Who is Eligible for SSI and SSDI Benefits?
The Social Security Administration (SSA) has very strict guidelines for what classifies as being disabled. Any medical condition with severity that impacts your work ability and ruins your chance to earn a sufficient income has the potential of being a disability. However, to qualify for benefits it must meet the requirements that are established by the SSA. A SSDI lawyer can help you determine if you qualify for benefits and can help you with the next steps if you’ve been denied.
How Does the SSA Define Disability?
To qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits, there are specific criteria involved. These criteria include:
Your disabling condition must be of a severe nature. Not all medical conditions are considered severe enough to warrant benefits. It can even be challenging to measure the severity of a medical problem. The SSA classifies severe impairments as medical problems that interfere with a person’s normal activities of daily living, which are called ADLs. As far as an adult goes, this is how they are impacted in regards to the ability work to or inability to work. When it is being considered for children, the ADLs involved the ability to participate in age-appropriate activities.
The disabling medical condition must last a minimum of a year in order to be approved for either kind of Social Security disability benefits – SSI or SSDI. If you file for disability benefits and your medical records indicate you have disabling and severe medical problems but those issues will improve within the next year, you will be denied benefits because of the duration not meeting the requirements. The duration of a condition is how the SSA decides if a disability claimant’s condition is permanent.
You must face mental or physical limitations, or a combination of those two, that eliminate your ability to return to one of your former jobs. Usually, the SSA looks at any work you performed during the last 15 years of your life. Your condition’s severity must render you unable to use your education and work skills toward any previous kinds of work duties or another kind of work. Also, you must not be able to use any remaining functional abilities toward any other kind of work.
Most disability claims are denied at the initial application level and even at the reconsideration levels, either because the claimant is believed to be able to return to a former kind of work or the claimant is believed to be able to perform some other kind of work duties. Applicants who receive a benefits denial based on their past work duties or are believed to be able to do some other kind of work have little chance to argue the merits of the case or dispute those beliefs. When the case reaches the disability hearing, you can rebut those allegations of being able to work. Your Milwaukee SSDI lawyer can challenge the claim that you can return to a past kind of work or that you can transition to some other kind of work by providing specific evidence and using example scenarios.
The challenge focuses on the applicant’s work history during the last 15 years, which is deemed to be the relevant time frame for disability claims. The challenge involves a detailed knowledge of the disability process, including an understanding of substantial gainful activity (SGA), unsuccessful work attempts, works skills transferability, and different medical-vocational rules, which called the grid. These are involved directly with the decision of whether or not to award someone disability benefits and whether to term someone as “disabled” or say they are “not disabled” per SSA guidelines. Of course, all these things are dependent on the case specifics. Having a good Milwaukee SSDI lawyer can make contesting allegations that you are able to return to work much more effective as well as easier.
What are the Requirements for SSI and SSDI
To be approved for either kind of Social Security disability benefits there are two kinds of criteria that must be met. These criteria fall under medical and non-medical criteria, which we will discuss further:
So far, we have mostly discussed medical criteria. The disabled individual seeking benefits must have a severe condition that is going to last at least a year and it imposes mental or physical limitations that prevent the applicant from being able to engage in substantial gainful activity and earning a living.
Your working ability is gauged in several ways. First, it involves going over all the medical evidence. A disability examiner does this initially and then a judge does this on the hearing level. Your limitations are then rated. A residual functional capacity (RFC) is used to determine that rating.
As an example, you might be given a sedentary rating, which basically rules out the different kinds of work other than work duties that are based primarily from a position while sitting and requires little exertion. Some claimants might be determined to have RFC limitations that force them to do only light duty work or medium duty work. Other claimants might have RFC limitations, such as one for mental functioning that limits many different kinds of work activity because of a limited ability to recall information, learn new things, concentrate or focus, or work well with others such as coworkers, customers, and supervisors.
A claimant might receive more than one rating. One might be a physical rating and the other a mental residual functioning capacity (MRFC) rating. These ratings are compare to past job requirements to determine if the individual seeking disability benefits can return to one of their former jobs. Their ratings can be compared to other jobs which match their combination of work skills and educational background requirements.
The RFC or MRFC rating you receive is based on your medical evidence provided during the Social Security disability application process. The more evidence that is provided, the more accurate your rating. You must provide detailed information about your medical treatment sources when you file for disability benefits. This also goes along with the importance of providing medical evidence that has been updated before you go to your disability hearing.
If your Milwaukee SSDI attorney can obtain a statement of support for your claim from one of your treating physicians that agrees your condition is severe and you are disabled, your odds of being approved for benefits significantly increase. Most Milwaukee SSI attorneys do this because they understand the significance of a treating physician’s opinion and statement when that document is presented to an administrative law judge who will rule on the case. It is believed that your treating physician knows more about your medical condition and your abilities than anyone else.
Providing Social Security with Non-Medical and Medical Information
When you have your initial interview for disability benefits, a disability claims representative at Social Security will get your medical information, which includes the names of all your treating providers, hospitals, and clinics as well as their addresses, telephone numbers, and the dates you were treated there. You will have to provide detailed information about your work history for the 15 years before you becoming disabled.
During this interview, the representative assigned to your claim will consider all of the non-medical requirements for both SSDI and SSI. Both SSDI and SSI require that you provide proof of citizenship or alien status to be eligible for benefits. Both programs require you to provide personal information, such as your date of birth, location of birth, and dates of any marriages and divorces.
Each disability has its own unique non-medical requirements in addition to the similar requirements. SSI is a needs-based program, so you must meet the income requirements. Currently, your income limitations are $733 per month for an individual and $1,100 per month for a couple. Some income is not counted in those figures, but your Milwaukee SSI attorney will know how to calculate those figures and can determine your eligibility. While your income doesn’t come into play for SSDI, you must have worked enough to earn sufficient credits and pay in the required taxes to be eligible for SSDI benefits. In most cases, that is five years of full-time work out of the last 10 years.
To learn more about SSI and Social Security disability, consult with an experienced SSDI lawyer at Tabak Law in Milwaukee.