How do you qualify for Social Security disability insurance benefits?

Social Security Disability Insurance Benefits (“SSDIB”) are also known as “Title II” benefits because they derive from Title II of the Social Security Act, 42 U.S.C. § 401 et seq. The applicable Federal Regulations are found in 20 C.F.R. 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:

  1. as a Disabled Individual Worker;
  2. as a Disabled Adult Child; or
  3. as a Disabled Widow, Disabled Widower, or Disabled Surviving Divorced Spouse.

To qualify for Social Security disability insurance benefits, you must first have worked in jobs covered by Social Security. Then you must have a medical condition that meets Social Security’s definition of disability. In general, Social Security pays monthly cash benefits to people who are unable to work for a year or more because of a disability.

Benefits usually continue until you are able to work again on a regular basis. There are also a number of special rules, called “work incentives,” that provide continued benefits and health care coverage to help you make the transition back to work.

If you are receiving Social Security disability benefits when you reach full retirement age, your disability benefits automatically convert to retirement benefits, but the amount remains the same.

Let’s look at the requirements more closely:

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 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 important to note that it is very difficult 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 in another way: that is when the claimant’s disabling condition is severe enough that he or she is unable to work and earn at least a minimum amount of money each month. The SSA will first determine whether you’re capable of doing your last job, or jobs you’ve had in the past 15 years. If you are not capable of doing your recent history of jobs, Social Security will determine whether you can do other types of work. The Social Security Administration will make this determination while taking into account the claimant’s age, highest level of education achieved, and the type of 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 his or her 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.

Medical Details Required for the Disability Evaluation

When Social Security asks you want your disabling conditions are, you should list of all of your impairments, conditions, and symptoms on the application for disability – even the less severe conditions. You should also take care to list of all the doctors, hospitals, and clinics that have treated you – along with their full contact information, including addresses and phone numbers.

As stated above, specific criteria for disability approvals are detailed in the Social Security Listing of Impairments. It is important that your doctor is familiar with these criteria when submitting medical records and opinions on your behalf. You should explain to your doctor just how your conditions limit your daily activities so that your doctor will notate this information in your medical records.

Non-Medical Requirements for Social Security Benefits

In order 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”. An individual who has earned enough credits this will be considered “insured” for SSDI purposes. The minimum number of years you are required to pay into the Social Security system to earn insured status is determined by your age.  If an individual stops working and paying Social Security taxes, he or she must be able to show that his or her disability began before his or her “date last insured”, which is when the insured status ran out.

In order to qualify for Supplemental Security Income (SSI) disability benefits, an individual must have income and assets under the SSI program’s strict limits.

Learn more about qualifying for SSDI or eligibility for SSI.

Appealing Disability Denials

It is common for an application for Social Security or SSI disability benefits to be denied in at the initial application stage (sometimes called the first round). In fact, well over 50% of all disability applications are denied.  In these cases, appeals are required for disability benefits to be approved.

To be frank, all too many claims are denied because the patient’s claim record lacks enough medical documentation to fully document and establish the severity of the disability.

If you’ve applied for SSDI or SSI and been denied, you should not start over with a new application. This is a common mistake made by (unrepresented) applicants for disability benefits. You should not start over with a new application because new disability claims will simply be denied again. Instead, you should file an appeal called a Request for Reconsideration, and make sure the medical evidence is complete in your file.  An experienced disability lawyer can advise you about what medical evidence will help you win an approval.

Hiring a Disability Lawyer or Representative

No matter what stage you are on in the disability application 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 who are not represented by counsel.

The Ortiz Law Firm has years of experience in handling Social Security disability insurance claims. If you think you may qualify for disability and have questions about the process, contact Mr. Ortiz at 850-898-9904 for a free case evaluation.