Qualifications for Social Security Disability

Types of Social Security Benefits

Two of the largest government programs for those too disabled to work are Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), both administered by the Social Security Administration (SSA). Only those who meet medical criteria and whose disability is severe enough may qualify for benefits under these programs.

SSDI pays benefits to you and certain members of your family if you are “insured” (you worked long enough and paid Social Security taxes). SSI pays benefits based on financial need and may cover those who are not “insured” (because they haven’t worked long enough and/or haven’t paid enough taxes, which can include those paid in cash “under the table” and children).

Application Process

As part of applying for benefits for either program, medical information and records need to be collected and organized so SSA can make a determination of whether or not you meet Social Security’s definition of disability. SSA has a Benefits Eligibility Screening Tool to help you find out which programs you may qualify for, if any.

In New Jersey, most Social Security disability claims are initially processed through the New Jersey’s Department of Labor and Workforce Development. Representatives take benefit applications in person, by telephone, by mail or online. The claimant (the person filing the application) is asked for information about impairments, where treatment has been received and other details relevant to the disability.

Normally, evidence of the disability is sought from the claimant’s own healthcare professionals in order to make a decision, but there might also be an independent consultative examination (CE) to obtain additional information. After collection of the evidence, staff makes the initial disability determination.

If the decision is in favor of benefits, the SSA computes the benefit amount and pays benefits. If the claimant was found not qualified for benefits, the file remains in the field office to be used in a possible appeal. The first level of appeals is within SSA, but further appeals can go through the federal court system.

Disability Determination

The consideration of whether you are disabled and qualify for benefits is a multi-step analysis.

1. Are you working?

If you are working and you make more than $1,130 a month, you generally won’t be considered disabled. If you are not working, you should complete an application for benefits.

1. Is your condition severe?

Does your condition interfere with basic work-related activities? If not, you are not disabled. If so…

1. Is your condition on SSA’s list of disabling conditions?

SSA has a list of medical conditions for each major body system. These conditions are so severe that if you are diagnosed with one you are automatically considered disabled. If your condition is not on the list, a determination must be made as to whether it is equally as severe as one that is listed. If so, SSA should find that you are disabled. If it is not on the list or found to be equal to one on the list, the next step is taken.

1. Can you do the work you did previously?

If your condition is severe but not at the same or an equal level as a listed condition, SSA determines whether or not it interferes with your ability to do the work you did previously. If not, your claim will be denied. If it does, the next step is taken.

1. Can you do any other type of work?

If you cannot do the work you did in the past, SSA needs to decide whether you can adjust to other work considering your medical conditions, age, education, past work experience and skills that could transfer to another line of work. If SSA determines you cannot adjust to other work, your claim will be approved. If you can adjust to other work, your claim will be denied.

SSA has a number of publications that may help you understand benefits, how determinations are made and different programs they have available.