for non-blind claimants. SSA specifies a higher amount for statutorily blind claimants.
Supplemental Security Income (SSI) – A federal welfare program for the disabled, blind and those over 65. Unlike social security disability, payments are funded out of general revenues, not out of the social security trust fund. Many states supplement the federal SSI benefit.
Vocational factors – Age, education, and previous work experience. SSA considers these vocational factors in combination with the medical factor (residual functional capacity or RFC) in determining an person’s ability to perform other work.
Waiting period – For social security disability there is a five month waiting period after the onset date (the date disability began) during which no social security disability benefits are payable. Because only full months are counted, the actual waiting period is nearly always more than five months. Only when a person becomes disabled on the first day of the month is the waiting period exactly five months.
Our Social Security Disability FAQs will also help you understand common SSDI concepts and terms.