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Understanding the SSA's evaluation process for benefits

The system of providing Social Security disability benefits involves a complex maze of rules, regulations and decisions regarding prior cases. By employing a sequential process to evaluate an eligible applicant's claim, the Social Security Administration will determine if there is indeed a "disability" that warrants benefits. For many California claimants, how their particular mental or physical impairment fits within the SSA's Blue Book, or Listing of Impairments, is crucial to the ultimate disability decision. However, even if a claimant's impairment is among those included in the Blue Book, it's not certain that disability benefits will be awarded.

It's important to note that a claimant will not receive benefits merely by having a certain, specific condition. The key issue is the extent to which that condition causes what are known as functional limitations. This requires an examination of the work history of the claimant to fully understand the types of activities they performed as necessitated by the nature of the job.

Unless a claimant has a severe condition, such as a terminal condition, the application process typically takes at least five months. More than 50% of initial applicants are denied. Reconsideration, the first level of appeal, has an even higher rejection rate. The next level of appeal is a hearing before an administrative law judge. At this stage, additional medical evidence can be presented. Furthermore, the claimant will have an opportunity to testify and explain the true impact of the impairment on their life and ability to work.

A claimant has a right, at any stage of the proceeding, to be represented by a Social Security disability lawyer. Often, this can make a difference in the outcome of the case.

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