General eligibility requirements for getting disability
One of the biggest mistakes that many disability claimants make is assuming that all they need to do to get SSDI or SSI disability benefits is complete a disability application and then wait for payment. Workers are not guaranteed disability benefits, even if they have worked and paid into the Social Security Trust Fund for years. Even workers who are disabled and cannot work find that they are denied benefits, often because they did not have sufficient medical evidence to prove the severity and limitations of their impairment.
With that in mind, it’s important to understand the general eligibility requirements for disability benefits. The information below will focus specifically on the eligibility requirements for Social Security Disability Insurance (SSDI), but whether you apply for SSI or SSDI benefits due to a disabling health condition, you will need to be able to prove that you have a medically determinable condition and that your condition is so severe you cannot work for at least 12 continuous months. To make this determination for SSDI benefits, the Social Security Administration will use the five-step sequential evaluation process.
Step 1: Is the claimant performing substantial gainful activity?
First the Social Security Administration will evaluate whether a claimant is working or performing substantial gainful activity.
Currently, the SSA defines gainful work as making more than $1,180 per month for non-blind individuals and $1,970 per month for the blind.
Claimants may also be considered not disabled if they are doing substantial work, even if it is not gainful or they are not earning money. For example, the volunteer working 40 hours per week would be considered not disabled because the SSA would assume they could also work comparable work for pay.
Step 2: Does the claimant have a medically determinable impairment?
Next, the SSA will decide whether the claimant has a severe impairment (or a combination of impairments) and whether their mental or physical health condition is expected to last 12 continuous months or result in their death. If the condition is not severe, which means it does not severely affect their ability to work, or it will not last 12 continuous months, the SSA will determine the claimant is not disabled.
Step 3: Does the claimant’s condition meet or exceed a listing in the SSA Listing or Impairments?
The Social Security maintains a listing of impairments and their corresponding conditions which they consider automatically disabling. If a claimant has a condition listed in the SSA Listing of Impairments and their corresponding conditions are as severe as the listed condition, the SSA will award disability benefits. At this step the SSA may also determine that although a claimant’s condition is not listed, it is as severe as a listed condition and also award benefits. If, however, the claimant’s condition is not a listed condition, and it does not meet or exceed a listed condition, the SSA will continue to step 4.
Step 4: Does the claimant’s condition allow them to perform any of their past relevant work?
If a claimant’s condition is not as severe as a listed condition and it does not meet a listed condition, the SSA will determine if they can perform any of their past relevant work. At this step it is imperative that a claimant have medical evidence that clearly outlines their limitations to do work-related tasks. After analyzing a claimant’s medical records, the SSA will determine the claimant’s “residual functional capacity” to work. If the SSA determines the claimant can perform their past work, they will deny their claim. If they believe the claimants cannot perform their past work, they will proceed to step 5.
Step 5: Can the claimant perform any work in the regional economy?
Finally, if a claimant cannot perform any past relevant work the SSA will evaluate their ability to adjust to new work. Evaluation of a claimant’s ability to adjust to new work includes reviewing a claimant’s age, education, past work experience, and a claimant’s transferable skills. If the SSA determines a claimant can adjust to new work, their SSDI claim will be denied. If not, the SSDI claim will be approved.
How can Higgins and Associates help me confirm that I qualify for benefits?
Understanding disability requirements is critical to winning SSDI or SSI benefits. So, what can Higgins and Associates do to help you qualify?
- Higgins and Associates can review your current employment activities and income and determine if you are working too much or making too much money to qualify for benefits. If you are working or earning too much money, there is no reason to apply. You will be automatically denied.
- Higgins and Associates can review your current health conditions and determine whether you have a severe medical impairment and whether your condition is listed in the SSA Listing of Impairments. Many claimants have a listed condition but fail to get sufficient medical evidence to prove the severity of the condition or that the condition will last 12 continuous months.
- Higgins and Associates can review your work history and determine whether your condition is so severe you cannot perform your past relevant work or retrain for new work. Claims are often denied because the SSA decides a claimant can retrain for new work. Higgins and Associates can help you gather the right medical evidence which lists specific limitations you have to work and perform your past jobs.
- Finally, Higgins and Associates can answer all of your questions about how to complete your application, what doctors to see to strengthen your disability claim, and what you need to do to improve your chances of winning SSDI.