An overview of Social Security’s disability evaluation process and what you need to do to get benefits.
Here is Social Security’s definition of disability: You are entitled to receive Social Security disability (SSDI) or Supplemental Security Income (SSI) benefits when you are no longer able to perform a “substantial” amount of work as the result of a physical or mental impairment that is expected to last at least 12 months, or possibly result in death. (To Social Security, a substantial amount of work, called “substantial gainful activity,” is making $1,130 or more per month, before taxes.)
Meeting the Definition of Disability
A shortcut to satisfying Social Security’s definition of disability is for a person’s disability or impairment to meet the level of severity described in the Social Security medical listings book (called the Listing of Impairments). This is the manual that describes dozens of conditions, ranging from arthritis and high blood pressure to asthma, heart failure, and depression. Satisfying the severity criteria quoted in the listing book will guarantee a disability approval.
A disability applicant’s medical condition must be very severe, however, to win a disability approval based on meeting the disability criteria in the listing book. Most individuals qualify for Social Security benefits the traditional way: by proving that their disabling condition is severe enough that they are unable to perform substantial gainful activity (SGA).
To determine whether you’re able to perform SGA, Social Security will look first to see if you’re capable of doing your last job, or past jobs you’ve had in the past 15 years. If not, Social Security will assess whether you can do other work. Social Security will make this evaluation while taking into consideration your age, level of education, and the type of skills you learned in the past.
For example, a person with a 9th grade education who cannot do his or her past work (for instance, because it requires heavy lifting) will not be expected to perform other work that goes beyond his or her educational limits. And individuals with severe mental or “affective” impairments (that is, low IQ, depression, or anxiety) will not be expected to perform other work that requires detailed attention and concentration.
Learn more about Social Security’s disability evaluation process.
Medical Details Required for the Disability Evaluation
When you apply for disability, include a full listing of all of your impairments, conditions, and symptoms, as well as a list of all the doctors, hospitals, and clinics that have been involved in your treatment (along with their addresses and phone numbers).
Specific criteria for getting approved for various medical conditions are included in the Social Security Listing of Impairments. It is important that your doctor is familiar with these criteria when submitting statements on your behalf. It is also useful to explain to your doctor just how your condition limits your daily activities so your doctor can include this information in your medical records.
Learn more about the medical evidence used in disability cases.
Non-Medical Requirements for Social Security Benefits
To qualify for SSDI disability benefits, an individual must have paid Social Security payroll taxes over a certain length of time. An individual who has done this will be considered insured (covered) for SSDI purposes. The number of years you are required to pay into the Social Security system varies by age. And if an individual stops working and paying Social Security taxes, they must be able to show that their disability began before their insured status ran out.
To qualify for SSI disability benefits, an individual must have income and assets under the SSI program’s strict limits.
Learn more about qualifying for SSDI or eligibility for SSI.
Appealing Disability Denials
It is not uncommon for an application for Social Security or SSI disability benefits to be denied in the first round. In fact, it is the norm, and appeals are generally required to win disability benefits. However, many claims are denied because the patient’s medical record lacks adequate documentation that fully establishes the severity of the disability.
If your application is denied, do not reapply. This is a common mistake made by applicants for disability benefits. Instead, file an appeal, and make sure the necessary medical information is in your file this time (a disability lawyer can tell you what medical evidence will help you win an approval).
Learn more about appealing a denied disability claim.
Hiring a Disability Lawyer or Representative
Once you get a notice of hearing for your appeal, you might want to seek the services of a qualified disability lawyer who can guide your case through the disability appeals process. Disability applicants with legal help have a much higher chance of winning than those who are not represented. There are many disability lawyers who offer free consultations before you hire them.