Factors that Determine Social Security Disability Benefits

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Social Security Disability is a federal program that helps provide assistance to those workers who are unable to work because of a physical or mental illness or injury. Disability benefits include a monthly payment, much like Social Security retirement benefits, and either permit a person early access to Medicare coverage or entitle them to Medicaid.

Although the idea of financially helping those who are disabled seems simple, the application and approval process is actually quite complex and time-consuming.

To start, there are three basic factors the Social Security Administration uses to determine whether you are eligible to receive disability benefits:

  1. You must have a severe medically determinable impairment that is mental or physical
  2. Because of the physical or mental impairment, you are no longer able to engage in substantial gainful work activity
  3. Your disability has either lasted 12 months or is expected to last 12 months, or your disability is expected to result in your death

Physical or mental impairment

The Social Security Administration requires disability applicants to suffer from a genuine physical or mental impairment that is “medically determinable.” To satisfy this requirement, your condition must be able to be discovered and diagnosed by doctors. When you apply for Social Security Disability benefits, it’s important to provide medical records and doctor statements as proof of disability.

Engaging in substantial gainful work

In determining whether the applicant can work, the Social Security Administration first considers whether that person can continue performing the work they did in the last 15 years.

If they cannot perform their past work, Social Security evaluates whether they can adapt to other work available in the economy. While evaluating whether the applicant can perform other work, the Social Security Administration will consider the person’s age, education, training, and work experience.

The time-period of your disability

Your disability must have lasted, or be expected to last, 12 months. While you don’t have to wait until a year has passed after your diagnosis to apply for benefits, the doctor must be able to project that the illness will last at least a year. The exception to the one-year rule is if your disability is expected to result in your death.

How the SSA determines if you are disabled

Once the Social Security Administration has evaluated whether you have a mental or physical impairment, whether you can engage in substantial gainful work, and the duration of your disability, it will determine if you meet their definition of disabled by considering five questions:

  1. Are you employed? If you are working and earn more than $1,170 a month (the definition of substantial gainful work), you will generally not be considered disabled.
  2. Is your condition severe? Your disability has to be severe enough to substantially impair your ability to perform work-related activities.
  3. Is your disability one of the SSA’s approved conditions? The Social Security Administration has a list of conditions so debilitating that applicants automatically qualify the applicant for benefits. If your condition is not on the list, you can still be approved for benefits if you can prove its impact on your health and your ability to work.
  4. Are you still able to do the same work you did before you became disabled? If your condition doesn’t interfere with your ability to continue doing the same work, then you are not considered disabled.
  5. Are you able to do any type of work? Being unable to perform your previous job or work does not mean you will be automatically considered disabled. You may be able to perform a different job that does not interfere with your condition. It’s important to note that the SSA is interested if you can perform any kind of work, even if it pays much less or is might be considered more “menial” than your prior career.

How a Social Security Disability lawyer can help with your case

An experienced Social Security Disability lawyer can be an invaluable asset to your case. Applying for and being approved for Social Security Disability benefits is a lengthy process, and most people are denied multiple times. Our attorneys are very familiar with the process, and they know what to expect at every stage.

Your attorney will request and review your medical records and determine if additional testing is necessary, evaluate potential problems with your case, and help you best present the details of your disability. In the case of a disability denial, your attorney will file your appeals and argue your case in front of the administrative law judge, if the case gets to that stage.



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