SSDRC authored by Tim Moore
Social Security Disability and SSI Questions and Answers
What is the Application Process for Social Security Disability and SSI?
How do you Win Benefits under Social Security Disability or SSI?
If I am determined disabled, how far back will Social Security pay benefits?
How do you prove your disability case if you have a mental condition?
What Can I Do to Improve My Chances of Winning Disability Benefits
Common Mistakes after Receiving a Denial of Social Security Disability or SSI Benefits
How to File for Disability - Tips for Filing
If You Get Approved For SSDI Will You Also Get Medicare?
How much does a Social Security disability attorney get paid?
Social Security Disability SSI Criteria and the Evaluation Process
How long does it take to be approved for SSI or Social Security disability?
What do you Need to Prove to Qualify for Disability Benefits?
Social Security Disability SSI and Fibromyalgia
Social Security Disability SSI and Degenerative Disc Disease
Can I Qualify For Disability and Receive Benefits based on Depression?
More questions about SSD and SSI
What Disabilities Qualify for SSI and Social Security Disability Benefits?
Social Security Disability Status
Social Security Disability Tips ó how a claim gets worked on
Social Security Disability, SSI Disability - Terms, Definitions, Concepts
Who qualifies for disability? - Qualifying is based on evidence of functional limitations
How to prove you are disabled
and win disability benefits
Contrary to myth, qualifying for disability benefits (SSD or SSI) is not rocket science. It is simply a matter of proving one's case through strong objective medical and vocational evidence, combined with a logical, rational argument for approval that is based on Social Security Administrative rules and regulations.
Though there is a list of medical impairments with detailed approval criteria, the majority of claims are not approved in this manner (listing-level requirements tends to be very specific and, in most cases, a person's medical evidence will not contain this level of detail). For the vast majority of claimants, winning a claim will involve proving that they have functional limitations that rule out the ability to engage in work activity.
In the Social Security Disability and SSI system, a simple diagnosis of a condition will not result in an approval for benefits. The emphasis is on how the individual's condition affects, and limits, their ability to engage in normal daily activities, and the ability to perform work activity.
For this reason, potentially anyone may qualify for disability benefits through one or both of the disability programs administered by the Social Security Administration...provided they can do the following:
1. Prove they have at least one severe medical impairment that is documented by objective medical evidence.
2. Prove that the condition has resulted in the types of limitations that, given the particular demands of their past work, make it impossible to return to their past work. For example, a person whose past work required them to climb ladders but now has significant degenerative disc disease would probably be found to be unable to return to this type of work.
3. Prove that they also cannot switch to some type of other work that they would usually qualify for--were it not for their combination of medical factors and vocational factors (this would include their age, education, and job skills).
4. Finally, the person's disabling condition must last at least one full year while being severe enough to make it impossible for them to engage in work activity. Note: a person does not have to wait until they have been out of work for a full year before applying. You can apply for disability at any time and SSA (through a disability examiner or judge) will be able to review the evidence and determine whether or not your condition will be disabling for this length of time.
Is there a difference between Social Security Disability and SSI?
The two programs administered by SSA -- Social Security disability (SSD) and Supplemental Security Income (SSI) -- have the same medical disability qualifications. Any person who files for disability must go through the same medical disability process to be found medically disabled for disability benefits.
In fact, disability examiners who make decisions on disability applications and reconsideration appeals make no distinctions between the two programs. The only time the two programs are considered separately is when an individual initially files their claim and the Social Security field office CR (claims representative) must determine whether they might qualify for SSD benefits based on work credits, or qualify for SSI disability based on need.
The medical disability evaluation process involves an application for disability benefits. During the application interview, Social Security claims representatives gather information about medical treatment sources, treatment dates, medications, testing, etc. They also get information about the types of work a person has had in the last fifteen years, which is what SSA refers to as the relevant work period.
How is a disability claim worked on?
As a former disability examiner (see the "about me" page: Tim Moore), I can speak from direct experience as to how a claim is processed at DDS, the state-level agency that makes determinations for disability decisions.
After a disability application is taken at a Social Security field office, it is transferred to the DDS agency in that state. Immediately, the case is assigned to a disability examiner. Just as immediately, the examiner will begin to send out requests for the claimant's medical records.
The wait for these records constitutes the single largest delay on a case. However, once the records arrive--usually, this takes weeks or even months for all the records to come in--the examiner will be in a position to evaluate the fundamentals of the case.
Note: when a case is particularly strong, the examiner may not have to wait for all the records. The decision may be made with just some of the records if they do support a finding of disabled. This is also where a disability representative (a disability attorney, or, like me, a non-attorney disability representative) may provide some early benefit on a case by doing pre-hearing case development and attempting to win the claim without the need for a hearing and all the extra months of waiting which that entails for the claimant.
Looking at the records, the examiner will be able to determine if the claimant has a condition that is listed in the impairment listings and whether or not they meet the listing criteria. As we noted, this is usually not the case. The examiner will then review the records to get an idea of what the claimant's residual functional capacity is, i.e. what they can still do despite their impairment.
This is for the purpose of determining if the claimant may be approved on the basis of what is known as a medical vocational allowance. Essentially, a claimant is approved this way when the final determination is that they cannot be expected to return to work due to the severity of their condition(s) and the limitations that are caused by it.
Just to restate: the Social Security disability process requires that a personís medical or mental conditions prevent them from performing any of their past jobs or any other kind of job they might be qualified to do considering their job skills, education, age, and functional limitations. If a person is prevented from doing any kind of substantial work activity, it is likely they will be medically approved for disability benefits.
However, there is more to Social Security disability benefit eligibility than a medical approval. Disability applicants must meet the non-medical requirements of one or both disability programs before their disability claim may be sent to a disability examiner (examiners make decisions on disability applications) for a medical determination.
Coverage for an SSD Claim
Every Social Security disability claim is based upon an insured status. Social Security disability is actually an insurance program that an individualís earnings establish insured status for through their payroll deductions. Internal Revenue reported wages create an individualís Social Security earnings record and each year an individual may earn as many as four quarters of coverage. These quarters of coverage, or work credits, determine if they are insured for Social Security disability benefits.
There are a few advantages to being insured for Social Security disability benefits. Sometimes, there are additional benefits payable for an individualís children or spouses should they be approved for disability benefits. Additionally, most Social Security disability beneficiaries receive higher monthly disability benefits. If a Social Security disability beneficiary has a very low monthly disability benefit, it is possible that they may be entitled to both SSD and SSI. However, the amount they will receive will be no more than the SSI disability monthly earnings limit.
Coverage for an SSI Claim
If an individual does not have a sufficient amount of quarters of coverage to be insured for Social Security disability, they may still meet the requirements of the Supplemental Security Income disability program. SSI is a disability program designed to help individuals who have not worked, have not worked much, or who have worked too far in the past to be insured for Social Security disability. The SSI disability program has a program for disabled children as well (All disability claims for minor-age disabled children are taken through SSI).
SSI Eligibility requirements for SSI disability involve resource ("resource" is a term for assets that affect SSI) and income limits. In this way, SSI is like many other social help programs.
Claims representatives evaluate for SSI eligibility when they conduct their disability interviews. Resources for the purposes of an SSI eligibility determination might include but are not limited to vehicles, boats, motorcycles, pensions, bank accounts, stocks, bonds, 401Ks, land, homes, heir property, jewelry, or any other items that can be easily converted to cash.
Income for the purposes of being SSI eligible might include wages, unemployment benefits, workmanís compensation benefits, VA benefits, etc. Currently, Social Security allows an individual to have $2000.00 in resources and couples are allowed to have $3000.00 in resources. They exclude the home and land an individual or couple uses as a residence and the most expensive vehicle owned from this limit.
Income limits are not so concrete because they are variable to the number of children in the household. When an individual completes their interview, the claims representative will evaluate their household composition and determine if they are under the income limits for the SSI disability program.
Can you qualify for SSI and still not qualify?
The income and resource limits are so important to the SSI disability program that an individual who is medically approved for disability benefits may be denied for disability benefits at the "end line SSI interview" for income or resources even if their medical records indicate that they otherwise satisfy the Social Security Administration definition of disability.
Return to: SSDRC, or the Social Security Disability Questions page