The Social Security Administration (SSA) oversees two programs that provide disability benefits to U.S. residents. The Social Security Disability Insurance (SSDI) program pays disability benefits to individuals who have contributed to the Social Security trust through income taxes. The Supplemental Security Income (SSI) program is different in that it provides benefits to disabled individuals who have limited income and resources.
SSDI and SSI eligibility is determined by looking at medical criteria defined in the Blue Book (Officially: Disability Evaluation Under Social Security). The list of impairments includes most common medical conditions that are severe enough to keep an individual from working. If an individual matches the requirements or is diagnosed with an impairment that is listed, they may qualify for SSDI benefits. However, determining eligibility is more complicated. SSDI pays benefits to people who are unable to work for at least one year.
The law defines disability as the inability to engage in any Substantial Gainful Activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.
The SSDI Blue Book is broken down into two main sections. Part A lists disability criteria that affect adults. Part B is dedicated to ailments causing childhood disabilities. Each of these parts are broken down further into sections such as Musculoskeletal System and then many sub-sections. The two newest sections for the adult category are Mental Disorders and Immune System Disorders.
How the Blue Book is Used to Determine Eligibility
The medical conditions listed in the Blue Book are used by government officials to determine if someone is eligible for SSDI benefits. Depending on the level of a claim, the decision-maker could either be a disability examiner or a federal administrative judge. Administrative judges only hear disability cases if legal matters are involved.
Social Security Disability Insurance claims are not approved only because an impairment is listed in the book. Many medical conditions are not listed in the Blue Book. The length and severity of an ailment is also a consideration in determining medical eligibility. This is where the medical documentation from your health care provider becomes critical.
How to File a Social Security Disability Insurance Claim
To file a claim for SSDI, individuals submit a claim form online, in-person or by mailing in a paper application. The application process can be tedious and requires a lot of personally identifiable information such as…
- Your birthdate and place of birth
- Your Social Security Number (SSN)
- Full name, birthdates and SSNs for current/former spouses
- Dates and places of marriage and/or divorce
- Banking information
- Name, address and phone number of medical provider
- Detailed information about your medical illnesses, injuries, etc. – including patient ID number, dates of treatment, medications and medical tests
- Current income information
- Name and address of your current and previous employers
Social Security Disability Insurance Documentation
In addition to the information above, an applicant will also need to provide documentation such as a birth certificate (only originals are accepted) and photocopies of other documents like pay stubs, W-2 forms (or tax returns if self-employed), etc.
Unfortunately, from 2006-2015, only 34% of SSDI claimants were approved – and over 10% of those were only approved after a reconsideration or appeals process. The SSA is a busy organization! It can take anywhere from three to five months for an application to be reviewed and decided. Individuals applying for SSDI should have savings or other resources available to cover expenses like rent/mortgage, utility bills and groceries.
To learn more about SSDI, visit The Social Security Administration website.