Social Security Disability Resource Center

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Mental Disability | What is a disability? | Tips
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Hearings | Appeals | List of Disabling Conditions

Determining Social Security Disability and SSI eligibility

If you file a claim for benefits through social security disability or SSI disability, your initial claim will be taken by a federal employee known as a claims rep. Typically, this will occur at a local social security office and the disability interview will be conducted in person, though the interview can be done over the phone for individuals who may find it difficult to visit a field office.

Once the claim has been taken, however, it is not actually processed to a decision point at the social security office. Instead, it is transmitted to a state disability claim processing agency (usually called DDS or disability determination services) and once there it is assigned to a disability examiner.

As a former disability examiner, I will discuss what elements go into the "pot" when it comes to determining social security disability and SSI eligibility.

1. Medical Records - When claimants file for disability, there are two things that have to be determined by a claims examiner.

A) Is the claimant currently disabled?

B) Was the claimant previously disabled and, if so, when did the disability begin?

To determine each of these (basically, we are talking about a claimant's eligibility for past due benefits, or disability back pay, and ongoing, or continuing monthly, disability benefits), a disability examiner must have access to a claimant's medical records. And this, obviously, includes older records that go back as far back as possible (hopefully, at least as far back as when a claimant alleged that their disability began). And it also includes a claimant's medical most recent records since a disability approval typically cannot be made if the social security administration does not have access to medical record documentation that has been generated recently (within the last 90 days).

Medical records form the basis for disability decisions because they provide substantive proof as to what a claimant can functionally do and not do. In other words, what a claimant's RFC, or residual functional capacity, is and their RFC rating is. RFC, of course, is measured against the requirements of a claimant's past jobs to see if they can possibly return to one of their former jobs. Which brings us to number 2.

2. Work history - The social security disability and SSI disability system uses a setup that is both medical and vocational in nature when it comes to determining disability claims. And the vocational aspect of the system is probably something that many claimants (who make the assumption that only their medical records will be used) do not consider when it comes to eligibility for benefits. However, work history plays a big role in deciding claims.

Some claimants who apply for disability will be approved because their records satisfy the criteria for a specific medical condition in the social security administration's impairment listing manual.

But for the majority of claimants an approval will only be made if a disability examiner can determine A) that their condition limits their functional capabilities to the extent that they no longer perform the duties of their past relevant work, and also B) that their condition limits them to the extent that they cannot be expected to transition to some form of other work for which they might be otherwise suited based on their work skills.

Work history, for adult disability claims, plays nearly as large a role in deciding the outcome of claims, as a claimant's medical history. And for this reason, it is vital that claimants supply to the social security administration as detailed as possible a list of their past jobs, along with the dates of their employment (how long the job was performed and whether or not it was performed in the last 15 years will determime if it is relevant to the disability claim that is under consideration).

In part 2 of this post, I'll discuss other elements that go into the mix as far as eligibility for disability benefits is concerned.

  • What medical conditions will get you approved for disability?

  • What kind of Mental Problems Qualify for Disability?

  • Which conditions will social security recognize as a disability?

  • Tips for getting Social Security Disability or SSI benefits approved

  • SSDRC Homepage:

    Social Security Disability and SSI Resource Center

    The Most Basic questions about Getting Disability Benefits

    Social Security Disability SSI and whether or not you can work

    Common Mistakes to avoid after being denied for Disability

    Social Security Disability SSI Questions and Answers

    More Social Security Disability SSI Questions and Answers

    Common Questions about Social Security Disability and SSI

    Winning Social Security Disability or SSI Benefits

    The SSI Disability Benefits Program

    Social Security Disability SSI and Doctors - Yours and Theirs

    Social Security Disability and SSI Claim Reviews

    Social Security Disability SSI System and Benefits for Children

    Denials, Appeals, and Getting a Disability Lawyer or Representative

    What you should know about Social Security Disability and SSI Denials

    Questions about Disability Lawyers and Hiring a Disability Attorney

    Various Types of Benefits including SSI, Mental, and Child benefits

    Social Security and SSI based on Mental Disability

    Social Security Disability or SSI Benefits for Children

    Disability Benefits through Social Security

    Filing for Social Security Disability or SSI Benefits

    Social Security Disability SSI: Medical Evidence and Records

    Filing your claim for disability benefits

    Eligibility for receiving disability benefits

    Resources on this site

    Social Security Disability, SSI Terms and Definitions

    Previously answered questions regarding SSD and SSI

    The SSDRC Disability Blog

    For Individuals living in North Carolina

    Disability in North Carolina

    North Carolina Disability Lawyer

    Getting disability in North Carolina

    Related pages:

    What Happens When You File an SSI or Social Security Disability Application?
    Appealing A Social Security Disability Determination
    Social Security Disability hearing decision time
    How do you earn credits for social security disability?
    If you purchase a house, does it affect eligibility for disability?
    Use a disability lawyer to Help with Medical Records
    Disability requirements and how to file in Illinois
    How to find out if approved for disability?
    Permanent disability benefits
    How do you Apply for SSI?
    What Conditions Qualify For Social Security Disability?

    Information on the following topics can be found here: Social Security Disability Questions and in these subsections:

    Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI

    These pages provide answers to basic questions about pursuing disability benefits

    What Mental Problems Qualify for Disability?
    Disability for a mental condition
    Tips for Filing for disability
    Financial Help Filing For Disability
    Checklist for filing for disability, SSI or SSD
    Qualifying for disability benefits, how to qualify for SSD or SSI
    Filing a disability application: the steps
    Disability award notice, how long it takes to get benefits
    How to Apply for Disability - Where do I go?
    What makes you eligible to get disability?
    How to check my disability claim status?
    Can a disability attorney speed up a disability case?
    SSI disability Award Letter
    How long to get approved for disability?
    How to apply for disability benefits
    How long does disability back pay take?
    What are qualifications for getting disability?
    What medical conditions can you file disability for?
    Disability Lawyer help questions
    Social Security Attorneys, Disability Representatives