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Social Security Disability SSI - Eligibility Requirements and Criteria to Qualify

What is a disability according to SSA? In a nutshell, it is potentially any condition that is severe enough to rule out a person's ability to work and earn a livable income (as defined by the federal government). To elaborate on this, we can begin with a basic question.

What is the definition of disability according to the Social Security Administration?

To be eligible to receive either social security disability or qualify for SSI benefits, the following eligibility criteria must apply--

1. The individual's condition must be severe. Not every condition is actually considered to be severe. How is severity measured? Severity is, to some extent, a subective determination; however, the social security administration tends to classify severe versus non-severe impairments by whether or not they significantly interfere with the individual's normal ADLs, or activities of daily living.

For adults, this will be reflected in their ability or inability to engage in work activity.

For children, an impact on daily activities will be reflected in the child's ability to engage in age-appropriate activities, the standard by which disability is measured for children.

2. The condition must last at least 12 months. This is the minimum time requirement for social security disability and SSI. If a claimant's medical records indicate that the condition is severe and even disabling, but will resolve to a non-disabling or non-severe state before one year, the claimant will receive a durational denial. Duration is how the social security administration decides that a claimant's disability is likely to be permanent.

3. The condition must impose enough physical or mental limitions, or both, that it eliminates the claimant's ability to go back to one of their former jobs (potentially any of their past work performed within the last 15 years). It must also be severe enough that the claimant cannot be expected to use their education and work skills, and remaining functional abilities, to do some type of other work.

This is basically the definition of disability that is used by SSA. Most claims, of course, are denied at the disability application and reconsideration levels, either on the basis that the claimant can go back to a past job, or that the claimant can do some type of other work which they have never done before. Unfortunately, claimants who are denied on the basis of past work or other work have very little opportunity to advocate the merits of their case.

At the disability hearing level, however, this changes. Claimants, with or without representation, may challenge the assertion that they have the ability to return to a past job or the ability to successfully transition to some type of new job.

Challenging these types of assertions will involve not only a good knowledge of the claimant's specific work history over the past 15 years (considered to be the relevant period), but will also typically require strong familiarity with concepts such as SGA, or substantial gainful activity, unsuccessful work attempts, transferability of work skills, and the various medical-vocational rules (collectively referred to as the "grid") that are used to direct a decision of "disabled" or "not disabled", depending on certain factors of the case. Obviously, having good representation provided by a disability attorney or a non-attorney representative can make the task easier as well as more effective.

The Requirements of Social Security Disability and SSI

Requirements to qualify for both disability programs fall into two sets of criteria. One is medical and the other is non-medical.

Medical criteria relates to much of what has been discussed so far. The individual who is filing for disability benefits must be deemed to have a severe condition that is long-lasting (at least one full year) and which imposes enough limitations, either physical or mental, that they cannot be expected to engage in work activity at a substantial and gainful level.

How is the claimant's ability to work gauged? By evaluating the medical evidence (this would be done by a judge at a hearing and by a disability examiner at all the prior levels) and then by rating the claimant's limitations.

For example, some claimants will be given an RFC (residual functional capacity) rating of sedentary, which rules out all work except work that is primarily based from a sitting position and which involves very minimal exertional requirements. Other claimants will be found to have residual functional capacity limitations that restrict them to light or medium level work. And other claimants will have mental residual functional capacity limitations that eliminate many possible forms of work activity based on a limited ability to concentrate, or to learn or recall information, or deal appropriately with coworkers or supervisors.

Once a claimant is given a rating, or ratings, this can be compared to the requirements of their past jobs to determine if they have the ability to return to one of those jobs. Their rating can also be compared to any other jobs for which their combination of education and work skills might ordinarily qualify them.

The physical (RFC) or mental residual functional functional capacity (MRFC) rating that is given to a claimant is based on a review of the claimant's medical evidence. Obviously, the more evidence that can be obtained, the more likely it will be for the claimant's limitations to be properly rated. And this, of course, is why it is so important for a claimant to supply detailed information about their medical treatment sources at the time that they file for disability. This also underscores the importance of getting updated medical evidence prior to a disability hearing.

Tip: A person with representation will have a markedly higher chance of winning if their disability attorney or non-attorney representative is successful in obtaining a qualified supporting statement from one of their treating physicians. And, fortunately, most attorneys who specialize in handling disability claims routinely do this as a statement from a claimant's own doctor tends to carry significant weight with an administrative law judge.

Providing Medical and Non-Medical Criteria Information to Social Security

During your initial disability interview, a claims representative at the social security office will obtain your medical information, including the names of your treating physicians, clinics, and hospitals, and their addresses, telephone numbers, and dates of treatment. You will also supply information about your work history for the fifteen years prior to your disability.

During this same disability interview, the Social Security claims representative will evaluate the non-medical requirements for both Social Security disability and Supplemental Security Income (SSI).

What are some of the non-medical requirements of Social Security disability programs? Both Social Security disability and SSI require proof of citizenship or alien status to be entitled to a benefit. Furthermore, both programs require personal information such as date of birth and marriages.

In addition to non-medical requirements that are the same for both programs, each disability program has itís own unique non-medical requirements as well. SSI has income and resource requirements because it is a need based program, and Social Security disability requires that you be insured through your work record.

Return to:  Social Security Disability Resource Center, or read answers to Questions

Related pages:

Who qualifies for disability? - Qualifying is based on evidence of functional limitations
The Social Security Disability Approval Process and the Criteria for Decisions
How does Social Security Disability decide that you cannot work?
How do you Win Benefits under Social Security Disability or SSI?
Medical Disability Requirements for SSD and SSI
The non-medical Disability Requirements for SSD and SSI

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

Filing for disability - How to file for SSD or SSI and the Information that is needed by Social Security
How to Apply for Disability - What medical conditions can you apply and qualify for?
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?
How to Prove you are disabled and qualify to win disability benefits
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
Social Security Disability SSI - Eligibility Requirements and Qualifications Criteria