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Social Security Disability Insurance benefits (“SSDI”) are also known as “Title II” benefits because they derive from Title II of the Social Security Act, 42 USC § 401 et seq. The applicable Federal Regulations are found in 20 CFR Part 404, or “Regulations No. 4.” There are several subcategories of disability insurance benefits as described below. An individual may qualify for SSDIB in one of three ways:
- as a Disabled Individual Worker;
- as a Disabled Adult Child or
- as a Disabled Widow/Widower or Disabled Surviving Divorced Spouse.
Medical Requirements for Social Security Disability
Meeting the Definition of Disability
One way to satisfy Social Security’s definition of disability is for the claimant’s disability or impairment to meet or “equal” the level of severity described in the Social Security book of listings called the Listing of Impairments. This is the comprehensive manual that identifies dozens of conditions – from physical conditions like spinal disorders to mental conditions such as severe depression and anxiety – and the level of severity of each condition that is required to “meet a listing.” If your condition satisfies all of the requirements of a particular listing, you are said to “meet the listing,” and your disability claim will be approved.
However, it is essential to note that it is tough to win a disability application based on meeting the disability criteria in the listing book. Most individuals who apply for Social Security disability will qualify differently based on their residual functional capacity.
When the claimant’s disabling condition is severe enough, they cannot work and earn at least a minimum amount of money each month. The SSA will determine whether you can do your last job or jobs you’ve had in the past 15 years. If you cannot do your recent jobs, Social Security will determine whether you can do other types of work. The Social Security Administration will make this determination while considering the claimant’s age, the highest level of education achieved, and the skills they learned in the past 15 years.
For example, an individual with a 9th-grade education (who did not obtain a GED) who cannot do their past work in manual labor (for instance, because it requires a lot of standing and walking) will not be expected to perform other work that goes beyond their educational limits. In the same vein, individuals with severe mental or affective impairments (such as having a low IQ or severe depression or anxiety) will not be expected to perform other work that requires detailed attention and concentration.
You Must Have a Severe Medical Disease or Condition
Then, you must have a medical condition that meets Social Security’s definition of disability. SSDI benefits are only available to those with a severe, long-term, total disability. Severe means that your disease or medical condition must interfere with your ability to perform basic work-related activities. Social Security generally pays monthly cash benefits to individuals who cannot work for a year or more due to a disability. Thus, long-term means your condition is expected to last at least one year.
Total disability means you cannot perform “substantial gainful activity” (SGA) for at least one year. Suppose you work and make over a certain amount ($1,550 per month in 2024 for disabled applicants, $2,590 for blind applicants). In that case, Social Security will find that you’re performing SGA and are not disabled enough to qualify for SSDI benefits.
The following links break down the requirements more closely:
Non-Medical Requirements for Social Security Benefits
To qualify for “regular” Social Security Disability Insurance (SSDI) disability benefits, an individual must have paid Social Security payroll taxes over a certain length of time and earned enough “work credits.” to be considered “insured” for SSDI purposes. If an individual stops working and paying Social Security taxes, they must be able to show that their disability began before their “date last insured,” which is when the insured status ran out.
Work Credits
To qualify for “regular disability” (also called disability insurance benefits, DIB, RSDI, and “Title II” or “Title 2” benefits), you must have worked long enough, paid in long enough–and recently enough–under Social Security to qualify for disability benefits (in addition to meeting Social Security’s definition of disability). That’s why some people know it as “workers’ disability.”
[Note: If you have not worked long enough and earned enough credits when you become disabled, you may apply for Supplemental Security Income (SSI) instead if you have low income and assets. To qualify for Supplemental Security Income (SSI) disability benefits, an individual must have income and assets under the SSI program’s strict limits.]The number of work credits you need to qualify for SSDI benefits depends upon how old you were when you became disabled. Generally, you need 40 credits, 20 of which were earned in the last ten years, ending with the year you become disabled. However, younger workers may qualify with fewer credits.
The rules are as follows:
- Before Age 24 – You may qualify if you have six credits earned in the three years ending when your disability starts.
- Age 24 to 31 – You may qualify if you have credit for working half the time between age 21 and when you become disabled. For example, if you become disabled at age 27, you would need credit for three years of work (12 credits) out of the past six years (between ages 21 and 27).
- Age 31 or Older – Generally, you need to have the number of work credits shown in the chart below. Unless you are blind, you must have earned at least 20 credits in the ten years immediately before you became disabled.
For example, if you are 50 when you become disabled, you need 28 work credits according to the chart above – or to have worked for seven years (and at least five of those years must have been within the last ten years).
The amount needed for a credit changes from year to year. In 2024, for example, you earn one credit for each $1,730 of wages or self-employment income. When you’ve earned $6,920, you’ve earned your four credits for the year.
IMPORTANT: Remember that whatever your age is, you must have earned the required number of work credits within a certain period ending with the time you become disabled. Your Social Security Statement shows whether you met the work requirement when it was prepared.
Approval for Disability Benefits
If your claim for disability benefits is approved, you will not receive SSDI benefits until you have been disabled for five months. This “waiting period” means that even if you are approved right away (for instance, because you just had a liver transplant), you would still have to wait five months for your checks to start.
However, it is more likely that your initial application will not be approved for months (or even years), typically after at least one level of appeal. In such a case, you would be paid disability backpay starting the sixth month after your disability began (your disability onset date).
You should also get a disability benefit check each month. If your household income exceeds a certain amount, you may even have to pay taxes on your disability benefits. Your family members may also be eligible for a partial monthly benefit. For more information, see our section on How to Get Disability Benefits for Your Dependents.
You can keep receiving SSDI as long as your medical condition prevents you from working. The SSA may still perform a continuing disability review (CDR) on your file every one to three years to determine if your condition has improved (and, therefore, your benefits should be cut off).
Denial of Disability Benefits
You can appeal the decision if your SSD application is denied (and over 65% of most initial applications are denied). However, you must request a review of the denial within 60 days of receiving the denial letter. The first step of the appeal process in most states – including Florida – is the Request for Reconsideration. In a Request for Reconsideration, your claim is evaluated by someone who did review the initial claim. Another claims examiner is assigned to the claim. If you are denied again at the Reconsideration level, you can appeal to the next stage by requesting a hearing with an Administrative Law Judge who works for the SSA.
Appealing Disability Denials
It is common for claims for Social Security or SSI disability benefits to be denied at the initial application stage (sometimes called the first round). Well over 50% of all disability applications are denied. In these cases, appeals are required for disability benefits to be approved. It would be best if you did not start over with a new application. This is a common mistake made by (unrepresented) applicants for disability benefits. A new application will likely be denied again.
Instead, you should file an appeal and make sure the medical evidence is complete in your file. All too many claims are denied because the patient’s claim record lacks enough medical documentation to establish the severity of the disability. An experienced disability lawyer can advise you about what medical evidence will help you win.
Hiring a Disability Lawyer or Representative
No matter where you are in the disability process – whether it be the Initial Application, Reconsideration, or Hearing stage of appeal – you should consider retaining the services of a qualified disability lawyer to help guide your case through the disability appeals process. It is well established that claimants with legal help have a better chance of winning than those not represented by counsel.
The Ortiz Law Firm has years of experience handling Social Security Disability Insurance claims. If you are pursuing Social Security Disability benefits and have questions about the process, contact Mr. Ortiz at (888) 321-8131 for a free case evaluation.