When you apply for disability benefits, Social Security will want to know the answers to some key questions to determine if you are eligible for disability. Here are some of the essential inquiries Social Security will make and why they matter; read on to find out if you should apply for disability and if you can get disability.
This is a question that matters only for SSDI applicants. In order to qualify for SSDI (Social Security Disability Insurance), you must pass the "recent work" test, which means you must have worked five of the past ten years, or, technically, 20 of the last 40 quarters. For a quarter to count, you must have made $1,360 during it. Social Security will look back ten years from the application date; if the last quarter you worked was five and a half years before your application date, for instance, you won't qualify for disability. For more information, read about required work credits for SSDI.
If you haven't worked much in the last five or ten years, you might be able to qualify for SSI, but SSI is reserved for those with very low income and assets. For SSI, your assets and your current monthly income (from nonwork and work sources, including any spousal income) have to be below certain amounts. For more information, read about SSI income limits and SSI asset limits.
If you have earned enough work credits to be eligible for SSDI or your income and assets are low enough to be eligible for SSI benefits, then Social Security will evaluate you against the following criteria to determine if you qualify as disabled.
Social Security and SSI (Supplemental Security Income) disability benefits are reserved for people who have severe medical conditions that make it impossible for them to work for at least 12 months. To be eligible for disability, you either have to have not done a significant amount of work for a year OR you must be expected to not be able to work a significant amount for at least a year. (If you have an illness that is terminal, however, the 12-month rule doesn't apply). For more information, read about how long you have to be disabled before you can get disability benefits.
If you've been off work for just a month or two when you apply, Social Security might deny your claim initially to see whether your impairment continues to keep you from working long term or if it improves. The same goes for medical conditions that involve impairments that are often temporary, such as having a broken leg, recovering from hip surgery, or suffering from whiplash after a car accident. If you apply based on one of these conditions, Social Security may quickly deny you; if you appeal, Social Security will review your case and could approve you if you are still unable to work.
The first thing Social Security checks when it receives a disability application is how much income you're currently earning. You are allowed to work a few hours a month and still technically qualify for disability benefits, but not much more. The rule is that a disability claimant must be unable to perform what Social Security calls "substantial gainful activity" (SGA). If you're doing a substantial amount of work, such as working 10-20 hours a week or making more than $1,000-$1,200 a month, you will likely have a hard time convincing a Social Security judge or claims examiner that you can't get a job and keep it. For more information, read about substantial gainful activity. This same rule applies for SSI eligibility and for SSDI eligibility.
If you haven't seen a doctor for your medical condition and you aren't receiving treatment, it will be hard to convince Social Security that your disability is severe. Social Security also won't know whether your condition could quickly improve with medical treatment; for example, if you tried a new medication. If you can't afford medical care, Social Security might pay for a consultative exam. For more information, read about applying for disability without seeing a doctor.
Social Security will look to see if your condition prevents you from doing your previous work. If you can't do your previous work, they will look to see if there is other work you can do. When making this determination, Social Security will consider various factors, like your medical records, your current abilities, and your age.
Does your doctor believe you're unable to work? Your doctor's opinion on your limitations is very important to Social Security. If your doctor doesn't think your impairment limits you from doing full-time work—or worse, if there's an indication in your medical records that your doctor thinks you're exaggerating your symptoms—your claim could fail. For more information, read about what to do if your doctor thinks you're exaggerating and how to get your doctor to cooperate with you on your claim.
Does your condition make it difficult for you to perform daily activities? If you get by without assistance doing your grocery shopping, cooking meals for you and your family, cleaning your house, and paying your bills, Social Security might wonder if your condition isn't severe enough to prevent you from working. Social Security looks at how your work activities and your daily living activities are limited to judge how severely a medical impairment affects your life and whether you can work. For more information, read about the importance of daily activities and Social Security's daily activity questionnaire.
How old are you? Claimants in their fifties have a better chance of getting benefits than those who are younger. Social Security's rules recognize that medical conditions deteriorate as people get older and that older people have more difficulty training for new jobs, especially if they worked physically challenging jobs for most of their life.
If you're in your thirties or forties, statistically, you have a lower chance of getting approved for benefits, but the most important factor in whether you get disability benefits is the severity of your medical condition. Even young people can have severe chronic illnesses like multiple sclerosis, cerebral palsy, epileptic seizures, congenital heart disease, or metastatic cancer. If you have such a disease, your youth won't affect your eligibility at all. For more information, read our article on how age affects a disability claim.
While you can apply for disability and even attend an appeal hearing without a lawyer, most claimants hire a lawyer if they are initially denied. In a survey we did of our readers, those who had a lawyer at some point in the process were approved 60% of the time, while those who went it alone were approved only 34% of the time. Especially if you don't have a clear-cut case, you might want to consider hiring a disability lawyer or advocate.