What are the requirements and criteria for Social Security Disability?

Eligibility for Social Security Disability and SSI benefits can be considered in two separate ways.

First, is the individual actually insured for SSD? In other words, has the person worked enough to achieve eligibility to apply for Social Security Disability?

If the person has (and in most cases, for an adult with a history of employment, this will be true), then the issue will be whether or not the person meets the eligibility requirements of the social security administration's disability program.

What are the requirements and criteria for Social Security Disability? The definition used by SSA is fairly obtuse, but this is what it boils down to. To be awarded disability benefits, a claimant must:

Criteria 1. Have a condition (physical or mental or both) that is considered severe. For claims in which there is only a non-severe impairment, the claim will be denied on this basis.

Criteria 2. Have a condition, physical or mental, which lasts for at least a year. Does this mean that the condition must last at least twelve months before a person can apply for disability? No, if the condition has not existed for at least twelve months at the time of application, when the case is evaluated, a projection will be made as to whether or not the condition will last this long. In cases where it is decided that a claimant's condition will not last at least this long, the claim may be denied on the basis of duration (failure to satisfy the minimum time period).

In addition to these requirements, there are additional requirements that determine an individual's eligibility for Social Security Disability benefits. After a claimant's medical records have been examined, the determination will be made as to whether or not the claimant can:

A. Return to their past work.

B. Perform some other type of work.

Even if an applicant for Social Security Disability has a severe impairment that has lasted, or can be projected to last, at least 12 months, if the determination is made that they can return to their past work, they will be denied for benefits.
What is past work? Past work can actually include any job that the claimant performed for a year or longer within the last 15 years.

If it is decided that a person cannot return to their past work, the next step will be to decide whether or not it is possible for them to do some "other type of work". This is, very often, how applicants for Social Security Disability are denied.

What is "other work"? Other work can include a wide range of jobs for which a person might be eligible to perform based on their age, education, work skills, the transferrability of their work skills, and the current limitations they have as a result of their medical or mental condition or conditions.

When a disability case is denied at the application or reconsideration/review stage on the basis that they can do other work, there is nothing a claimant can do about this, other than to appeal the decision.

However, when a claimant gets to a disability hearing before a judge, the lawyer that handles their case can present the argument that A. they are incapable of returning to their past work and B. they are incapable of doing other work. When a representative or lawyer successfully makes this argument, a claimant will meet the program criteria and eligibility requirements and be approved for disability benefits.

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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