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Who Qualifies For Social Security Disability Insurance

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Appealing Denied Social Security Disability Application

Qualification Steps for Social Security Disability Insurance (SSDI)

Its common for applicants to be denied. In fact, only about 1 in 3 applicants are initially approved for SSDI benefits. The two main reasons for denial are usually a lack of work credits, or that applicants do not meet the criteria for disability.

If you have been turned down, you do have the right to go through a Social Security Disability appeal process. Either you or your designated representative can file a Request for Reconsideration. Your initial appeal will then be turned over to Disability Determination Services, who will thoroughly review your file.

If you are denied again, you can proceed to the next level of appeal which is to appear in front of an Administrative Law Judge. An Administrative Law Judge will conduct a hearing in which all of your medical records and testimony will be heard before the judge renders a decision in the form of a written notice.

If you are still denied benefits, then you have a final appeal step you can take: filing a lawsuit in U.S. district court. You will need an attorney for this step if you havent already retained one. This can be an expensive and time consuming option, and as a result, less than 1% of disability claimants take their cases to this level.

Health Resources For People With Disabilities

Federal, state, and local government agencies and programs can help with your health needs if you have a disability.

Visit USA.govs Government Benefits page to learn more about government programs and services that can help you and your family.

Disability Requirements For Social Security Disability Benefits

You must also be considered disabled to be eligible for SSDI benefits. The Social Security Administration determines disability by the following requirements:

  • You can no longer perform your former job and
  • You cannot perform other work due to your medical condition and
  • Your disability has lasted or is expected to last for at least one year, or result in your death.

The SSA maintains a Medically Approved Listing of Impairments. If your medical condition is on the list, you may automatically qualify for benefits. However, if your disability isn’t on the list, this doesn’t mean you’re not entitled to SSDI benefits.

If you don’t qualify for SSDI benefits, you may be eligible for Supplement Security Income benefits . To be approved, you must be disabled and meet strict asset and income rules.

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Do You Have A Medical Condition That Prevents You From Being Able To Work For A Year Or More

Social Security and SSI disability benefits are reserved for people who have severe medical conditions that make it impossible for them to work for at least 12 months. To be eligible for disability, you either have to have not done a significant amount of work for a year OR you must be expected to not be able to work a significant amount for at least a year. . For more information, read about how long you have to be disabled before you can get disability benefits.

If you’ve been off work for just a month or two when you apply, Social Security might deny your claim initially to see whether your impairment continues to keep you from working long term or if it improves. The same goes for medical conditions that involve impairments that are often temporary, such as having a broken leg, recovering from hip surgery, or suffering from whiplash after a car accident. If you apply based on one of these conditions, Social Security may quickly deny you if you appeal, Social Security will review your case and could approve you if you are still unable to work.

Disability Benefits For Veterans

How to Qualify for Social Security Disability Benefits ...

You may be eligible for disability benefits if you’re on disability from your service in the Canadian Armed Forces or Merchant Navy.

You may get social assistance payments from:

  • your province or territory
  • your First Nation

These payments will depend on your household income, savings and investments.

You may also be eligible for health-related benefits from your province or territory. These benefits may include benefits that help cover the cost of:

  • medications
  • medical aids or devices

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How To Medically Qualify For Social Security Disability Insurance

If you are unable to work because of a medical condition, you may qualify for disability benefits from the Social Security Administration . To qualify for disability benefits, you must medically qualify per the SSA guidelines. The SSA uses a medical guide, which is called the Blue Book, to determine if an individual is disabled.

The Blue Book includes sections for the different systems of the body. Each system has listings for the conditions that body system could have that are disabling. Each listing has criteria that must be met in order to medically qualify using a disability listing.

These sections include the Musculoskeletal System, Special Senses and Speech, Respiratory Disorders, Cardiovascular System, Digestive System, Genitourinary Disorders, Hematological Disorders, Skin Disorders, Endocrine Disorders, Congenital Disorders that Affect Multiple Body Systems, Neurological Disorders, Mental Disorders, Cancer , and Immune System Disorders. In each section are descriptions for each qualifying condition.

Youll find exactly what medical criteria, such as test results, treatments, etc. that are needed to medically qualify for disability benefits. Its best to review the Blue Book with your doctor to make sure you have met the needed criteria. Your doctor can help orchestrate any tests that are needed to qualify.

Have An Eligible Impairment

According to the Social Security Administration, one of the steps in the application process is determining whether the applicant has an impairment that the SSA determines to fall under the definition of disability. If you feel you have one of the impairments, you must submit medical documentation from your healthcare provider. An SSA agency in your state may also request an independent consultive examination.

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How Do You Get Disability For Listed Medical Conditions

If your disability is listed in Social Security’s Listing of Impairments, the first step is to get a diagnosis of the condition from your doctor. A mere diagnosis will get you an automatic disability approval for only a few conditions, however, like ALS, an organ transplant, or certain serious cancers, such as esophageal cancer, mucosal melanoma, anaplastic carcinoma of the thyroid gland, or small-cell carcinoma . For all other conditions, the next step is to determine if your medical condition meets the specific criteria for that condition. The listing requirements are often quite complex our illness-specific articles simplify the medical criteria in the listings so that you can understand whether your condition will qualify for disability.

If you haven’t had the clinical or laboratory tests required in the listing, you can ask your doctor to perform them. Or you can wait for the SSA to pay for a consultative exam, but this makes your claim take longer. It’s generally better if the test results are already in your medical record before you apply. Then you can check to see if your test results meet the requirements of the listing, and if they match the criteria or are close, you can apply for disability.

What Is A Disability

How Sick Must You be to Qualify for Social Security Disability?

The first thing you need to consider when determining whether or not you qualify for Social Security Disability Insurance benefits is whether or not you are disabled by the Social Security Administration’s standards.

You need to understand that just because you are unable to continue working in your current occupation due to your condition, the Social Security Administration might not determine that you are disabled by their standards.

In order to be considered disabled, you must be suffering from a long-term or permanent disability that completely prevents you from performing any type of work activity whatsoever.

For example, suppose that you have been working as an administrative assistant for the past fifteen years. Your job may have required you to move around the office quite a bit. Now, due to a disabling condition, you are no longer able to perform the duties required of your work activity.

While you may be disabled in your eyes, the Social Security Administration may not see it that way. They may determine that you could successfully perform another type of work, such as that of a receptionist.

If it is possible that you can perform other types of work in the national economy, you will likely not qualify for SSDI benefits.

The Social Security Administration has published a Blue Book of medical listings that qualify individuals for SSDI benefits.

However, proving that you are disabled is not the only factor when determining your eligibility for SSDI benefits.

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Musculoskeletal System And Connective Tissue

The SSA reports that the largest category of diagnoses among disabled workers receiving disability benefits was diseases of the musculoskeletal system and connective tissue. These disabilities, which represented 32.3 percent of the diagnoses, involve damage to ones nerves, muscles, tendons or ligaments. Examples of this type of disorder include:

  • ArthritisAn individual with rheumatoid arthritis, a disorder of the immune system, must experience significant limits on his or her ability to work to qualify for benefits under this medical diagnosis. Rheumatoid arthritis is sometimes referred to as a connective tissue disorder.
  • Back pain Abnormal curvature of the spine may affect an individuals ability to walk as well as the function of other body systems. The intensity of back pain and the limitations on an individuals ability to function are considered in a disability diagnosis related to back pain.
  • FibromyalgiaFibromyalgia is a complex syndrome in which a person has widespread pain in the joints, tendons, muscles and soft tissues that lasts for more than three months. Claims reviewers will try to assess whether there is adequate evidence to show that the condition limits a persons ability to perform any type of gainful work.
  • Reflex Sympathetic Dystrophy RSD describes a range of symptoms that may occur from injury, diseases or surgery. RSD is characterized by intense burning or aching pain typically caused by trauma to a single extremity.

What Are The Work History Eligibility Requirements For Ssdi

To meet the work eligibility requirements to qualify for SSDI, you must have worked long enough and recently enough to qualify. Eligibility is based on the number of work credits you have earned. For each quarter of work with income of a certain amount, you can earn one work credit.

The amount of work needed changes, but for example, in 2017, if you earn $1,700 per quarter or more in the year, you would earn four credits for the year.

How many credits you will need to qualify for benefits will depend on your age. These general rules apply:

  • Generally, you must have earned 40 work credits with 20 of them having been earned in the last 10 years.
  • If you’re younger than 31 years old, you may qualify for SSDI benefits with fewer work credits.

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Which Medical Conditions Are Likely To Qualify For Disability

While any of the above medical conditions are SSDI and SSI qualifying disabilities, some medical conditions are more likely to lead to an approval of benefits than others. We recently surveyed our readers about their experiences in applying for disability benefits and compared their answers to government statistics. For details, see our article on survey statistics on getting Social Security disability for common medical conditions.

Why Is There A Shortfall In The Disability Insurance Trust Fund And What Can Be Done About It

What You Should Know about Qualifying for Social Security ...

As described above, Disability Insurance is funded by a dedicated share of payroll tax contributions0.9 percent of taxable wages paid by workers and the same amount by employers. Since the mid-1990s the Social Security Administration has consistently projected that the Disability Insurance trust fund would have sufficient reserves to cover all scheduled benefits until 2016, but that after that date, additional funds would be needed to avoid a shortfall in the necessary funds to continue paying full benefits. If no action is taken to address the shortfall, the Disability Insurance trust fund will only be able to pay 80 percent of scheduled benefit levels after 2016.

Congress has addressed similar shortfallsin both the Disability Insurance trust fund and the Old Age and Survivors Insurance trust fund, which pays retirement benefitsnearly a dozen times in the past by temporarily reallocating the share of overall payroll tax revenues that is dedicated to each trust fund. In some cases, they have reallocated funds from the Disability Insurance trust fund to the Old Age and Survivors Insurance trust fund in others, they have reallocated funds from the Old Age and Survivors Insurance trust fund to the Disability Insurance trust fund.

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Does A Medical Condition Have To Match The Blue Book Listing

An individual filing for Social Security disability benefits does not necessarily have to satisfy the exact listing requirements for a particular illness or condition to be awarded disability benefits based on the condition. You can be awarded disability benefits if Social Security considers aspects of your condition medically equivalent to the criteria in the listing or a related listing. This is called “equaling a disability listing.”

Alternatively, you can be eligible for disability benefits if you don’t meet or equal the criteria for the blue book listing, if your condition limits your functioning so much that you can’t work. The SSA will consider the effect of your condition on your capacity to perform routine daily activities and work and will then determine whether there is any kind of job you can safely be expected to do. For more information, see our section on how Social Security decides if your limitations make you disabled.

How Have The Number And Share Of People Receiving Disability Benefits Changed Over Time And What Accounts For These Changes

There has been little change over the past two decades in the share of nonelderly adults receiving Supplemental Security due to a disability. In 2011, 2.4 percent of nonelderly adults received Supplemental Security for a disability, compared to 2.1 percent in 1996. This comparison does not, however, take into account demographic and economic changes, particularly the aging of the population and the increase in poverty, which both have increased the number of people who are potentially eligible for Supplemental Security.

Controlling just for income, participation in Supplemental Security by working-age adults who are potentially eligible because of low income has actually declined over the past decade and a half. In 2011 there were 17.6 nonelderly adults receiving Supplemental Security for every 100 nonelderly adults with incomes below 100 percent of the poverty line, compared to 18.5 nonelderly adults in 1996. In other words, the number of nonelderly adults receiving Supplemental Security grew at a slower rate than the number of nonelderly adults with very low incomes.

The share of nonelderly adults receiving Disability Insurance has increased over time. This is largely due to demographic factors, including:

A number of factors account for this one-percentage-point increase in the disability-prevalence rate after accounting for the changes in the age and gender distribution of the workforce, including the following:

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Benefits For Disabled Widows Or Widowers

If something happens to a worker, benefits may be payable to their widow, widower, or surviving divorced spouse with a disability if the following conditions are met:

  • The widow, widower, or surviving divorced spouse is between ages 50 and 60.
  • The widow, widower, or surviving divorced spouse has a medical condition that meets the definition of disability for adults and the disability started before or within seven years of the worker’s death.

Widows, widowers, and surviving divorced spouses cannot apply online for survivors benefits. However, if they want to apply for these benefits, they should contact Social Security immediately at 1-800-772-1213 to request an appointment

To speed up the application process, complete an Adult Disability Report and have it available at the time of your appointment.

We use the same definition of disability for widows and widowers as we do for workers.

Extended Period Of Eligibility

5. Social Security Disability Insurance (SSDI) & Planning for Work (2020)

Following your trial work period, you will enter a 36-month extended period of eligibility. It is in this period that you can work and still receive benefits only as long as your earnings are less than what Social Security considers substantial. Social Security deducts what they consider work expenses that are a direct result of your disability from your total monthly earnings. These work expenses can range from prescription drug copays, transportation to and from work, and specialized work equipment.

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How Much Does The Di Program Cost

In 2016, the disability insurance trust fund received $160 billion, mainly from the 1.185 percent tax on wages that workers and employers both pay. Total payments from the DI trust fund were $146 billion, mainly for benefits to disabled workers and their families, meaning that income exceeded outgo by $14 billion in 2016. The cumulative assets in the disability insurance trust fund totaled $46 billion at the end of 2016. Administrative expenses were 1.9 percent of outgo from the DI fund, and the remaining portion paid for benefits.

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