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Definition of disability for eligibility for SSDI or SSI

Anyone who gets a serious injury that keeps them from working should investigate whether they may be eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) through the federal Social Security Administration (SSA). These benefit programs use a unique definition of “disability” different than those used in workers’ compensation or private disability insurance policies.

SSDI and SSI

SSDI is a government-administered disability insurance program that people fund through their payroll deductions. Just as deductions are made for Social Security retirement benefits, credit is also given toward disability – should an otherwise eligible person become disabled from working before eligible for retirement benefits.

First, an SSDI applicant must meet work history requirements – basically, they must have worked recently enough and enough over time to meet program criteria. Because as a person works, they continue to pay into the program, they “earn” coverage in this way.

Second, they must be disabled. The law says that an applicant is disabled for SSDI and SSI purposes if they have a severe, medically determinable physical or mental impairment (or combination of impairments) that is expected to last continuously for at least a year or result in death, and that prevents them from engaging in substantial gainful activity (SGA).

The same definition of disability is used as part of eligibility for SSI, which is a federal welfare program for people who have limited assets and income and are disabled, blind or over age 64.

The five-step process

The agency uses a five-step analysis of every applicant to determine whether they are disabled from working. The sequential evaluation process asks:

  1. Is the claimant working, or engaging in SGA? A claimant may earn a small amount monthly and still not be considered working because it’s not “substantially gainful.” If yes, then not disabled. If no, go to step 2.
  2. Is the claimant’s impairment (or combination of impairments) severe? If no, then not disabled. If yes, go to step 3.
  3. Does the impairment (or combination of impairments) meet or equal an impairment on the agency’s official listing of impairments that automatically mean the claimant is disabled if they have one? If yes, then disabled. If no, go to step 4.
  4. Can the claimant perform past relevant work (PRW)? If yes, then not disabled. If no, go to step 5.
  5. Is there other work the claimant can perform despite their impairment, considering their limitations from their medical conditions, education, work experience and age? If yes, then not disabled. If no, then disabled.

This is an introduction to the concept of disability in federal Social Security programs. A claimant who is denied benefits after their initial application may request review and appeal at several steps. An attorney can provide significant assistance with an SSDI or SSI claim at any stage of the process.

The attorneys at The Townsley Law Firm in Lake Charles, Louisiana, represent SSDI and SSI claimants in the surrounding parishes, across the state, in Texas and nationwide in their applications and appeals for benefits.

 

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