Social Security Disability Eligibility

At first glance, qualifying for Social Security Disability Insurance (SSDI) might not seem that complicated. There are, generally speaking, two requirements: you must be disabled (more on what that means later) and you must have worked and paid into Social Security for a certain amount of time before the disability starts. However, each of these two requirements can be challenging to understand and their standards difficult to meet.
Here, we analyze each of the two general requirements that must be met in order to qualify for SSDI: the medical requirement (proving you’re disabled), and the employment requirement (proving that you have earned enough work credits in the past to qualify for SSDI). This work credits are sometimes called quarters of coverage or just quarters. We will begin with the simpler of the 2 requirements – the employment requirement.

REQUIREMENT 1: Do you have enough work credits to qualify?

When you submit your application for SSDI, the first part of your application to be processed is the determination of whether you meet the employment requirement; or, in other words, determining whether you have worked long enough and recently enough to have earned enough credits to qualify for SSDI.

This analysis is performed first because it is simpler than determining whether someone is disabled. Therefore, if you do not meet the employment requirement, then the question of whether you are “disabled” will not even be considered.

In order to determine if you have enough work credits to qualify, you will have to address the following questions:

• Have you worked in the past?
• How many credits have you earned?
• Have you worked recently enough to qualify?
• Have you earned enough work credits to qualify?

Have you worked in the past?

The first question in determining whether you have enough credits to qualify for SSDI is, “Have you ever worked and paid into the SSA (via FICA deductions)?” If the answer is no, then you cannot qualify for SSDI. If the answer is yes, then you must determine when you worked and how much you earned during that time.

How many work credits have you earned?

The SSA converts your earnings into work credits, and then adds up your total work credits in determining whether you qualify for SSDI. The dollar amount you must have earned in order to qualify as having earned a “credit” changes each year. For example, in 2015, if you earn $1220, you will be considered to have earned one work credit. Any additional earnings can go toward additional credits, with a maximum of 4 credits for each year you worked.

Have you worked recently enough to qualify?

Once you calculate your number of work credits, you can determine whether you have enough work time and work credits to qualify for SSDI. The next test is whether you have worked recently enough to qualify. The standard for determining if you have worked recently enough to qualify change depending on your age and the requirements are as follows:

• If you are 31 or older, you must have worked 5 out of the last 10 years.
• If you are 24-30, you must have worked half of the time since turning 21; and
• If you are under 24, you must have worked at least 18 months of the last three years.

Have you earned enough credits to qualify?

If you meet the standard for having worked recently enough, then you must see whether your previously-calculated credits are enough to meet the SSA’s standards. The older you are the more credits you need to have earned. This is the point at which it is helpful to involve an attorney in the process: an attorney can help you calculate the number of credits you have, and can review the SSA’s standards to see if you have earned the credits you need.

REQUIREMENT 2: CAN YOU PROVE THAT YOU ARE DISABLED?

Once you have met the employment requirement, then the more difficult part of the process begins: proving that you are disabled.
To you, your disability probably feels like second nature. After all, you deal with it every day. But when it comes to applying for SSDI, your own knowledge of your disability isn’t enough. Not only must you meet the Social Security Administration’s (SSA) definition of “disabled,” but you must also be able to prove to them that you meet this standard.

Step 1: Are you working right now?

If so, then the SSA will determine whether your employment is considered a “substantial gainful activity,” or SGA, by looking at how much money you are making. Those figures change each year. For example, in 2015, a non-blind disabled person must earn more than $1090 per month in order for his employment to be considered a SGA.
If you are earning more than $1090 per month, the SSA is likely to deny your claim immediately unless. However, if you are earning less than $1090 per month that does not automatically mean that you are unable to participate in SGA. For example, if it appears that you are deliberately choosing to perform less work than you could be, or if your reduced earnings are due to some cause other than your disability, then your claim could still be denied due to SGA issues.

Step 2: Is your condition(s) severe?

In order to qualify for SSDI, your condition(s) must be considered “severe.” To determine whether the one medical condition or a combination of conditions are, in fact, severe, the agency looks to see if those conditions interfere with basic work-related activities in more than a small way. This is the first part of the process where you medical records and doctor’s opinions matter.

Step 3: Do you have a medical condition which is listed with Social Security?

The easiest way for the SSA to ascertain whether your medical condition(s) are meet the test for disability appears in the SSA’s Listing of Impairments . The SSA will first try to determine whether your medical condition meets or equals listings. If you do, then the process stops and you will be considered disabled.

However, for most applicants, the process is not that simple. They may have a condition which is not listed, they may have more than one condition, or they may have symptoms which are similar to a number of listed conditions but do not met the strict definitions of the SSDI listings. The end result is that most applicants must work a little harder to determine whether they are “disabled” for SSDI purposes.

Step 4: Does your disability prevent you from doing your previous or current job?

If your condition does not appear in the SSA’s handbook, you will have to take further steps to prove to the SSA that you are disabled. In order to determine whether your condition is severe, ask yourself whether it prevents you from doing your previous or current job. The bottom line is that you must be able to clearly demonstrate that returning to your past job is not an option. For example, if your previous job required you to perform Task A, then your medical information must support your claim that you are unable to perform Task A and, therefore, cannot continue in your past employment.

Step 5: Does your disability prevent you from performing other work?

Even if you are not able to do your previous job and you are not currently employed (or are employed but earning less than $1090/month), you still have to demonstrate to the SSA that you are unable to do other types of employment activity. In official terms, the SSA wants to know whether your condition prevents you from participating in any full time work.

This part of the process can be made easier if you are over the age of 50. If you has always done heavier duty jobs over the last 15 years the test for people at age 50, 55, and 60 gets easier at each age milestone. The reason behind this changing test is due to SSA acknowledging that the older a work becomes, the harder it will be for them to be retrained to a different occupation they have never done before. For individuals between the age of 18 to 49, the test for disability is whether you can perform consistent, competitive, full-time employment of any kind in the open labor market.

Given that the SSA determines whether your impairment qualifies as a disability by analyzing your ability to work, it is important that your medical information be as thorough as possible in this area.

Proving that you can’t perform your past job is not usually the difficult part of this process. The more complicated step is showing that you also cannot perform any other full time work. You need to know that this is the way in which the SSA denies most disability claims. The SSA examiners have a book called the Dictionary of Occupational Titles, and they use this book to see if you can perform any other type of work. This is where the process gets tricky, and why it is likely in your best interest to hire a disability attorney for help. The bottom line is that you must be able to prove that your disability prevents you from performing your prior work as well as any other work for which you are qualified. If you are unable to prove this, then your claim is likely to be denied. Also the realities of the economy and job market are not considered in this process. So, for example, if the SSA says you can do other work as a clerk, you cannot present evidence that there are no clerk jobs in your area or that “no one will hire you” because of your medical conditions. This part of the process occurs in a vacuum and does not consider the real world conditions of claimants for benefits.

NOTE: If you do not have enough work credits to qualify but you meet the test for disability you may qualify for a different benefit called Supplemental Security Income or SSI.

Will your condition affect you for more than 12 months?

Finally, even if your condition is severe and it prevents you from participating in SGA, your claim will still be denied unless you can demonstrate that your condition will affect you, or has affected you, for more than 12 months.

Conclusion

As you have seen, determining whether you qualify for SSDI may sound like 2 easy questions (are you disabled, and have you worked before); however, these 2 questions quickly spiral into a great number of confusing and difficult standards. This is why the majority of SSDI claims are initially denied. However, by familiarizing yourself with the SSA’s requirements and by seriously considering enlisting the help of a professional, you can help to increase your chances of obtaining SSDI approval.