Social Security Disability RC

How to file for disability, Filing for SSI
Disability Requirements, Disability Status
How long is the wait?, Disability Application
Social Security Disability list of impairments
How to Qualify for Disability, Mental Disability
Disability Lawyers FAQ, Disability Back Pay

How to Qualify for Disability



 
How do you qualify for Social Security Disability or SSI? And what do you need to do in order to qualify? Qualifying for disability benefits from the Social Security Administration means proving that your limitations are severe enough to rule out your ability to work and earn a "substantial and gainful income", otherwise known as SGA.

There are two methods of qualifying for SSD or SSI. The first is by satisfying a listing in the SSA list of impairments, and the second is by receiving a medical vocational allowance approval. In either instance, proving that your case meets the Social Security definition of disability depends entirely on the information in your medical records. At a disability hearing, however, what your medical evidence has to say can be a matter of interpretation and, therefore, how your case is presented can make the difference between winning or losing the case.

What needs to be proven in order to qualify?

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 their ability to perform work activity.



Related: What kind of cases win disability benefits?

For this reason, potentially anyone will 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 lack the ability to 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.

What do you need to do in order to qualify?

A) Make sure you have current medical records when you file your claim. If you do not have current medical records to document your condition, it will be very difficult to be awarded benefits. In fact, it will be difficult for Social Security to even make a decision on your case. If you have not been seen by a doctor in the last 90 days, Social Security will send you to a consultative medical examination performed by an independent physician. However, these exams are short and usually do not provide the information you need to be approved for disability. So, try to have recent treatment when you apply. If not, get treatment and report this to Social Security after you file your claim.

B) Make sure you list all your medical treatment sources. Current medical providers can help prove that you are disabled. But older medical records can establish how far back your disability exists which can affect your eligibility for back pay and medicare benefits.

C) Make sure you point out all your medical conditions and how they affect you when you apply. The disability examiner working on your case will be explicitly looking for signs of how you are limited by your medical condition, which can be physical or mental, or both. The examiner will look to see if you can or cannot do your past work. If you can't do your past work, the examiner will still consider whether you can do some type of other work. So, it is vital that you point out all your conditions and symptoms.

D) Consider looking at your own medical records to see if your doctor or doctors have indicated how your condition affects you. Social Security looks primarily at how your condition limits you, not just that you have a particular condition. If your records lack any mention of your physical or mental functional limitations, you may wish to address these on future medical visits.

E) If you have a condition, make sure you have been treated specifically for it. Many individuals allege anxiety or depression, or a particular physical issue, without actually having been treated by it. If you receive medication for depression or anxiety from your regular doctor, you may wish to seek more specific treatment from a mental health provider to more fully document your condition.

How is a disability claim worked on?

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 or 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.

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.

More on the differences between the two programs at: What is the difference between Social Security Disability and SSI?

More on how disability claims are worked on:

How Will Social Security Decide a Disability Case that's filed?

Social Security Disability Tips ó how a claim gets worked on.

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 vs SSI. 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 than do SSI recipients. 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.

How Many Work Credits Do You Need To Have For SSI or Social Security Disability Eligibility?

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. Here's what SSA has to say on the topic of How You Qualify for disability.








Essential Questions

What is the Social Security Disability SSI list of impairments?

Can you work while getting or applying for Disability?

How Often Does Social Security Approve Disability The First Time You Apply?

Tips for getting Social Security Disability or SSI benefits approved

What medical conditions will get you approved for disability?

What kind of Mental Problems Qualify for Disability?

Receiving a Disability Award Letter

Conditions Social Security will recognize as a disability

Previously answered questions regarding SSD and SSI

Applying for disability in your state



Most popular topics on SSDRC.com

Social Security Disability SSI Questions

The listings, list of disabling impairments

Can a mental illness qualify you for disability?

Disability Lawyers prevent unnecessary denials

How much Social Security Disability SSI back pay?

How to apply for disability for a child or children

Filing a Social Security Disability SSI application

Filing for disability - when to file

How to apply for disability - where to apply

Qualifications for disability benefits

How to Prove you are disabled and Win your Disability Benefits

Qualifying for Disability - The Process

How to get disability for depression

Getting disability for fibromyalgia

SSI disability for children with ADHD

What is the Application Process for Social Security Disability and SSI?

Common Mistakes to avoid after being denied for Disability

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New and featured pages on SSDRC.com

Who can help me file for disability?




Related pages:

Who qualifies for disability? - Qualifying is based on evidence of functional limitations
How to qualify for disability - The Process of Qualifying for Benefits
To qualify for Social Security Disability or SSI, how severe must a condition be?
Can You Qualify for Disability if you did not work much?
How Do You Qualify For Disability without Money To Go To the Doctor?
The Qualification Criteria for Social Security Disability
What If You Did Not Work Long Enough To Qualify For Disability?
Qualifying for disability benefits with the social security administration
Qualifying for Disability - What is Social Security Looking for?
Do You Qualify For Social Security Disability Insurance?
What do you Need to Prove to Qualify for Disability Benefits?
What kind of Mental Problems Qualify for Disability?
Do You Have To Qualify For SSI Financially?
How does work qualify you for disability? (work credits)
Getting a Disability Lawyer in California
Will I qualify for disability Benefits in California?
How long does it take to get disability in California?



These pages answer some of the most basic questions for individuals who are considering filing a claim.

Can you get temporary Social Security Disability or SSI benefits?

Permanent Social Security Disability

What is the difference between Social Security Disability and SSI?

Who is eligible for SSI disability?

Can I Be Eligible For SSI And Social Security Disability At The Same Time?

What makes a person eligible to receive disability benefits?

Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?

What happens if I file a disability application and it is denied by a disability examiner or Judge?









For the sake of clarity, SSDRC.com is not the Social Security Administration, nor is it associated or affiliated with SSA. This site is a personal, private website that is published, edited, and maintained by former caseworker and former disability claims examiner, Tim Moore, who was interviewed by the New York Times on the topic of Social Security Disability and SSI benefits in an article entitled "The Disability Mess" and also by the Los Angeles Times on the subject of political attempts to weaken the Social Security Disability system.

The goal of the site is to provide information about how Social Security Disability and SSI work, the idea being that qualified information may help claimants pursue their claims and appeals, potentially avoiding time-consuming mistakes. If you find the information on this site helpful and believe it would be helpful to others, feel free to share links to its homepage or other pages on website resource pages, blogs, or social media. Copying of this material, however, is prohibited.

To learn more about the author, please visit the SSDRC.com homepage and view the "about this site" link near the bottom of the page.