Social Security's definition of "legally disabled" is different from that of other programs.
The Social Security Administration (SSA) administers benefits to disabled individuals under two programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). SSDI is available to disabled individuals who have worked for a certain number of years and paid taxes into the Social Security program. SSI, on the other hand, is a needs-based program and eligibility depends upon a person's income and resources. It's not uncommon for a person to qualify for both programs, although this will depend on a person's work history and financial situation.
The definition of legally disabled is the same for both programs.
These federal programs are available only to those who meet Social Security's definition of "disability," which is different from the disability definitions used by Medicaid and most private disability insurance policies. The Social Security Administration defines disability as:
SSA decides whether you meet this definition by following a five-step process.
First, SSA asks whether you are working and earning more than the "substantial gainful activity" threshold ($1,470 a month for 2023). If you are, you will usually not be considered disabled, unless you're blind or have low vision. Blind applicants are allowed to make up to $2,460 per month.
Second, your condition must be "severe": it must significantly limit your ability to do basic work tasks. If your impairments aren't severe, you are not disabled.
Third, Social Security will decide whether your impairments meet those found in SSA's Listings of Impairments, which lay out the criteria for many of the most serious disabling conditions to qualify for disability benefits.
If your condition doesn't meet a listing, you move on to step four, which looks at whether you have the ability to return to any of your jobs from the previous 15 years. Social Security will assess the physical and mental requirements of your prior jobs, and determine whether you're still able to perform them based on your "residual functional capacity" (RFC). Your RFC includes your physical ability to push, pull, lift, carry, stand, sit, and walk as well as your mental ability to follow directions, maintain concentration, keep up your attendance, and deal with co-workers and the public.
If Social Security decides your RFC prevents you from doing any of your past jobs, it will move on to step five, which asks whether there are there any other jobs that you can do. In making this determination, SSA will consider your age, work experience, and your RFC. In general, those who are older (over 50) and have little education are less likely to be found capable of adjusting to other work—unless they have job skills they could transfer to less demanding work.
How does Social Security make decisions for those over 50? The SSA's "grid rules" consist of a series of tables that dictate when a person is disabled based on his or her age, RFC, education, and vocational history. For example, if you're a 55-year-old individual with a high school education, a history of unskilled work, and you're limited to sedentary or light work, Social Security will find you disabled based on the grids.
If you're not disabled according to the grids, or you're under 50, the SSA will try to identify jobs that you can do that your RFC doesn't rule out. For more information, read our article on how Social Security decides whether your RFC allows you to do any jobs.
Note that in some circumstances, Social Security can skip step four (whether you can do your prior work) and find you not disabled at step five if you can adjust to other work.
Applications for Social Security disability benefits can be filed online, over the phone, or in person through your local SSA field office. The application will ask about your health problems, daily activities, work history, and recent medical treatment.
After you've filed your claim, a disability claims examiner, working for a state agency called Disability Determination Services (DDS), will make an initial determination on your case, usually within four to five months. The initial decision is based on your recent medical records, your function report, reports from friends and family, and sometimes consultative medical examinations with a doctor arranged by DDS.
It's important to have documentation from your doctor about how your medical condition limits your ability to work. Claims examiners are supposed to give substantial weight to the opinion of your treating doctor, so it is often helpful to ask your doctor to submit a statement. For more information on providing good evidence, read about the medical evidence you need to prove disability.
Unfortunately, only a fraction of disability applicants are approved at the initial level. If you're denied benefits, you'll need to appeal.
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