Being medically and non-medically denied for SSDI or SSI
When you apply for disability, be it SSDI or SSI benefits, you can only be approved medically. Meaning that your medical records will be evaluated to first determine whether or not you meet a disability listing (listings are contained in the blue book and regard specific approval criteria for specific medical conditions).
If you do not meet a disability listing, your claim will be reviewed to see if you can be approved for disability through the medical vocational allowance process. This essentially means that your medical records will be evaluated to determine how your medical condition limits your ability to do physical and/or mental tasks and these limitations will be used to assess whether or not you can perform work activity.
All disability approvals are medical in this sense. However, disability denials can be made for medical and non-medical reasons.
Non-medical requirements are unique to each disability program.
SSDI non-medical requirements
The non-medical requirement of Social Security Disability is that you have worked enough to be fully insured and disability insured.
The fully insured criterion has a maximum requirement of 40 quarters of coverage, and, depending on your age at the time you became disabled, it could be less.
You also have to be disability insured. This means you must have worked and have worked 20 quarters of the previous 40 quarters prior to becoming disabled. The requirement also varies dependent upon the age you become disabled.
If you meet these requirements, your disability claim may be approved for Social Security Disability and if you do not meet them your disability claim may be denied.
SSI non-medical requirements
If you are applying for SSI, the non-medical requirements involve income and resource limits. SSI is a need-based disability program and, as such, you have to prove need. The resource limit for a single person is $2000.00.
The home you live in and the highest valued vehicle your own are excluded from this limit. Once these are excluded, your bank accounts, 401K, stocks, bonds, additional land or houses, and any other resource that easily converted to cash are counted against this limit. If you are a couple, the resource limit is $3000.00.
If you are over the resource limit your SSI claim will receive a non-medical denial.
Income is another factor that must be considered when applying for SSI. If you or your spouse have pensions, rental income, work income, etc., it will count against the current benefit amount. Sometimes they are able to pay some SSI, but not the total monthly amount, or sometimes your SSI claim will be denied.
The important thing to remember is that non-medical factors can cause your disability claim to be denied prior to being sent for a medical determination for both programs. And if you are applying for SSI disability, your claim could be denied even if you are medically approved if you do not meet the income and resource limits at the end line interview.
Lastly, even if you are medically approved for either program, your disability claim can be non-medically denied should it be shown you are working and earning over the SGA limit.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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