How Does the SSA Determine Disabilities and Qualifications for Benefits?

Social Security Disability Insurance (SSDI) provides benefits to help replace lost income for disabled individuals who can no longer work. In December 2016, more than 260,000 disabled Tennesseeans met the SSA’s strict definition of a disability and received Social Security benefits.

To receive benefits, the SSA must first determine you are disabled and whether you qualify for benefits. Below, our social security disability attorney explains how the SSA determines disabilities and qualifications for benefits.

If you live in Tennessee and need help applying for benefits or appealing your SSDI ruling, call our disability attorney at (731) 513-5279.

How the SSA Determines Disabilities

To qualify for Social Security Disability, you need to meet the SSA’s definition of disability, as well as properly apply for the program.

Definition of a Disability

SSA’s strict definition of disability comes directly from the Social Security Act. Qualifying as disabled means you:

  • Cannot work due to severe medical condition that has lasted (or is expected to) more than 1 year or result in death
  • The condition must prevent you from doing work you did in the past
  • The condition must prevent you from adjusting to other work

The SSA also has a long list of impairments that are considered approved disabilities, if connected to the inability to work. However, if your condition is not listed in the SSA’s library of impairments, you can still apply for SSDI. It just requires more documentation and the potential for more appeals.

Application Requirements

The application process for disability benefits is complex and requires several different forms that collect information regarding your disability. You can apply in person, in your state’s local SSA office, or you can apply online.

Required information for the application process includes:

  • Social Security number
  • Birth certificate
  • Contact info for all of the health care providers you have visited or received treatment from (including the dates of your visits)
  • Names and dosage of all medications you take
  • Medical records from your health care providers
  • Labs and test results
  • Summary of your work history and the type of work you performed
  • Information about your medical condition and how it affects your ability to work

You are also required to give consent for the health care professionals who have treated you to provide the SSA with information regarding your medical condition.

Who Determines If You Qualify for SSDI?

If you qualify for disability benefits, your case is forwarded to your state’s Disability Determination Services office.

Doctors and disability specialists who work in this office will review all information in your application. They will also reach out to your healthcare providers to get additional information on your condition including:

  • Details on your condition(s)
  • When the condition(s) began
  • How your condition(s) limit your activities
  • Medical test results
  • Treatments received
  • Your ability to do work-related activities

If the state’s agency cannot determine your disability based on this inquiry, they may ask you to have a special examination. The SSA covers the cost of this exam.

What the SSA Looks For When Reviewing an Application

When it comes to determining disability, the SSA looks at a few key factors.

Can You Work?

The SSA will look to see if you are currently working and earning substantial gainful activity. This is a monthly average that changes each year. If your monthly earnings average is less than the definition of substantial gainful activity, they’ll look at your medical condition.

How Severe Is Your Condition?

The state’s agency will evaluate the severity of your medical condition(s). To qualify as disabled, your condition must significantly limit your ability to do basic work activities for at least 1 year.

If your abilities are not limited, you would not qualify for benefits. If your medical condition prevents you from working, your case will move forward.

Is Your Condition On the Listing of Impairments?

The next step in the process is to determine if your condition is on the Listing of Impairments. This is a list of impairments considered severe enough to prevent substantial gainful activity. There is a list for adults and a separate list for those under 18 years of age.

Can You Perform Your Past Work?

If your medical condition is not on the list of impairments, the state’s agency will consider your past work. They will determine if your medical condition prevents you from performing any of your past work. If they find that the condition does not prevent you from your past work, you would not qualify for disability. If it does, then your case will move to the next phase of the process.

Work Adjustment

If the state’s agency finds that your condition prevents you from performing any of your past work, they will look to see if there is any work you can perform despite your medical condition. Factors taken into consideration include:

  • Age
  • Education
  • Past Work Experience
  • Other skills

If the state agency determines you can perform other work, you would not qualify for disability benefits. If you cannot perform other work, you will qualify as disabled and receive benefits.

Work Credits

Lastly, to qualify for SSDI benefits, you must have work credits (generally 40 credits). This means you need to have paid Social Security tax in the past. Depending on your age will determine the number of work credits you need to receive benefits. If you have not worked before, or if you do not have enough work credits, you may not qualify for benefits, even if you meet the SSA’s strict definition of being disabled.

If you have a long-term or permanent disability but do not qualify for SSDI benefits, you may still be able to get SSI benefits since they are need-based. However, you’ll need to meet the separate set of criteria to qualify.

Need Help Applying for SSDI? Work With a Disability Attorney

There is no requirement that you enlist the help of an attorney to file for disability. However, the process is complex and lengthy, with numerous forms, documentation, and deadlines. On top of that, states like Tennessee are known for higher rates of SSDI claim denials. In fact, nearly 70% of all cases were denied in 2018.

While it is possible to appeal unfavorable determinations, working with a qualified and experienced disability claims attorney. If you’re applying for SSDI benefits or have been rejected by the Tennessee SSA agency, The Law Offices of Michael Hartup can help you improve your case eligibility and help you navigate the system. Fill out our online contact form or call (731) 513-5279 to talk to someone at our Jackson, Tennessee office. Like us on Facebook for more news and resources on disability benefits in Tennessee.