What Disqualifies a Person from Qualifying for Disability?

Submitted by Eric on

You may believe that because you have a serious medical condition that prevents you from going to work that you will automatically qualify for disability benefits. 

However, there are some things that will disqualify someone from being eligible for disability benefits. These could be the time your medical condition lasts is less than 12 months, your medical condition doesn’t appear in the Social Security Administration (SSA) blue book list of eligible medical conditions, you are still earning a living which is over the SSA’s threshold for eligibility for disability benefits and for SSDI you may not have accumulated sufficient work credits to qualify. 

Social Security Disability Requirements For Adults

To qualify for Social Security Disability Insurance (SSDI) benefits as an adult, you must meet the following requirements that are determined by the Social Security Administration (SSA).

  • You have a medical condition that can be found in the SSA’s blue book listings of qualifying medical conditions.
  • You are unable to work for at least 12 months because of a diagnosed disabling medical condition.
  • You are not permitted to work and take part in substantial gainful activity (SGA) because of your medical condition. You cannot undertake work you did earlier or adjust to any other kind of work because of your medical condition.
  • You should respond quickly to any communication you receive from the (SSA) otherwise your application could be delayed.
  • You are prepared to wait up to 5 months before your application is approved;
  • You need to have worked long enough and recently enough to qualify for disability benefits and have accumulated enough work credits for the time you have worked. The number of work credits you need to qualify for disability benefits depends on your age when your disability commences. Normally you will need 40 credits, 20 of which should have been earned in the past 10 years which ends in the year your disability begins. However, younger workers may still qualify with not so many work credits.
  • If your initial claim for disability benefits is denied you should be prepared to file an appeal which gives you a second chance to win your claim for disability benefits.

How to Apply For Disability Benefits

As long as you have gathered sufficient medical evidence that proves you are unable to work, and you have the number of work credits required to qualify, you can file a claim for disability benefits. What the Social Security Administration (SSA) wants to know from your disability benefits application is if your disability prevents you from working and earning a living. The sorts of medical evidence you should use to support your claim include results of medical tests such as blood and urine tests, X-rays, Magnetic Resonance Imaging (MRIs), Computerized Tomography (CAT) scans, and ultrasounds. In addition to these tests, you may also need to include a recent report from your physician describing your diagnosis and its symptoms which prevent you from working, the treatment you are receiving and its effects.

Before you begin the application process for Social Security disability benefits, you should have all of your medical evidence readily available so you can easily attach it to your application. 

How to File a Disability Benefits Claim

You can start the process of filing your disability benefits claim by visiting the SSA’s website (www.ssa.gov/disabilityonline) where you will be asked to enter basic information such as:

  • your name, address and Social Security Number (SSN);
  • dates of your employment, employers' names, and the type of work you performed;
  • your total income earned in each of the last 3 years;
  • the names of the doctor(s) and hospital(s) through which you sought treatment;
  • the sort(s) of medical treatment you were given;
  • information about any income you earned when you did not pay Social Security taxes;
  • information about any workers’ compensation awards;
  • your bank account details (for direct deposit).

If you find it too difficult to complete an online application, you can also apply over the phone or by arranging an in-person appointment at a local SSA office. 

Not Meeting a Blue Book Listing

To ensure you qualify for disability benefits your ailment needs to meet a blue book listing. The SSA has hundreds of medical conditions covered in the blue book.

You have to provide medical evidence to prove you meet the conditions listed in the blue book for your medical condition.  If you are unable to do this you can request that your doctor carries out a residual functioning capacity (RFC) assessment which shows what you are physically and mentally capable of doing.

If it is clear you don’t have the physical or mental capacity to work for at least 12 months you may be eligible for disability benefits.

Not Having Enough Work Credits

In order to qualify for Social Security Disability Insurance (SSDI) you need to have accumulated enough work credits. The number you need to qualify will depend how long you have worked. 

To be eligible for SSDI, you must meet a recent work test and a duration work test. The number of credits required to meet the recent work test will depend on your age.

Before age 24, you may be eligible if you have earned 6 credits in the 3 years ending when your disability began. From Age 24 to 31 years you could qualify if you have credit for working half the time between age 21 and the time your disability starts. If you are 31 years or older you usually need to have earned at least 20 credits in the 10 years just before your disability commenced.

Being Able To Work

If you can still work, then you may not qualify for disability benefits as one of the requirements for SSDI is not being fit enough to work for at least 12 months.

Making Too Much Money

To qualify for disability benefits, a person must not be able to engage in substantial gainful activity (SGA) earning up to a certain amount. If you are able to make more than the SGA, then you will not qualify. For 2024 the threshold is $1,550 per month. For an applicant who is statutorily blind the amount is $2,590.

Get Help With Your SSD Claim

It’s never easy to win an SSDI claim, but if you seek help from an attorney, he or she will ensure you have the right evidence to prove you are eligible and will work on your behalf to get the SSDI benefits. 

Once your application is submitted, you can also evaluate your chances of getting SSDI benefits by tuning into these signs your disability claim will be approved or denied.  

Curious what conditions automatically qualify you for disability? Click here to find out.

Additional Resources

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