What is disability for Social Security purposes?

Social Security’s definition of disability is very specific.

In order to be found disabled under Social Security regulations:

  • You must be unable to do any type of "substantial gainful work" because of your medical condition(s); and
  • Your medical condition(s) must have lasted, or be expected to last, at least 12 consecutive months or expected to result in death.

There are two programs administered by the Social Security Administration that provide disability benefits: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).

What help is available for disabled individuals?

SSDI pays benefits in a manner similar to retirement benefits, based on your work history. The rule of thumb to qualify for SSDI is that you must have worked for five of the last ten years, not necessarily consecutively, and have a physical or mental impairment that meets the definition of disability described above. The Social Security Administration has a great deal of information on this topic in their Disability Benefits publication. Individuals eligible for SSDI benefits become eligible for Medicare coverage 24 months from onset or eligibility, as determined by the Social Security Administration.

SSI pays benefits to people who are disabled but lack the work history to qualify under the SSDI program. SSI also pays benefits to individuals over the age of 65 but do not qualify for retirement or spousal benefits. In addition to the disability and/or age requirements, Social Security also looks at your assets, other income and living arrangements to determine eligibility for SSI. Benefits under the SSI program are quite small with a maximum benefit of $721 in 2014. Social Security may supplement your income with SSI if your SSDI or retirement benefits are less than the maximum SSI benefit. The Social Security Administration has a great deal of information about this program in their Supplemental Security Income (SSI) publication.

Social Security has an obligation to provide benefits quickly to applicants whose medical conditions are so serious that their conditions obviously meet disability standards. Compassionate Allowances are a way to expedite the process for individuals with very rare diseases and certain types of cancer. The Compassionate Allowance list now contains more than 200 conditions that automatically qualify an individual for disability benefits

What if I think my child is disabled?

Social Security has a strict definition of disability for children.

  • The child must have a physical or mental condition(s) that very seriously limits his or her activities; and
  • The condition(s) must have lasted, or be expected to last, at least 12 consecutive months or result in death.

Children from birth up to age 18 may get Supplemental Security Income (SSI) benefits. They must be disabled and their household must have little or no income and resources. The Social Security Administration has a lot of information about children with disabilities on their website and in their publication, Benefits for Children with Disabilities.

What if I'm a military veteran? Can I receive disability benefits from Social Security?

Military service members can receive expedited processing of disability claims from Social Security through the Wounded Warriors program. Benefits available through Social Security are different than those from the Department of Veterans Affairs and require a separate application.

The expedited process is used for military service members who become disabled while on active military service on or after
October 1, 2001, regardless of where the disability occurs.

What if my disability claim is denied?

If your application for disability benefits is denied, you have a right to appeal. While you can represent yourself in your appeal, it may be in your best interest to consult with an attorney. Statistically, claimants represented by attorneys in their appeals are approved at a significantly greater rate than individuals representing themselves.

If your initial claim is denied, the first step in the appeal process is to file a Request for Reconsideration. You can file your appeal online or by submitting the form to your local Social Security office. Your appeal must be filed within sixty (60) days from the date of your denial notice.

If your first appeal is denied, you can request a hearing before an administrative law judge. Again, this appeal can be filed online or by submitting the form to your local Social Security office.

If your appeal is denied by an administrative law judge, you have a right to file a Request for Review. If the Appeals Council denies the request, then you have a right to file a complaint in Federal court.