Applying for Social Security Disability

Topics on This Page

• Non-Medical Requirements
• Medical Requirements
• List of Qualified Injuries
• SSI Qualifications
• Disability Filing Process
• Fraudulent Disability Claims

Disability Guide Topics

• Social Security Disability Guide
• Filing for SSDI: Medical Records
• Disability Claim Determination
• Collecting Disability Payments
• Why a Disability Claim Gets Denied
• Other Benefits and Disability for Children
• When to Talk to a Lawyer

Social security pays benefits to persons who cannot work because of a medical condition or illness that is expected to result in death or last for at least one year. The qualifications, eligible injuries, process and other details can be complicated and cumbersome, as outlined below.

Qualifications for SSDI

Non-Medical requirements

There are non-medical requirements for social security disability. You must meet each category to receive benefits. As a worker, you receive four credits each year that you work corresponding to the quarter of each year. The first quarter of the year is January thru March; the second quarter is April thru June; the third quarter is July thru September and the fourth quarter is October thru December.

Under the recent work requirement, if you become disabled:

In or before the quarter you turn 24 – you need one and one-half years of work during the three year period ending with the quarter that you became disabled

In the quarter after you turn 24 but before you turn 31 - work during half the time for the period beginning with the quarter you turned 21 and ending with the quarter you became disabled.

In the quarter, you turn 31 or later – work five years out of the ten-year period ending with the quarter you became disabled.

The duration of work requirement means that you have to show you worked long enough to receive benefits. Examples of this test are if you become disabled (Various ages are listed and are not exhaustive):

• Before age 28 – you need one and a half years of work
• Age 38 – four years of work
• Age 46 - six years of work
• Age 54 - eight years of work
• Age 60 – nine and half years of work

Medical Requirements: SSDI Five Step Process

Social Security applies a five-step process to determine disability. This process set out in federal rules and regulations. The steps in the process are:

1. Are you Working?

If you are working and your earnings average more than a certain amount each month, you will generally not be considered disabled. This amount changes every year.

2. Is Your Medical Condition "Severe"?

Your medical condition must significantly limit your ability to do basic work activities—such as walking, sitting, and remembering—for at least one year.

3. Is your Medical Condition on the List of Impairments

Conditions on this list are considered so severe that they automatically mean that you are disabled as defined by law. If the severity of your medical condition meets or equals that of a listed impairment, the state agency will decide that you are disabled. If it does not, the state agency goes on to step four.

4. Can you do the work you did before?

At this step, the state agency decides if your medical condition prevents you from being able to do the work you did before. If yes, you qualify, if not you go to the last step.

5. Can you do any other type of work?

The agency evaluates your medical condition, your age, education, past work experience and any skills you may have that could be used to do other work. If you cannot do other work, the state agency will decide that you are disabled.

Listing of Medical Impairments

Social Security regulations include a listing of medical impairments organized by body system, that provide a basis for determinations that many individuals are disabled without further evidence of their inability to work or consideration of their age, education, and work experience. The major categories with their subheadings are listed below:

Qualifications for SSI

Who qualifies for Disability Benefits?

To qualify for SSI you must be:

• Blind;
• Age 65 or older;
• Disabled—the medical requirements for disability are the same as those for an adult seeking SSDI. It is possible to get both SSDI and SSI
• A child that is blind or disabled -- there is a listing of impairments that applies to children.
• Have few resources and no income.

Social Security Definition of Income

Income for SSI purposes includes wages, social security disability benefits, pensions, food, and shelter. Social Security does not count all of your income when deciding whether you qualify for SSI. For example, they do not count:

• The first $20 a month of most income you receive
• The first $65 a month you earn from working and half the amount over $65;
• Food stamps;
• Shelter you get from private nonprofit organizations;
• Most home energy assistance.

If you are, married part of your spouse’s income and resources are included when deciding whether you qualify for SSI. If you are younger than age 18, Social Security includes part of your parents’ income and resources.

Social Security Definition of Resources

Resources are things that you own. They include real estate, bank accounts, cash, stocks, and bonds. An individual can qualify for SSI if they have no more than $2000 in resources. A married couple can qualify if they have no more than $3000 in resources. Social Security does not count everything you own in deciding whether you have too many resources to qualify for SSI. For example, they do not count:

• The home you live in and the land it is on;
• Life insurance policies with a face value of $1,500 or less;
• Your car (usually);
• Burial plots for you and members of your immediate family; and
• Up to $1,500 in burial funds for you and up to $1,500 in burial funds for your spouse.

You must also live in the United States or the Northern Mariana Islands and be a U. S. Citizen

Application Process

Social Security has embraced the advances in technology and you can do many things online. Social Security has developed a Benefits Eligibility Screen Tool (BEST). Using BEST you can determine your eligibility for disability and supplemental security income. BEST is user friendly and can be used by someone trying to help a friend or relative who is concerned about benefits as well as the potential claimant.

Where and How to Apply

Social Security’s toll free number 1-800-772-1213 allows you to:

• apply for benefits on the phone
• make an appointment with your local Social Security Office to apply in the office.

You can also apply for benefits online. One of the great advantages of using the online service is that it you apply at your own pace. You can print preliminary application information that will tell you what type of information you need to gather to complete your application. You can save the application and return to it when you have the medical information that you need. It will also direct you as to what information you may need to send into Social Security. Once you have filed the application, Social Security will contact you to verify information, to request additional information or to set up appointments with Social Security doctors if they do not have enough information.

Information Needed to Apply for SSDI

• General Information
• Social security number
• Birth or baptismal certificate
• Medical information
• Names, addresses and phone numbers of the doctors, caseworkers, hospitals and clinics that took care of you and dates of your visits;
• Names and dosage of all the medicine you take;
• Medical records from your doctors, therapists, hospitals, clinics and caseworkers that you already have in your possession;
• Laboratory and test results
• Employment Information
• A summary of where you worked and the kind of work you did
• A copy of your most recent W-2 forms or if self employed your income tax return for the past year.

Activities of Daily Living (ADLs)

Social Security collects your activities of daily living on the Disability Report. On the disability report you give information about how your condition affects you ability to work and daily tasks such as getting dressed, taking care of your home, shopping, going out with friends, hobbies and any other task you may do on a routine basis.

Income and Asset Information:

Income and asset information is important if you are also applying for SSI benefits as income and assets can affect your SSI payments and eligibility.

Workmen’s Compensation can affect SSDI benefits as Social Security has rules against windfalls. The total of benefits you receive from both programs cannot exceed 80 percent of your average current earnings before you became disabled.

How Long Does the Application Process Take?

It can take up to three to five months to get a decision once your application is complete. You should apply for benefits as soon as you feel you are disabled.

Recieving Benefits During Application (Presumptive Disability)

Qualifications for Presumptive Disability Payments

Social Security pays presumptive disability benefits in the following situations.

• If you are applying for the first time for SSI based on disability or blindness
• You medical condition is such that it presents a strong likelihood that you will be found disabled under Social Security rules and
• You meet all non-medical factors of eligibility
• You can only get presumptive benefits for six months; benefits will end in six months even if you have not received a decision on your application.

Fraudulent claims

How the SSA Deals with Fraudulent Applications

Social Security will pursue criminal prosecutions for anyone who makes a knowingly fraudulent claim for Social Security disability benefits, or about work history or identity. The penalty if convicted can be a fine, imprisonment or both.