The federal social security disability insurance program was established to protect workers no longer able to work and their dependents.  The program provides a monthly benefit for the disabled person and their dependents as well as providing Medicare to the disabled person after 24 calendar months of entitlement to social security disability payments.  The Supplemental Security Income program (SSI) is also available to those unable to work – even if they have never worked – with a modest monthly benefit ($794 for 2021) – and Medicaid health insurance benefits.   

While it might seem appropriate that securing these government benefits would be designed to be easy for the disabled, securing social security disability insurance and/or SSI benefits can often be challenging.  Here are the essentials to securing social security disability benefits.

File a claim for social security disability benefits with the social security administration

If you find yourself unable to work due to a mental or physical condition, don’t expect anyone from the federal government to come to your door with a social security disability application.  You must file the claim yourself.  A social security disability application can be filed at your local social security administration office (there are several in the Chicago metropolitan area and throughout the country).  Find your local social security office by entering your zip code at this social security administration web page: https://secure.ssa.gov/ICON/ic001.action#officeResults.  You can also file a disability application online at https://www.ssa.gov/benefits/disability/.

Many prospective disability applicants worry about filing “the right” disability application.  Realize, however, that you are not expected to know the details of disability program qualification: social security personnel are trained to take the appropriate disability claim.

Have sufficient “Quarters of Coverage” for Social Security Disability Insurance

Social security disability insurance is a social welfare “insurance” program you pay for through FICA taxes.  In general, social security disability insurance coverage requires working and paying FICA taxes for at least 5 of the 10 years prior to the disability.  SSI does not have a “quarters of coverage” requirement: you can have never worked and still get SSI.  SSI is no “easy money” program, however.  The monthly benefit is small and requires financial “need”.  Income, resources, or spousal income reduce the monthly disability benefit under SSI, so one must basically be indigent to qualify for the full SSI benefit. 

You must be “Disabled”

At the risk of sounding like “Captain Obvious”, both social security disability insurance and SSI require that you be disabled and unable to work.  But like most matters with the federal government, the term “disabled” is carefully defined, and not always what one might assume. 

Many workers assume that they are disabled for social security disability purposes if they can no longer work in what they “were trained to do”.  This is incorrect.  A 35-year old airline pilot with a heart condition that precludes a valid FAA license obviously cannot be a pilot.  But if she is able to work at McDonalds taking food orders our former highly skilled airline pilot may be shocked to learn she is not “disabled” under the Social Security Act. 

You Must Not be Working

Engaging in what social security calls “substantial gainful activity” is an absolute bar to disability benefits.  While you may be thinking that “Captain Obvious” has struck again, it is true many with very serious medical conditions continue to work simply because they have no other choice.  These conditions may be so serious that they would easily qualify for disability benefits but for the work; yet the substantial gainful activity will keep them from getting social security disability.

As noted above, the Social Security Administration defines working as engaging in “substantial gainful activity”.  Many are surprised to learn that “substantial gainful activity” can be part-time work: you can’t be assured that social security will not call your work “substantial gainful activity” just because it is no longer full time.  Social security does assume that monthly earnings below a given monetary threshold will not be considered “substantial gainful activity”.  For 2019 that monthly threshold is $1,220.  

As a matter of course, social security personnel often advise disability claimants that they “can make” up to $1220 a month.  Most experienced social security disability lawyers, however, know that any work activity – even if not “substantial gainful activity” – may weaken the strength of their client’s disability case.

You must be Disabled Due to a Bona-Fide Mental or Physical Condition

Your disabling condition must be a legitimate medical condition diagnosed by medical professionals and supported with medical evidence.  For example, a person without a medical diagnosis is unlikely to secure disability benefits.  Similarly a person claiming disability due to rheumatoid arthritis for whom diagnostic and laboratory tests do not support this diagnosis will likely be denied disability benefits.

Medical evidence also needs to support the severity of the disability alleged.  One claiming disability due to a back impairment with multiple levels of “severe” stenosis on radiography is much more likely to be approved for disability than one with radiographic evidence of only “mild” degenerative disease of the spine.

Disability Cannot be Due to Substance Abuse

You cannot receive social security disability insurance or supplemental security income if you are disabled because of alcohol or drug abuse.  The Social Security Administration applies a simple test to determine if substance abuse is causing your disability: if you would cease to be disabled if you ceased drug and alcohol abuse then you will not be eligible for social security disability benefits.  But the alcoholic with cirrhosis of the liver would likely be eligible for disability benefits even if she is still drinking because the liver damage has been done: stopping alcohol would not reverse the cirrhosis of the liver.

Prescribed Medical Treatment

As noted above, getting social security disability insurance benefits requires insured status, inability to do any work at all paying over $1,310 a month, and a legitimate diagnosed medical condition.  

Another important part of qualification for social security disability benefits is ongoing medical care for the disabling condition.  Failure to cooperate with medical treatment, such as disregarding medical advice or failing to take prescribed medications, makes it harder to win social security disability.