If you currently have a disability that interferes with your ability to earn money, you may be eligible to receive disability benefits through the Social Security Administration (SSA). The SSA runs several federal programs to provide service and cash benefits to Americans of all ages and ability levels.
The Social Security Disability Insurance (SSDI) program is intended specifically for those whose disabilities prevent them from working and earning to their full capacity. The program currently serves more than 8 million people across the United States.
In general, you must meet two main criteria to be approved: Your condition must be considered severe enough, and you must have worked long enough to have paid into the Social Security system. However, the most important of these is your disability determination since waivers and adjustments are available to those who haven’t been able to earn enough work credits to qualify.
The Blue Book – also called the Disability Evaluation Under Social Security or sometimes the “List of Impairments” – is a comprehensive tool to determine if your disability qualifies you for Social Security benefits either with SSDI or Supplemental Security Income (SSI). The Blue Book lists every impairment that could qualify you for disability payments. If your medical condition is not listed here, it is very difficult (but not impossible) to be approved.
In addition to listing the name of the disability, the Blue Book also includes a description of symptoms and necessary test results or a diagnosis that will qualify you, since simply having the condition on its own is not enough. Since these Social Security disability benefits are based on the severity of your condition, you must meet certain criteria to show your condition limits you enough that you can’t perform regular work.
The Blue Book breaks down its list of impairments into a section for adults with disabilities and a separate section for children since the qualifying criteria will change for each. This resource is entirely online and it’s highly recommended you consult it to ensure your disability is listed and you meet the criteria listed. If possible, work with your primary care provider to review the listing before you apply for Social Security disability benefits. In addition to the listed impairments, the Blue Book also gives detailed information about the disability programs the SSA runs as well as the kinds of medical evidence you’ll need to provide to validate your claim.
The SSA Red Book is intended mostly for those who work with disabled people who are receiving either SSDI or SSI benefits such as educators, counselors, or advocates. This reference tool outlines the employment provisions and support that the beneficiaries must comply with while receiving their payments.
The Red Book discusses what happens when you return to work, how to access SSA employment services, and several additional resources to help you get back to work. You will also find specifics related to how much you can work and earn while still receiving disability insurance, and what the transition into full-time work will look like. This includes factors like your Trial Work Period (TWP), Extended Period of Eligibility (EPE), an explanation of Substantial Gainful Activity (SGA), and how different disabilities such as being blind will affect you.
There are five main components that are looked at when reviewing your claim to determine if you are “disabled” according to the SSA. This process occurs independently of the other main qualifying feature of having accumulated enough SSA work credits to be considered vested in the system.
For each of these steps, if a disability examiner decides you are approved, you will move on to the next subsequent step. If you are denied, you will not proceed and your disability application will be rejected. Once you are approved, there is a mandatory five-month waiting period before you receive your first payment. The waiting period helps eliminate fraud.
The Substantial Gainful Activity (SGA) level is used to determine if a disabled person is earning too much to qualify for benefits. The SGA varies depending on the individual’s disability with the highest level of SGA reserved for blind individuals. All SGA levels fluctuate along with the average national wage index to account for trends in the labor market and economy.
In 2022, the SGA level for blind people is $2,260 and for non-blind disabled people is $1,350 (up from $1,310 in 2021). This means you can’t be earning more than this amount per month and still qualify for disability benefits.
Since the SSA doesn’t want to discourage people from returning to work when they are able, the agency has set up a Trial Work Period (TWP). This allows those currently receiving SSDI benefits to return to work for nine months without jeopardizing their monthly compensation, even if they end up earning more than the SGA during this time. However, at the end of the nine-month period, the SSA will no longer consider you disabled if you have been able to consistently earn more than the SGA.
This first step of determination is typically done at the federal level and if you meet the SGA standard, your application will be forwarded to your local Disability Determination Service (DDS) field office to complete steps 2-5.
Severity is a key factor to understand. Although many people may suffer from a certain physical or mental impairment, they may not meet the medical eligibility the SSA has determined significantly affects their ability to work.
The basis for this determination depends on how long your disability will affect your ability to work. You must prove that your medical condition is severe enough to limit work for at least 12 months or end in death. DDS will review your ability to perform basic physical work functions such as standing, sitting, lifting, or walking, and cognitive functions such as hearing, speaking, carrying out instructions, or remembering.
Step 3: Does the impairment or condition meet the severity to be considered one of the listings in Social Security’s Blue Book of Impairments?
Your condition must typically be found in the list of impairments in the SSA’s Blue Book. If it’s not, you may still be considered disabled by the SSA, but this doesn’t happen often. You may need the assistance of a Social Security disability attorney with experience helping claimants with their disability claim. DDS will use your medical record as well as non-medical evidence you submit along with your application to determine your level of severity.
To expedite applications and bypass unnecessary steps, the SSA has programs in place to help those with disabilities that obviously qualify them for benefits. One is the Compassionate Allowance (CAL) program that lists conditions that are always approved, usually related to cancer, amyotrophic lateral sclerosis (ALS), and brain disorders. If your condition qualifies you for Compassionate Allowances, the SSA will be able to process your application faster and get you benefits sooner.
The other program is Quick Disability Determination (QDD), which launched in 2008. QDD is a computer-based tool that digitally screens applications when they are submitted to fast track applications with the most serious conditions.
Step 3 is often considered the most crucial step in your disability adjudication. If it’s found your condition meets the standards listed in the Blue Book, you are considered disabled in the eyes of the SSA and might begin receiving benefits after passing steps 4 and 5.
DDS will look at your past work history and try to determine if you are still able to complete this work and engage in SGA. DDS will only look at your relevant past work (usually within the last 15 years) and use information provided about your duties, training, education, and medical evidence to determine your level of residual functional capacity (RFC). The RFC refers to how much of your previous work you can still perform despite having a disability.
This step makes it essential you include detailed information about your past work including duties and responsibilities, rate of pay, required supervision, how you had to use your body or cognitive abilities to perform these tasks, and when your condition began affecting your ability to work.
If it’s determined you can still perform these functions, you will be denied benefits. Keep in mind that the DDS does not evaluate your ability to get a job. If it’s decided you can’t perform your old job functions, your application will move on to step 5.
In the final step of the disability determination process, DDS will assess your ability to adjust to a similar kind of work that will allow you to engage in SGA. Considering factors like your age, education, training, past work experience, and any transferable skills, DDS will decide if you’re able to find other work that will allow you to earn enough.
If DDS decides you can adjust to a new line of work, it will present you with at least three job possibilities that meet your skill set. If DDS decides you cannot move into a new line of work, then you’ll be approved for benefits.
The disability determination process involves multiple steps, requiring analysis of your application and supporting evidence. Due to the limited resources of the SSA, it is common for decisions to take 3-5 months. There are certain avenues such as the Compassionate Allowance program and the Quick Disability Determination process that can shorten this time frame. Additionally, in cases where DDS takes a much longer time to make a decision, some people may qualify for SSDI back pay which can cover some of the time lost in the application process.
If your application for SSA disability benefits is denied, you can always begin the appeals process by requesting reconsideration. In this first step, a claims examiner will simply review your original application to see if an error was made. If you’re still denied, you can request an appeals council look at your case. An administrative law judge will review your case, look at new evidence, and decide to approve you or not. The last option for recourse is to appeal to the federal district court.
For additional help applying for disability insurance or determining which Social Security disability program is right for you, reach out to an SSDFacts Advisor today.