Understand Social Security’s Definition of Disability

The SSA has a strict definition of disability. To qualify for SSDI or SSI, you must meet the following criteria:

• You cannot perform substantial gainful activity (SGA): The SSA will assess whether you are working and earning above a specific threshold. If you are able to work and earn over a set amount, you may not be considered disabled.
• You have a medically determinable condition: The SSA requires that your disability be verifiable with medical evidence, including a diagnosis from a doctor and test results.
• Your disability is severe and long-lasting: The condition must be severe enough to prevent you from working and must last for at least 12 months or be expected to result in death.

Gather Medical Documentation

The most important part of proving your disability to the SSA is providing detailed medical evidence. Without strong medical documentation, it’s unlikely your claim will be approved. Here’s what you need to do:

• Get a Diagnosis: You must have a diagnosis from a licensed healthcare provider, such as a primary care doctor, specialist, or rheumatologist. Your medical records should clearly show the severity of your condition.
• Provide Detailed Medical Records: Submit doctor’s notes, hospital records, test results, and any other documents that confirm your condition. This helps the SSA understand the full extent of your disability.
• Be Consistent with Treatment: Demonstrate that you have been following a consistent treatment plan, including medications, therapy, or other forms of medical care. Lack of treatment or inconsistent treatment could harm your case.
• Include Specialists' Opinions: If you are seeing specialists for your condition (e.g., pain management or mental health professionals), include their assessments and records as well.

Prove Your Ability to Work Is Impacted

The SSA needs to see that your disability severely impacts your ability to work. It’s not just about having a condition; you must show that the condition prevents you from working. This can be proven in several ways:

• Functional Limitations: You need to provide medical evidence that shows how your condition limits your ability to do basic tasks like sitting, standing, walking, lifting, or concentrating. This may be documented through medical reports or an RFC (Residual Functional Capacity) evaluation from your doctor.
• Work History: Your work history can help show how your condition prevents you from performing the type of work you did in the past. The SSA will look at the physical and mental demands of your previous jobs and determine if you are still capable of performing them.
• Daily Activities: The SSA may also ask about your ability to perform daily activities like cooking, cleaning, shopping, or taking care of personal hygiene. In some cases, a Functional Capacity Evaluation (FCE) or a work assessment may be necessary to provide more detailed evidence of your limitations.

Understand the SSA’s Five-Step Evaluation Process

The SSA uses a five-step process to determine if you are eligible for disability benefits. Here’s an overview of the steps:

• Step 1: Are you working? If you are working and earning above the Substantial Gainful Activity (SGA) threshold, the SSA will determine that you are not disabled.
• Step 2: Is your condition severe? Your condition must be severe enough to interfere with your ability to perform basic work activities (e.g., standing, walking, or lifting).
• Step 3: Is your condition on the SSA’s Listing of Impairments? If your condition is listed in the SSA’s List of Impairments, you may qualify for disability benefits automatically. If it is not listed, the SSA will determine if your condition is equal in severity to a listed impairment.
• Step 4: Can you do your past work? If your condition prevents you from doing your previous job, the SSA will move to the next step.
• Step 5: Can you do any other type of work? The SSA will assess if you can perform other types of work based on your age, education, and work experience. If not, they will approve your disability claim.

Prove That You Have No Ability to Do Other Work

The SSA will evaluate whether you can adjust to other types of work. This involves considering your age, education, and work experience. They’ll also consider how much physical or mental exertion the new job requires.

To improve your chances of proving that you can’t do other work:

• Provide Supportive Statements: Statements from your employer, co-workers, or family members can help show that you are unable to work due to your disability.
• Provide Opinions from Experts: Have your doctors provide detailed opinions on your ability to perform other types of work. This could include vocational experts or medical professionals who can offer insight into how your condition impacts your work ability.

Follow the Proper Application Process

To apply for SSDI or SSI, you must complete the application process accurately and submit all required documents. Missing information or errors can delay your claim. Here's how to apply:

• Apply Online: The quickest way to apply is through the SSA’s online portal. Be sure to provide accurate information about your medical condition, work history, and other relevant details.
• Apply in Person or by Phone: If you prefer, you can also apply in person at your local Social Security office or call their toll-free number for assistance.
• Submit All Required Documents: Include medical records, doctor’s reports, and any other documents requested by the SSA.

What to Do If Your Claim Is Denied

It’s common for initial claims to be denied, even if you have a valid case. If your claim is denied, you have the right to appeal. Here’s what you can do:

• Request Reconsideration: If your claim is denied, you can request a reconsideration by the SSA, where they’ll review your case again.
• Request a Hearing: If reconsideration is denied, you can request a hearing before an Administrative Law Judge (ALJ). This is a critical stage where you can present your case in person.
• Appeals Council: If the ALJ denies your case, you can appeal to the SSA’s Appeals Council for further review.