Social Security Disability Benefits: Who Is Eligible?

When facing a severe illness or injury, the last thing a person needs is the stress of wondering how the bills will be paid. In the event of long-term illness or injury, lasting at least one year, the Social Security Administration provides disability benefits for eligible candidates to ease the financial burdens of those who are unable to work.

Not everyone who is unable to work due to illness or injury is entitled to Social Security disability benefits. Only those who the SSA determines to be suffering from long-term, severe disabilities (unable to work for more than 365 days) may receive benefits. Generally, the SSA considers a disability to be short-term when it is not expected to last beyond a year.

That is, however, only one aspect of the required showing. To determine whether an applicant is eligible to receive benefits, the SSA employs a five-step process. If at any point in the evaluation an individual is confirmed as disabled or rejected as not sufficiently disabled, the process is complete and no further analysis will be applied to the application.  

Step One: Employment and Monetary Considerations

The first thing the SSA considers is an applicant’s employment situation and income. Generally, the SSA will not find an applicant who is able to work in some capacity and earns more than about $1,000 a month to be disabled.

Step Two: Determination of Severity

If the applicant’s income falls under the wage cap, the applicant must then demonstrate that he or she has a medical condition that may affect the ability to work.

Step Three: Consulting the List of Disabling Conditions

If the applicant’s condition does impair the ability to work, the SSA then evaluates whether the specific condition constitutes an eligible impairment. The SSA maintains a list of severe conditions, such as malignant brain tumors, severe epilepsy and paranoid schizophrenia. If the applicant’s condition is among the listed conditions and they satisfy all of the criteria of the listing, or the condition is deemed equally severe to the listed disabilities, the applicant is deemed disabled for purposes of obtaining social security benefits.

However, not every person who ultimately receives benefits has a listed condition. If an applicant’s condition is not included in the list of qualifying disabilities or equal to such a disability, the applicant is not necessary ineligible for benefits. It simply means that the analysis must continue.

Step Four: Ability to Perform Previous Work

If the SSA finds an applicant’s condition to be sufficiently severe, but not equal to those on its list, evaluators will consider whether the condition prevents the applicant from doing the work he or she performed in the last 15 years. If the applicant remains able to perform such work despite his or her condition, evaluators will find the applicant ineligible for benefits. If the applicant can no longer perform previous work due to disability, the evaluators will move to the final step of the evaluation process.

Step Five: Ability to Perform Alternative Work

If an applicant’s condition prevents him or her from performing the kind of work he or she previously performed, evaluators will consider whether the applicant can adjust to alternative work. To deny benefits, the SSA must prove that an applicant could sufficiently adjust to other gainful employment. If instead, an applicant’s condition, age, education, past work experience and transferable skills demonstrate that adjustment is unlikely, the applicant will be granted disability benefits.

Special Situations

Some applicants may be eligible for expedited or special consideration by the SSA:

• Military members who became disabled while on active duty or after October 1, 2001 are eligible for expedited processing of their disability benefits application
• Legally blind applicants are allowed a greater wage cap limit for the purposes of the first step of the benefits analysis
• The process for obtaining benefits for a disabled child is different than the process used for adults

For Further Reference

Attempting to navigate the Social Security system while you or someone you care about is battling a disability can be a challenging and frustrating experience. If you have questions about Social Security disability benefits, please contact an experienced social security disability benefits attorney.