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What are the eligibility requirements and criteria to qualify for disability?




 
The short answer

The quickest way to describe the requirements for disability, according to Social Security, is to say that 1: your condition must be severe (the difference between severe and non-severe would be a broken leg vs. a sprained ankle), 2: your condition must last at least 12 months, and 3: your condition must physically or mentally limit you enough to prevent you from being able to work while earning what SSA calls a substantial and gainful income (see the SGA limit link two paragraphs below).

How does Social Security determine if you are disabled according to SSA requirements? After you apply for disability, your case will be assigned to a disability examiner. The examiner, on day one, will request your medical records. When they arrive, which may take weeks, the examiner will read them to determine if you have a condition that meets a listing. If you do, you may be awarded disability. If you do not have a listing-level condition, the examiner will determine what your physical and mental limitations are to see if you can work--either work you have done in the last 15 years (the relevant period) or any other type of work. If the examiner finds that you can't return to work, you may be awarded disability benefits.

Is how much money you might be making, or how much money you have in the bank part of the requirements for disability?

Income requirements - When it comes to income, you cannot be making more than the limit for SGA. The SGA limit is the cap on earnings if you either get or are receiving disability. The earnings limit applies to both SSD and SSI equally.

Money in the bank or other assets - SSD is not concerned at all with any assets you may have whether its vehicles, real estate, stocks, bank accounts, or life insurance cash value. SSI is concerned with all those things, but only if your countable assets go above $2000. What does not count? The home you live in does not count. The car you mainly drive does not count. The money in bank accounts that goes to your bills does not count. What does count is "excess". Excess cars, real estate, and cash not intended for bills.

The longer and more detailed answer

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 and requirements must be met--

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.








  • 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:

    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