Many times there is a stigma about who receives Social Security benefits, but rarely do we discuss the difficult qualification process to receive benefits. It is not easy to qualify for Disability Insurance benefits and the Center on Budget and Policy Priorities released the following to show the stringent guidelines that must be met.
Eligibility criteria are strict, and most SSDI applicants are rejected. Applicants for SSDI benefits must be:
- Insured for disability benefits (essentially, they must have worked for at least one-fourth of their adult life and five of the last ten years).
- Suffering from a severe, medically determinable physical or mental impairment that is expected to last 12 months or result in death, based on clinical findings from acceptable medical sources.
- Unable to perform “substantial gainful activity” (any job that generates earnings of $1,220 per month for most people, $2,040 for blind people) anywhere in the national economy — regardless of whether such work exists in the area where the applicant lives, whether a specific job vacancy exists, or whether he or she would be hired.
Lack of education and low skills is considered for older, severely impaired applicants who can’t realistically change careers — but not for younger applicants. There is a five-month waiting period for SSDI, but Supplemental Security Income may be available during that period for poor beneficiaries with little or no income and assets.
SSA weeds out applicants who are technically disqualified (chiefly because they haven’t worked long enough) and sends the rest to state disability determination services (DDS) for medical evaluation. Applicants denied at that stage may ask for reconsideration by the same state agency, and then appeal to an administrative law judge (ALJ) at SSA. Roughly half of people who get an initial denial pursue an appeal.
Ultimately — if we follow a cohort of applicants to the end of their application and appeal process — fewer than 4 in 10 are awarded benefits. Among applicants who meet the program’s technical requirements, slightly more than half are found medically eligible for SSDI.
After The Decision
SSA monitors disability decisions at all stages of the process. SSA conducts ongoing quality reviews at all stages of the application and appeal process. Many reviews occur before any benefits are paid, thus reducing errors. Allowance rates at the initial application and reconsideration stages have been relatively stable over the last decade. However, allowance rates dropped noticeably at the ALJ stage from 2010 to 2014, as SSA strengthened oversight of hearings. (These allowance rates reflect decisions made in a particular year, on applications filed in different years, so they aren’t directly comparable to those derived from following a cohort of applicants through their entire process.)
Allowance rates remain higher at the ALJ stage than at the initial stage, however. This is partly because ALJs often see claimants whose condition has deteriorated in the 18 months or so since their application was turned down and whose application is better documented (typically with the help of an attorney) than at the DDS stage.
