Disability Claim Process

Social security disability claim

Social Security Determining Qualifications

If you become disabled, then you generally need the following:

  • In or before the quarter you turn age 24 – 1.5 years of work during the three-year period ending with the quarter your disability began.
  • In the quarter after you turn age 24 but before the quarter you turn age 31 – Work during half the time for the period beginning with the quarter after you turned 21 and ending with the quarter you became disabled.
    Example: If you become disabled in the quarter you turned age 27, then you would need three years of work out of the six-year period ending with the quarter you became disabled.
  • In the quarter you turn age 31 or later – Work during five years out of the 10-year period ending with the quarter your disability began. Plus an additional 5 years of previous work.

How the Decision is made by Social Security Administration

There is a five-step process to decide if you are disabled.

Are you working?

If you are working and your earnings average more than a certain amount each month, you generally may not be considered disabled. The amount changes each year. If you are not working, or your monthly earnings average the current amount or less, the state agency then looks at your medical condition.

Is your medical condition “severe”?

For the Texas state agency to decide that you are disabled, your medical condition must significantly limit your ability to do basic work activities—such as walking, sitting and remembering—for at least one year. If your medical condition is not that severe, the state agency will not consider you disabled. If your condition is that severe, the state agency goes on to step three.

Is your medical condition on the List of Impairments?

The state agency has a List of Impairments that describes medical conditions that are considered so severe that they automatically mean that you are disabled as defined by law. If your condition (or combination of medical conditions) is not on this list, the state agency looks to see if your condition is as severe as a condition that is on the list.

If the severity of your medical condition meets or equals that of a listed impairment, the state agency will decide that you are disabled. If it does not, the state agency goes on to step four.

Can you do the work you did before?

At this step, the state agency decides if your medical condition prevents you from being able to do the work you did before. If it does not, the state agency will decide that you are not disabled. If it does, the state agency goes on to step five.

Can you do any other type of work?

If you cannot do the work you did in the past, the state agency looks to see if you would be able to do other work. It evaluates your medical condition, your age, education, past work experience and any skills you may have that could be used to do other work.

If you cannot do other work, the state agency will decide that you are disabled. If you can do other work, the state agency will decide that you are not disabled.

Special Disability Claim Rules for the Blind

There are a number of other special rules for people who are blind. If you are blind, special rules apply that allow you to receive benefits when you are unable to work.

Benefits are paid to people who are blind under two programs: the Social Security disability insurance program and the Supplemental Security Income (SSI) program. The medical rules used to decide whether you are blind are the same for each program. Other rules are different. The different rules for each program below are described below.

You may qualify for Social Security or SSI disability benefits if you are considered “legally blind.” You may be considered to be legally blind if your vision cannot be corrected to better than 20/200 in your better eye, or if your visual field is 20 degrees or less in your better eye.

If your vision does not meet the legal definition of blindness, you may still qualify for disability benefits if your vision problems alone or combined with other health problems prevent you from working.

For Social Security disability benefits, you also must have worked long enough in a job where you paid Social Security taxes. For SSI payments based on disability and blindness, you need not have worked, but your income and resources must be under certain dollar limits.

SSI Disability Claim Decision

When the state agency reaches a decision on your case, you will receive a letter. If your application is approved, the letter will show the amount of your benefit and when your payments start. If your application is not approved, the letter will explain why and tell you how to appeal the decision if you do not agree with it.

If you disagree with a decision made on your claim, you can appeal it.

Next Steps Upon Disability Claim Approval

If your application is approved, your first Social Security disability benefits will be paid for the sixth full month after the date your disability began.

Here is an example: If the state agency decides your disability began on January 15, your first disability benefit will be paid for the month of July. Social Security benefits are paid in the month following the month for which they are due, so you will receive your July benefit in August.

Monthly Disability Benefit Determination

The amount of your monthly disability benefit is based on your average lifetime earnings. The Social Security statement that you receive each year displays your lifetime earnings and provides an estimate of your disability benefit.

It also includes estimates of retirement and survivors benefits that you or your family may be eligible to receive in the future. If you do not have your Social Security statement and would like an estimate of your disability benefit, you can request one at www.socialsecurity.gov or call the toll-free number, 1-800-772-1213.

Disability Benefits for Your Family

Certain members of your family may qualify for benefits based on your work.

They include:

  • Your spouse, if he or she is 62 or older;
  • Your spouse, at any age, if he or she is caring for a child of yours who is younger than age 16 or disabled;
  • Your unmarried child, including an adopted child, or, in some cases, a stepchild or grandchild. The child must be younger than age 18 or younger than 19 if in elementary or secondary school full-time; and
  • Your unmarried child, age 18 or older, if he or she has a disability that started before age 22. (The child’s disability also must meet the definition of disability for adults.)

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