SSDI & SSI: Definition of 'Disabled'
Once you file a Social Security disability claim with the Social Security Administration (SSA), the SSA will determine your eligibility for the program (based on age, employment, marital status or Social Security coverage information), and then the SSA will evaluate whether or not you are disabled. Read on to learn more about how the SSA reaches its determination and the criteria involved.
The SSA's Definition of "Disabled"
In the context of Social Security, the definition of disabled is a long-term disability that renders you unable to work in any capacity. You must not be able to engage in any "substantial gainful activity" (SGA) because of a physical or mental medical condition.
The SSA considers you disabled if the following criteria are met:
- You cannot perform the work that you did prior to your medical condition.
- You cannot do other types of work because of your medical condition.
- Your disability has lasted for a continuous period of at least 12 months, or is expected to result in death.
Social Security only covers total disability; it doesn’t pay any benefits disabilities that are partial or short-term. Furthermore, to verify a disability, the SSA may require you to supply information from your doctor or disability specialist regarding the nature of your medical condition, when it began, how it adversely affects your work, the results of medical tests, and any treatment you have received.
How the SSA Makes Its Determination
Once the SSA has determined that you are eligible for Social Security disability benefits, your application is reviewed by a state agency, known as Disability Determination Services (DDS). The state agency then follows a step-by-step process to determine whether and how much you are working, whether your condition is severe, whether it fits within a list of medically allowable impairments, and whether you are able to perform work in your past job or any other job, considering your age, education, skills, and medical limitations.
1. Whether you are working and your monthly earnings exceed the current allowable amount.
- If you’re currently working and your earnings average or exceed the amount designated (in 2014 the monthly amount was $1,070), you generally cannot be considered disabled. If you are not working, the state agency will consider the next factor.
2. Whether your medical condition is "severe" and has continued for at least a year.
- Not every disability qualifies for SSA benefits. To meet the "severe" requirement, your condition must be so severe that it interferes with even basic work activities - such as sitting and walking - and it must have continued for at least 12 months. Otherwise, the state agency may not consider you disabled.
3. Whether your medical condition is on the list of impairments.
- The SSA maintains a list of medical conditions that are so severe that it automatically considers you disabled. If your medical condition is on the list, the SSA will determine that you are disabled. If it’s not on the list, it doesn’t necessarily mean that you are not disabled. The SSA will look at the next factor to determine eligibility.
4. Whether you can do the work you once did.
- If your medical condition is severe but not at the same level of severity as one on the list of pre-determined impairments, you may qualify for disability if the SSA determines that your condition prohibits you from doing your current or previous work. If you can still perform the work, your claim will be denied. If you can no longer perform the work you once did, the state agency will look to the last factor.
5. Whether you can do any other type of work.
- Sometimes a person who cannot do the work they did in the past may be able to adjust to some other kind of work, despite their medical condition. For example, if you previously worked as a mail carrier, the agency examiner may look to see if you can switch to a different job that involved less strenuous work. In making this determination, the SSA will consider your medical conditions, age, education, past work experience and any transferable skills you may have. If your medical conditions allow you to work in a different capacity than your prior work, the SSA won’t consider you disabled. If you cannot adjust to other work situations, you may be considered disabled.
Special rules apply if you are blind or have low vision, if you are a worker's widow or widower, a disabled child, or a wounded warrior or veteran. You may wish to find more detailed information by visiting the SSA's website.
How an Attorney Can Help You
The Social Security claims process can be daunting. If you have further questions about whether you qualify for Social Security disability benefits, it's in your best interests to contact a Social Security disability attorney for a free initial claim evaluation. A skilled attorney will be able to help determine your eligibility for disability benefits and resolve any problems that may arise with your claim.