Close up of approved Social Security Disability Claim Form. How to prove you can't work.

To qualify for Social Security Disability Insurance (SSDI), you must show proof that your injury or disability is preventing you from performing your normal work duties. Understanding how to prove you can’t work can help you build a successful case and gain approval for the benefits you need.

Who Can Apply for SSDI (Social Security Disability Insurance)?

In Illinois, if you become disabled from an illness or injury and can no longer work, you are entitled to file a claim for Social Security Disability Insurance (SSDI) through the Social Security Administration (SSA). However, you must qualify for benefits based on strict SSA guidelines, so it is important to know how to prove you can’t work to collect SSDI benefits.

To qualify for SSDI, you must show proof of the following:

  • Your illness or injury is preventing you from doing your job
  • You expect to be out of work for at least one year
  • Your job is covered by Social Security
  • You have earned sufficient work credits based on a taxable work history
  • You have medical records showing a disability prognosis
  • Your medical condition meets Social Security’s definition of a disability

If you prove you can’t work, meet all the SSA requirements, and your SSDI claim is approved, SSA will award you payment for total disability only. SSA does not pay benefits for short-term disabilities or partial disabilities. The amount of your monthly disability benefit payment will be based on your Social Security earnings record and paid for up to one year, or until you can work again on a regular basis.

After receiving disability insurance benefits for two years, you will automatically get Medicare coverage. If you are receiving SSDI benefits when you reach full retirement age, your disability benefits will automatically convert to retirement benefits, but the payment amount will remain the same.

Importance of Professional Legal Representation

When you’re suffering from a disability, you may be experiencing pain and other health issues. Filing for SSDI and knowing how to prove you can’t work can be challenging, but you don’t have to do it alone. The SSA allows you to assign a legal representative, a Social Security disability attorney, who can help you through the filing process.

Your attorney can correspond with the SSA on your behalf, fill out the necessary paperwork, collect your medical records to apply for benefits, and accompany you to necessary hearings to complete your application. Your attorney can also manage the appeals process if your application is denied. Unfortunately, denied SSDI claims are common, as about 45% of initial SSDI claims are denied. Many are denied due to incomplete applications, errors in information provided, and lack of sufficient medical information to support the claim.

How many times can you get denied for disability? If your claim is denied, you can file an appeal, but you can only be denied for disability 5 times, including your initial application. If your initial application is denied, your attorney can file an appeal 4 more times, but each time your appeal is denied, you must appeal at a higher level.

Gathering Medical Evidence

To qualify for SSDI, you must have a qualifying disability according to Social Security’s definition of a disability. SSA’s requirements for proving you can’t work include the following three guidelines:

1.      Your medical condition prevents you from working or engaging in any type of substantial gainful activity (SGA)

2.      Your medical condition prevents you from doing the work you did previously and adjusting to any other type of work

  1. Your medical condition has lasted or is expected to last for at least one year, or to result in permanent disability or death

To show proof of your medical condition, SSA will require copies of your medical records from a licensed physician who is treating you. These medical records must show a medical diagnosis, all treatments including X-rays, ultrasound and MRI images, lab tests, prescribed medications, and a prognosis for improvement.

To qualify for SSDI, your medical condition must significantly limit your ability to perform basic work-related tasks and activities, such as walking, standing, sitting, lifting, or remembering for at least 12 months. If it doesn’t, the SSA will find that you do not have a qualifying disability.

In addition, your medical condition must be found in the SSA Bluebook list of disabling conditions. These conditions are considered severe enough to prevent a person from engaging in any type of substantial gainful activity (SGA). If your medical condition is not on the list, the SSA will compare it to a similar condition on the list and evaluate it.

In some cases, the SSA will require SSDI applicants to see a licensed physician or specialist retained by the SSA, rather than a private physician. In either case, you should know what to expect at an SSDI medical exam, which is done to show proof of your physical and mental limitations. SSDI medical exams play a major role in proving you can’t work and approval or denial of SSDI claims.

Steps to Obtain Medical Documentation

Every applicant who files an SSDI claim is responsible for providing medical documents that show proof of his or her impairments and the severity of those impairments. However, the applicant’s attorney or the SSA, with the claimant’s permission, can help the claimant get medical evidence from his or her own medical sources who have evaluated, examined, and treated the claimant for his or her impairments. The SSA will also request copies of medical documents as evidence from hospitals, clinics, and other health facilities when it’s appropriate.

What Documents Should Be Included as Evidence?

When collecting evidence to show proof of physical or mental impairments, there are specific documents that should be included:

  • A physician’s report with the claimant’s major complaints and impairments
  • Medical exams with findings and the claimant’s diagnosis
  • Results of laboratory testing
  • Results of diagnostic tests including X-rays, ultrasounds, and MRIs
  • Prescription medications for pain and/or other aggravating factors
  • A physician’s report with the claimant’s prognosis for improvement

Work-Related Evidence for SSDI in Illinois

When filing for SSDI in Illinois, eligibility relies on your previous work history, the severity of your disability, how long you will be out of work, and proving you can’t work.

Work History and Job Duties

The SSA requires that you have worked recently enough and long enough to earn a certain number of work credits to qualify for SSDI. Social Security work credits are based on your total yearly wages or self-employment income, and you can earn up to 4 credits each year. The amount of yearly wages needed for work credits changes every year. In 2023, you earn 1 credit for each $1,640 in wages or self-employment income. When you earn $6,560, you have earned your 4 work credits, the maximum you can earn each year.

Your job duties will be evaluated based on the type of work you did in the past, work you can do in the present and future, and work limitations due to any impairments. The SSA uses earnings guidelines to evaluate whether your work activity counts as SGA. In 2023, if you are working, and your average monthly earnings are greater than $1,470, the SSA will generally not consider you to have a qualifying disability.

Proof of the Impact of the Impairment on Work Abilities

The SSA looks closely at how your impairment impacts your work abilities. To evaluate this, they rely on their Bluebook list of impairments (Part A) which outlines specific medical conditions for adults and how each condition impacts work abilities. For example, musculoskeletal disorders may involve the bones or major joints, muscles, ligaments, tendons, and soft tissues. The severity of an impairment may be linked to chronic joint pain or stiffness, loss of muscle mass and strength, fractures, rheumatoid arthritis, or curvature of the skeletal spine.

A Demonstration of Limitations in Functional Abilities

Under the category of impairments listed as neurological disorders, many impairments place limitations on motor functions, attention, communication skills, and decision-making skills. For example, a diagnosis of early-onset Alzheimer’s disease or Huntington’s disease may limit a worker’s physical and mental functional job abilities. A more severe diagnosis of epilepsy or a brain tumor may result in seizures, problems with concentration, remembering details, applying information, maintaining pace for basic work applications, and interacting with other workers.

Neurological disorders often result in disorganization of motor function in at least 2 extremities. They commonly result in extreme limitations such as the ability to stand up from a seated position, maintaining balance while standing or walking, and/or the use of upper extremities persisting for at least 3 consecutive months or longer.

Under the SSA Bluebook list of impairments, a neurological disorder must result in a marked limitation in physical functioning and a marked limitation in at least 1 of 4 areas of mental functioning: applying information, interacting with co-workers, concentration, memory, maintaining pace, or managing oneself.