What Are the Rules and Requirements for Social Security Disability Cases?

There are rules on both medical eligibility and financial eligibility for disability benefits.

There are several rules and requirements you must meet to be approved for Social Security disability. To be eligible for either SSDI (Social Security disability insurance) benefits or SSI (Supplemental Security Income) disability benefits, you must be both financially eligible and medically eligible. The Social Security Administration (SSA) examines the medical issues (that is, whether your illness or injury is disabling) as well as legal/financial issues (that is, whether you have earned enough credits for SSDI or have low enough income and assets for SSI) and determines whether you meet the rules and requirements. 

Medical Requirements for Disability

One of the most important rules for Social Security disability is that your medical disability must have lasted, or be expected to last, for at least one year for benefits to be awarded. There are no temporary disability benefits through Social Security. In addition, Social Security disability is for fully disabled, not partially disabled, people.

To qualify for benefits, under either SSDI or SSI, you must have a medical condition that is severe and either:

  • meets the strict requirements of a Social Security impairment listing, or
  • makes working at any of your past jobs impossible, or
  • makes working at a less physically or mentally strenuous job impossible. (Social Security takes into account your education, age, and skill set, but not whether there are jobs in your area, when making this determination.)

For instance, one way to meet the requirements of the impairment listing for lung cancer is to have a pathology report of a lung biopsy showing small cell lung cancer. No evidence of how the cancer or treatment side effects limit your ability to work is necessary. On the other hand, if you don't meet a listing, you need to have evidence that your medical condition causes specific functional limitations that keep you from being able to perform job duties.

For more information, see our article on qualifying medically for disability.

Financial Requirements for Disability

On the legal/financial side, if you earn a certain amount of money per month (called the "substantial gainful activity," or SGA level), you are considered to be gainfully employed, and therefore not eligible for disability benefits. In 2016, the SGA level is $1,130 per month. To learn more about substantial gainful activity, see our article on the SGA earnings limit for disability. You are generally allowed to be working and earning up to this amount when you apply for disability benefits.  

In addition, for SSDI, you must be insured under the Social Security disability insurance program, meaning you've paid taxes into the system for the required number of years and your insurance hasn't expired because you stopped working too long ago. The work requirements for Social Security disability are a little stricter than for Social Security retirement or for Medicare. The work requirements vary by age, but to give you an idea, a 55-year-old must have worked at least eight years to be eligible for benefits, and five of those years must have occurred within the last decade. For more information, see our article on work requirements and financial eligibility for SSDI.

For SSI, you don't need to have worked, but there are family asset and family income limits. The income limit for the SSI program is based on something called the monthly federal benefit ($733 per month), but income you earn for work is not all counted. The asset limit is $2,000 (your house and car don't count). There are different income and asset limits for married couples. For more information, see our article on financial eligibility for SSI.

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