What Are the Non-Medical Requirements in a Disability Case?

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There are two aspects to processing a disability claim: financial/legal and medical.

Financial and Legal Requirements for Disability

Generally the first aspect of processing a disability claim has to do with financial and legal requirements -- issues that have nothing to do with a claimant's medical conditions or medical eligibility. 

The main barrier to benefits is that you can't be making more than a certain amount of money from work and still be eligible for benefits. For more information, see our articles on how much you can work and still get disability benefits.

Social Security will also screen your file to see if you are eligible for one of its programs: SSDI or SSI. SSDI is for workers who have paid into the Social Security retirement system for years. SSI is for low-income people who don't qualify for SSDI. There are different eligibility requirements for each program.

SSDI Non-Medical Requirements

For SSDI (for workers who have paid Social Security taxes), the non-medical requirements have to do with whether the claimant has worked the required number of quarters. For more information, see our articles on the non-medical requirements for SSDI.

SSI Non-Medical Requirements

For SSI (the low-income, needs-based disability benefit), the SSA will look at the applicant's income and assets to see if they are over the limits. In addition, if a non-U.S. citizen is applying for SSI, the SSA will look to see if the applicant is in a qualifying alien category. For more information, see our articles on the non-medical requirements for SSI.

Medical Requirements for Disability

The other aspect regards the medical determination of whether or not a claimant is disabled according to Social Security Administration (SSA) rules and regulations. Medical determinations are handled by disability claims examiners (and by administrative law judges if the case goes to appeal). Learn more about medical eligibility for disability benefits.

Who Evaluates Medical and Financial/Legal Eligibility?

When you file a claim for disability, the application is taken by a claims representative at the Social Security office. Claims reps do not evaluate claims for their medical eligibility, but they do look at an applicant's nonmedical eligibility. If they find that an applicant appears eligible for either SSDI or SSI, the claims rep will transfer your file to Disability Determination Services (DDS), where disability claims examiners are based. Claims examiners decide whether or not an applicant is medically disabled, with the help of a medical consultant.

If a claims rep finds that you are working and earning more than a certain amount of money, or you don't have enough work credits for SSDI and but you have too much income or assets for SSI, you will get a "technical denial." You usually receive notice of a technical denial fairly quickly.

However, as part of their medical eligibility assessment, claims examiners at the DDS will also be interested in whether you are working and earning money. If a DDS claims examiner finds you are "engaging in substantial gainful activity," you can be issued a technical denial by the DDS, which can take a few months. Learn more about technical denials.

by: , J.D.

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