Tuesday, January 22, 2008

Who is eligible for Social Security Disability or SSI Disability?

Regarding the issue of who is eligible for social security disability or SSI disability, there are two ways to approach the issue. And by that, I mean the medical requirements to become eligible for disability and the non-medical requirements to become eligible for disability.

For SSD (social security disability benefits), the non-medical aspect of eligibility revolves around SGA. What is SGA? SGA is substantial gainful activity. It is defined as the amount a person may earn each month while still remaining eligible to either apply for disability benefits, or continue receiving benefits if you have already been approved. For more information on this topic, please visit this page: SGA, substantial gainful activity.

For SSI (supplemental security income), the non-medical aspect of eligibility involves SGA as well. However, it also involves resources. For the purposes of the social security administration, "resources" means the same thing as assets. To be eligible to apply for SSI or receive SSI benefits, a person cannot have more than two thousand dollars in countable assets. This would include money in a savings account, cash value in a life insurance policy, excess vehicles (cars other than the one you use for primary transportation), and excess real property (any real property other than the home you live in).

The non-medical aspects of a disability case are handled by the social security office where you initially file for disability. When it comes to the medical aspects of a disability case, however, this part of the process is handled by two different types of decision-makers.

At the disability application and request for reconsideration (this is the first appeal) levels, the individual who determines whether or not a person is eligible for social security disability or SSI is a disability examiner. This individual will gather a claimant's medical records, read and review them, and, then, in consultation with medical and mental experts assigned to his or her unit, will render a determination that is either an approval or denial.

At the disability hearing level, the the individual who determines whether or not a person is eligible for social security disability or SSI is a disability judge. He performs a similar function to a disability examiner, but, unlike a disability examiner, will actually meet the applicant and his attorney. He will typically question the claimant regarding his or her medical history and work history to determine if the claimant has the ability to return to their past work, or the ability to perform some other type of work.

To be eligible for social security disability or SSI, a person must satisfy the definition of disability that is used by the social security administration. And this means that their medical evidence must prove that:

1. They have a condition, physical or mental, that is severe.

2. Their condition must limit their ability to work.

3. Their condition must prevent them from either being able to work at all, or, if they can work, it must limit them to the extent that they cannot earn the SGA amount for that given year.

4. Their disability must already have lasted for one full year, or it must be projected that their disability will eventually last at least one full year.

A person who satisfies these conditions will be eligible to receive social security disability or SSI disability benefits. Of course, this definition makes it plain that a claimant must be able to present satisfactory medical record documentation, preferably including detailed statements from one or more treating physicians who can cite the claimant's functional limitations and inability to sustain employment.

Return to the Social Security Disability SSI Benefits Blog