What is a disability for purposes of eligibility for SSDI?

It does not seem like the question of whether someone is disabled from working and eligible for monthly Social Security Disability Insurance (SSDI) benefits should be a complex one. But the Social Security Administration (SSA) has its own definition of disability for purposes of SSDI (and Supplemental Security Income or SSI). The agency has a five-step process it utilizes to get to yes or no on the question of disability.

Definition of disability

SSA’s definition of disability is different from those used in other kinds of disability support programs like workers’ compensation, or short- or long-term disability insurance policies. For SSDI (or SSI) purposes, the definition of disability follows:

  1. Inability to make a meaningful amount of money: The claimant must be unable to engage in substantial gainful activity (SGA), meaning that they cannot have earnings more than a specific amount per month. The SGA amount in 2023 will be $1,470 per month for individuals who are not legally blind. Broadly, this means that the agency has determined that earning less than this is not enough for self-support.
  2. Medical impairment/s must cause the limits on working: The claimant’s inability to earn SGA must be caused by a physical or mental impairment, or the combined impact of all impairments.
  3. Impairments must be medically established: The impairments must be “medically determinable,” meaning that they are “anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques.”
  4. Impairments must be long term or result in death: The impairments must be expected to last for a continual 12-month period or be fatal.

Legal counsel can help to develop the case

An experienced attorney can assist an applicant in gathering all necessary or relevant financial or medical evidence to support the claim. Generally, reports, office notes, opinions and test results from the claimant’s treating medical professionals provide the strongest support, but it is important to consider whether there is sufficient medical proof of ALL impairments since the law requires that the SSA consider the impact of all impairments in combination.

The lawyer can assist the claimant evaluating any impairments not clearly established by treating doctors, review medications and notify SSA of upcoming medical appointments and scheduled tests.  The attorney can also discuss with the claimant what to expect if SSA has scheduled the claimant for a consultative examination.

The earlier an attorney becomes involved with an SSDI claim, the sooner the attorney can help develop the medical record before the agency, but a claimant can almost always submit evidence later in the process so bringing in a lawyer later is still a good idea.

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