SSDI & SSI: Definition of 'Disabled'

What happens after you file a Social Security disability claim with the Social Security Administration (SSA)? How does the Social Security Administration decide if you're disabled? Read on for more information about how the SSA defines disability and reaches disability determinations.

Basic Eligibility Requirements

The first step is for the Social Security Administration to make sure you meet all basic non-medical eligibility requirements. These include things like income, resources, and residency. 

For either program, the Social Security Administration will find you do not meet eligibility requirements if you earn “substantial gainful activity" amounts, whether or not by full-time work. This amount is $1,470 in 2023.

The Social Security Administration's Definition of "Disabled"

The definition of "disabled" under the Social Security Act is the inability to engage in any work because of physical or mental impairment. This physical or mental impairment must have lasted or last for a continuous period of at least 12 months or be expected to result in death. This is called the duration requirement.

Remember that the Social Security disability programs cover only total disability. They don't pay partial disability or short-term disability benefits. If the Social Security Administration finds a claimant disabled, the claimant may receive the following additional perks beyond the monthly benefits:

Social Security Disability Insurance

• Possible benefits to certain family member beneficiaries, including dependents

• Converted payments to retirement benefits when the claimant reaches retirement age

• Eligibility for Medicare health care after a qualifying period of 24 months

Supplemental Security Income

• Eligibility for Medicaid, which helps pay for medical treatment

• Eligibility for Supplemental Nutrition Assistance Program (SNAP), formerly food stamps, which helps buy food. You may contact your local Social Security Office for more information

How the Social Security Administration Makes Disability Determinations

After the Social Security Administration finds that you meet basic eligibility requirements for Social Security disability benefits, the Social Security Administration will send your case to a state agency. This agency is called the Disability Determination Services (DDS). The DDS will review your case to make sure you meet all the medical program eligibility requirements. This is done by following a sequential evaluation process:

• The DDS first considers whether your impairment is “severe." A “severe" impairment is one that significantly limits your physical or mental ability to do even basic work activities. These activities may include sitting, walking, pushing, using judgment, or dealing with changes in a work setting. Your impairment must also meet durational requirements.

• If the DDS finds that your impairment is “severe," it will consider whether it “meets or equals" one of the impairments in the Social Security Administration's Listing of Impairments. The Social Security Administration finds these impairments so severe that if you have one and it meets certain criteria, the DDS determines you cannot engage in substantial gainful activity and makes a finding of disability.

• If the DDS finds your impairment doesn't “meet or equal" a listing, it will consider whether you can do your prior work. If you can still perform your prior work with your medical condition, the DDS will deny your claim. But, if you cannot, the DDS will move on to the last step.

• Sometimes a person who cannot do the work they did in the past may still be able to adjust to other work. The Social Security Administration will consider your limitations resulting from your medical conditions, age, education, past work experience, and any transferable skills you may have. If these factors allow you to adjust to other work, the Social Security Administration won't consider you a disabled worker. If you cannot adjust to other work, you may be considered disabled.

Disability Determination Services makes your initial disability determination. The Social Security Administration sends you a letter with the decision. It usually takes between three and six months for an official decision. If you are found not disabled, you can appeal the decision by filing a request for reconsideration.

Special rules apply if you are blind or have low vision, if you are a worker's widow, widower, or dependent, a disabled child, or a wounded warrior or veteran. You may find more detailed information by visiting the Social Security Administration's website.

Does Your Disability Qualify You for SSI/SSDI Benefits? An Attorney Can Help

The Social Security claims process can be daunting. But it doesn't have to be. A legal professional with insurance benefits experience can help determine your eligibility for SSDI/SSI benefits. A disability representative may help resolve any issues that may arise with your claim. If you have further questions about whether you qualify as a disabled individual, it may be beneficial to contact a Social Security disability attorney today.