What wins Social Security Disability Benefits?

Let's be honest: The name of your disability impairment does not mean an ultimate win for your SSDI case. There are various factors that can win or lose disability cases.

Each year approximately 64 million people apply for disability – out of those only 30% of the DI claimants actually win the disability benefits. This means that only about one third of the total disability claimants ultimately win their SSDI benefits application. At most times, it's not the particular impairment/disability or medical condition that wins the disability claim – in fact, the Social Security Administration determines a DI claimant's eligibility based on various medical and non-medical requirements, including the residual functional limitations.

According to a research by the Centre on Budget and Policy Priorities, an average American has a 1/3^rd chance of dying or qualifying for Social Security disability benefits before they reach their retirement age. However, it is important to state that the Social Security Disability Insurance program is more than just a retirement program – it provides hope and vital support in terms of monthly benefits paycheck to claimants who are unable to work under Substantial Gainful Activity (SGA) due to serious and long-lasting medical disabilities/impairments or conditions. Also, it can take years to get approved for disability, therefore, the SSA has not only a rigorous process for evaluation of disability eligibility in order to choose the most deserving but it also has a periodic review process to make sure that those on the receiving end of the disability paychecks are actually unable to do substantial work and provide for themselves.

The Disability Periodic Review

While evaluating an SSDI application for benefits approval, the SSA has initiated a continued disability review also known as the disability periodic review. So, even if a claimant has secured disability payments, the people who will actually keep on receiving these benefits will be in the last (that is medical improvement not expected) of the three categories of the periodic review:

• - Medical Improvement Expected (every six to 18 months),
• - Medical Improvement Possible (every three years) and
• -Medical Improvement Not Expected (every five to seven years)

However, since there is no sure fire way (medically) to determine 100% that a person's impairment is not possible forever nor any scientific way to determine that a person may recover totally, the SSA relies heavily on either its own doctors' opinion or through a written statement by a supportive doctor that the disability claimant is seeking the treatment from, for their disability.

SSDI benefits are earned

The Social Security benefits are earned benefits that provide extremely vital blanket for people on the verge of poverty and unemployment due to their inability to perform substantial gainful activity. Moreover, the SSDI benefits are earned and provide vital protection to workers through their payroll tax contributions in FICA taxes. To-date, almost 156 million workers have earned SSDI benefits due to a long-lasting impairment and today 8.5 million are on monthly disability paychecks based on disabled worker benefits from SSDI.

Listed Medical Conditions

The Social Security Administration has a list of all kinds of medical impairments and disability conditions in its Blue Book (with 200+ medical conditions) that it considers as eligible for the SSDI payments. However, if a DI claimant does not meet a condition directly, but is able to prove that their disability has functional limitations, then they may also qualify for SSDI. For example, a person with a knee problem might not qualify as it is not listed in the Blue Book of SSA, however, if that DI claimant has a degenerative disk disorder or arthritis in their back as a functional limitation arising from that knee problem, will be eligible for disability benefits. Similarly, having a congestive heart disease will not mean that you will automatically qualify for your disability benefits. Instead, in order to be eligible, a DI claimant will need to prove to the SSA that the congestive heart failure has had and will probably have functional limitations such as abnormal stress test results (for instance ETT tests), ischemic episodes or abnormal imaging results post-surgery.

Inability to Work

Although benefits will not stop immediately if a DI claimant wants to return to work, they will be evaluated for continued disability review to make sure that they are indeed unable to do any kind of substantial employment exceeding the grace periods of time for employment under Trial Work Period and the Ticket to Work program.

Good Medical Records

Needless to say, if a person has good medical records backing up their disability application, they will have an increased chance of getting approved. The SSA requires a DI claimant's SSDI application to be backed up by strong medical evidence and documents including all possible medical tests performed, details of any treatments taken, treatments that worked and that didn't, how the condition affects a claimant's daily functioning and possibly a written statement by the claimant's physician or doctor stating the residual limitations.

Work credits

In addition to all above, a DI claimant must have enough work credits to qualify for SSDI. You can read more on this here. 

Lastly, in our work in helping disability claimants applying for SSDI we also found that qualifying for disability had increased chances of winning if a person had quitted work before applying. Being represented by a lawyer was also vital in winning. Additionally, some other factors may be considered for instance age, gender, etc. For more information on whether you qualify, or need help in applying for your SSDI application, you can seek consultation of our social security disability attorneys here.