The topic of this blog post is by far one of the most frequent questions we get at Collins Price. The Social Security Administration uses a wide array of criteria and a multi-stage appeals process to determine if an individual qualifies for Social Security Disability Insurance (SSDI) or the Supplemental Security Income (SSI) programs.
The basic definition of a qualifying disability is very simple: SSDI defines a qualifying disability as “the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”
The definition of disability for children under the age of 18 is slightly different but is defined as “a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months.”
So, when Social Security evaluates whether someone is disabled, they approach the situation with a few key questions that we break down further below.
Can you work?
Social Security refers to work or holding a regular job as ‘substantial gainful activity.’ In simpler terms, all this means is that Social Security will evaluate whether the medical conditions you reference in your claim prevent you from working or engaging in work that provides you with a substantial means of financial support.
This doesn’t mean you can’t work part-time or hold minor jobs, but you have to be limited in terms of your earnings below a certain amount of money each month to qualify. If you’d like to learn more about working part-time while applying for disability, you can read our blog post on the topic here.
Are your medical problems well documented and severe?
Social Security takes a ‘trust but verify’ approach to approving disability claims. It’s not enough to suffer from severe medical impairments and to testify to their effects personally.
You will need to prove that your medical problems are severe, ongoing and chronic. Claimants with strong claims prove that by working with the medical providers who have monitored or cared for those problems over the years. In many cases, successful claimants provide Social Security with doctors’ notes, medical tests, visit history and sometimes even personal letters from their providers that support their claim for disability.
Have your medical problems persisted for at least 12 months?
Social Security will not consider a claimant disabled unless their medical problems are severe and lasting enough that they render or are expected to render that individual unable to work for 12 months or longer. Those 12 months also need to be continuous which means you won’t qualify if your problems come and go and you have short periods of disability that add up to 12 months.
If you have been or expect to be out of work for 12 continuous months due to physical or mental health problems, you will likely meet this standard.
Depending on which program you apply for (SSDI or SSI), Social Security has various non-medical qualifying criteria that they use to evaluate your claim.
Those non-medical considerations are largely financial and include proof of age, Social Security Disability Insurance coverage information, employment records, and marital status. Because these can be involved, we’ll cover non-medical criteria in a future blog post.
Talk to a Local Social Security Attorney
Because the Social Security disability process can be long and sometimes confusing, we recommend that claimants consider seeking the counsel of a local Social Security disability lawyer.