Social Security Disability Guidelines

Here are the basics of how Social Security will process and decide your disability claim.

Updated by , Attorney · UC Law San Francisco

Are you thinking about applying for Social Security disability benefits? First, learn the basic eligibility guidelines for Social Security disability insurance (SSDI). If you think you could qualify for SSDI, Supplemental Security Income (SSI), or both, this article will help you get familiar with how Social Security makes disability decisions.

Basic Eligibility Guidelines for Social Security Disability Benefits

The Social Security Administration (SSA) has set guidelines or requirements you must meet to qualify for disability benefits. For medical disability or vocational disability, you must meet all of the following:

  • Your condition, physical or mental, must be severe enough to significantly affect your ability to do basic work-related tasks.
  • Your condition must have lasted at least one full year (by the time of the disability decision), or Social Security must believe it will last at least one year.
  • Your condition must be severe enough that it prevents you from earning a monthly amount equal to what's known as the substantial gainful activity (SGA) level.

To qualify for the SSDI program, you must have worked and paid Social Security taxes for many years. To be eligible for the SSI program, you must have a low income and few assets. Learn more about the financial eligibility guidelines for SSDI.

Social Security's Disability Determination Process

Under Social Security's disability guidelines, all claims for SSDI and SSI are processed with the following steps.

1. After you apply, a Social Security claims representative will contact you for a disability interview. Your interview will take place either in person at a Social Security field office or over the phone.

2. After the disability interview, the SSA representative will complete the appropriate paperwork and transfer your claim to a state agency (Disability Determination Services, or DDS), where it's assigned to a disability claims examiner.

3. The claims examiner will review your claim and decide your case. To do this, the examiner will begin the process of gathering your medical records by contacting your doctors' offices and any hospitals where you've been treated. This process can take weeks or even months.

4. After gathering your records, the examiner will work with a medical consultant (a doctor or a psychologist, or both, assigned to the examiner's work unit at DDS) to determine the following:

  • whether your symptoms and test results meet or equal the requirements of a disability listing
  • the nature of your past work, including the related work skills
  • the nature and extent of your mental or physical limitations
  • whether you can return to your past work with your current mental or physical limitations, and
  • whether you can perform other types of work (using the SSA's medical-vocational grid rules if you're 50 years old or older).

If the claims examiner agrees that you can't perform your past work and you can't perform, or learn to perform ("adjust to," in Social Security terms), some other type of work, the SSA will determine that you're disabled and eligible to receive Social Security disability benefits.

Important Factors in the Disability Determination

The two most important things in a disability case are your medical records and work history.

Medical records are key to proving a case. Your medical records should contain both objective evidence like test results but also your doctor's subjective opinion on the specific tasks you can and can't do. When you apply, you should describe in great detail the history of your medical treatment, including contact information for your doctors (and psychologists or therapists).

Your work history can also play a significant role in the outcome of your case because whether Social Security believes you can still do your prior job depends on what skills and functions it requires. For this reason, you should provide complete and detailed information regarding your work history on your work activity questionnaires.

The claims examiner will also consider the skills involved in your previous job when deciding whether you can be expected to do another type of job. For more information, see our section on how Social Security decides if you can do past work or other work.

Social Security Disability Guidelines Allow You to Get Help With Your Claim

Although the basic disability application process is fairly straightforward, how you approach each requirement can make a difference in your chances of winning your case. That's why the Social Security disability guidelines allow you to get outside help throughout the process. You have the right to hire a disability advocate—a disability lawyer or non-lawyer representative—to help you throughout the SSDI or SSI claims process.

A disability advocate has expert knowledge of Social Security's application and appeal guidelines and can help you build your strongest case. And your chances of winning your claim are better if you work with a disability advocate (either lawyer or non-lawyer rep). Learn more about how to decide if you need to hire a disability advocate to help with your claim.

Updated August 10, 2022

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