5 Chief Considerations When Determining Eligibility for SSDI Benefits

by | Published on Apr 10, 2019 | Medical Record Review

SSDI (Social Security Disability Insurance) and SSI (Supplemental Security Income) programs are designed to provide genuinely disabled or blind Americans with the economic support they need, and are major income sources for them. Medical chart review and analysis is an important step in disability determination, which in turn increases the significance of medical review solutions. It is not easy to qualify for disability benefits and many people turn to private disability insurance. What makes it difficult to be eligible is the SSA (Social Security Administration)’s strict definition of disability.

To be considered disabled, you must be unable to do any substantial work due to your medical condition, and your medical condition must have lasted or is expected to last at least one year or result in your death. For children to meet the disability definition, the child must have a physical or mental condition that seriously limits his/her activities; and the condition must have lasted or expected to last at least one year or result in death.

  • To be eligible for SSDI, you must have worked and paid taxes to Social Security for a sufficient period of time. In addition, you must be the insured worker or the worker’s adult child or widow(er), meet SSA’s medical disability criteria, and not be performing any substantial work as defined by the SSA.
  • To be eligible for SSI based on a medical condition, you must have little or no income or resources; be a US citizen or meet the requirements for non-citizens; meet SSA’s medical disability criteria and must not be performing any substantial work as defined by the SSA.

Let us now consider in some detail the 5 things that the Social Security Administration would consider to determine if you should receive social security disability insurance.

1. Are you working when applying for SSDI benefits? If you are working and earning enough to support yourself, you may not qualify for the benefits. The income limit may change from year to year, and in 2019 if you earn more than $1,220 a month, you will not qualify for disability benefits.

2. How severe is your impairment? Your condition must be severe enough to restrict you from working. Disabled individuals are unable to work, or unable to complete the tasks they normally would have before their disability.

3. Is your disability/impairment included in the SSA’s Listing of Impairments? All disabilities do not qualify for disability benefits. If your specific disability is recognized by the SSA, you may qualify for benefits provided you meet the specific requirements of the condition required by the SSA.

Social Security would then determine if you are eligible for “compassionate allowance” – i.e. whether your case is one that qualifies for the benefits as soon as diagnosis is confirmed

Whether your case is a quick disability determination case wherein a computer program screens the information provided and decides whether it is accurate.

4. Can you do the work you used to do earlier? If your disability does not come under SSA’s Listing of Impairments, you must prove that the condition is so severe that it limits your ability to work. The SSA would then approve your disability claim.

5. Can you perform other types of work? In case you are unable to perform the tasks you were doing earlier, the SSA would want to know whether you can do any other type of work, or whether you can work if some changes are made to the way you work. The SSA would consider factors such as your medical condition, age, education, your past work experience, and transferable skills that could follow you to a new job. If you are found to be able to do other types of work, you will not be considered disabled.

It is best to apply as soon as you become disabled, because the disability claim processing can be long drawn out. Medical evidence would be requested from your doctors, hospitals and other institutions that provided the treatment, and a medical record review would be conducted to determine your medical eligibility for disability benefits. The SSA would request information such as what your medical condition is and how it began; how your medical condition limits your activities; what the medical tests have shown, and what treatment you have received. In addition, they may also ask the doctors for information regarding your ability to do work-related activities such as sitting, walking, lifting, carrying, and remembering instructions. In case they need additional information, the SSA will arrange for special examinations at no cost to you. If you disagree with the decision made by the SSA, you have the right to appeal the decision by sending a request in writing to the Social Security office so that it reaches there within 60 days of the date you received the letter containing the SSA’s decision.

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