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Published on June 17, 2023

Social Security Disability Benefits: Eligibility and Legal Process

Social Security Disability Insurance is an indispensable lifeline for millions of Americans living with disabilities. It might be the only hope for thousands more like you or a recently incapacitated loved one. It is, therefore, essential to confirm your eligibility and the legal process of addressing claim denial if it unfortunately happens.

The Social Security Administration clearly defines the qualifying criteria on its website. In summary, you must have worked jobs covered under the Social Security Authority and sustained a disability lasting more than one year or ending in death. In case your claim is denied, you can appeal the decision with the help of a disability attorney.

Eligibility for Social Security Disability Benefits

There are generally two steps to satisfying the qualification criteria. One, you must have worked jobs covered under social security for specified durations, known as quarters, explained under Disability reference number EN-05-10029 on their website. Two, you must have a medical condition that fits the SSDI definition of disability.

1. Are You Working?

If you were working and your average earnings revolved around a certain amount, for example exceeding $1,470, then you aren’t eligible. This is determined by the Disability Determination Services. You can find more information on the SSA website under publication reference number EN-05-10003.

2. Do You Suffer From a “Severe” Condition?

The cut point is that the condition should severely limit your ability to carry out basic work-related activities like sitting, walking, lifting, standing, and power of recall for at least a year. Remember that your condition or disability should be debilitating, meaning you can’t work any job.

3. Is Your Condition on the List?

The SSA lists severe conditions that qualify for social disability benefits. You must have any of them or something similar to make the cut. The medical condition must be tough enough to prevent you from meeting the required work quarter or SGA. Some conditions under the Compassionate Allowances, like pancreatic cancer and acute leukemia, qualify automatically.

4. Can You Handle Your Previous Job?

Your medical impairment should keep you from working your previous job even at a reduced capacity. If you can handle it, you are disqualified from receiving social benefits because your condition doesn’t qualify as a disability.

5. Can You Find Alternative Employment?

If you cannot do your previous job, can you successfully handle a different one and earn some income? Is there another job you can handle despite the medical impairment? If not, you qualify for SSDI benefits. They consider your age, education, medical condition, and work experience when making the decision.

Legal Process After Claim Denial

According to the SSA, only 38% of first-time applicants qualify to receive social security benefits. Below is a legal process to follow if your claim gets denied.

 File for Reconsideration

You have approximately three months from the day of the first-time application denial to file for reconsideration. Ensure you rectify the things SSA listed in their response before seeking redress. Ensure you have a disability lawyer to help with the appeal.

Book a Hearing With an Administrative Law Judge

You can take the matter before an administrative law judge if your reconsideration claim is denied. The judge will review your case after questioning present medical experts and witnesses. Finally, the judge may overturn or uphold SSA’s decision or uphold it.

Submit New Medical Evidence

In case of a misdiagnosis, you can present the new findings from a different physician to the SSA when appealing their decision to deny your first claim. This gives the determiners and evaluators more reasons to grant your social disability benefits. Of course, one could say that finding a truly trustworthy doctor will help avoid a misdiagnosis–but this is still not a guarantee that you’re completely safe from being misdiagnosed. 

Secure a Doctors’ Testimonial

A doctor’s evaluation carries a lot of weight in assessing your case. If the SSA denies your initial application, have your doctor fill out and submit a revised residual functional capacity form. This validates your worsening or new medical issues. You can also present official documentation of your condition to the SSA to reinforce your belief that it is severe enough to warrant financial support.

Legal Consultation and Representation

Whether you are a first-time applicant or appealing a decision, having a legal mind working for you is always wise. Having a seasoned disability attorney on your team maximizes your chances of success.

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