To determine who is eligible for Social Security disability, the Social Security Administration considers a variety of factors including your age, your work history and work credits, your income, and the nature of your disability.
Who Is Eligible for Social Security Disability Benefits?
In Illinois, Social Security disability claims are handled by the Bureau of Disability Determination Services (DDS), a state department that determines eligibility for all disability applicants. When an application for benefits is submitted to DDS, eligibility for benefits is based on a number of factors including the applicant’s age, work history, accumulated work credits, taxable income, and qualifying disability based on medical evidence.
To determine who is eligible for Social Security disability benefits, DDS reviews each applicant’s determining factors and medical information based on medical records from a licensed physician. In some cases, they may schedule a consultative examination (CE), a medical exam conducted by a licensed physician appointed by the Social Security Administration. This is to ensure that the applicant’s medical condition meets all SSDI eligibility requirements, or is shown on the List of Medical Conditions.
If the condition is not on the list, DDS looks at the severity of the condition compared to conditions on the list. If your medical impairment prevents you from performing any of your past work, you will likely qualify for SSDI benefits. If it doesn’t, DDS will look at other work you can do despite your medical impairment. If you can’t perform other work, you will qualify for disability benefits. If you can perform other work, you will not qualify and your SSDI claim will be denied. When SSDI benefits are denied, a social security disability lawyer can help you by filing a Request for Reconsideration, a Request for an Administrative Hearing, or a Request for a Review by the Appeals Council.
What Conditions Qualify for SSDI Benefits?
The Social Security Disability List of Impairments has a significant impact on determining who is eligible for benefits. The list defines an impairment as a physical or mental condition that results from anatomical, physiological, or psychological abnormalities and can be proven by medically acceptable clinical and laboratory diagnostic techniques. Medical evidence must establish an applicant’s physical or mental impairment. A letter or statement about the individual’s symptoms is not sufficient proof.
The List of Impairments is extensive and breaks disabilities down into two categories: Part A (adults over the age of 18) and Part B (children under the age of 18). Conditions commonly considered in both categories include the following:
Cardiovascular System Impairments
Impairments shown in this category affect the proper functioning of the heart or the circulatory system, which includes arteries, capillaries, lymphatic drainage, and veins. These disorders may be congenital or acquired, and may result in the following impairments: aneurysm, chronic heart failure, chronic venous insufficiency, heart transplant, ischemic heart disease, peripheral arterial disease, recurrent arrhythmias, and symptomatic congenital heart disease.
Digestive System Disorders
Disorders of the digestive system are considered based on their severity and duration. Common impairments include gastrointestinal hemorrhage, hepatic (liver) dysfunction, inflammatory bowel disease, malnutrition, and short bowel syndrome. These conditions may result in complications, including digestive obstruction and manifestations in other body systems.
Endocrine Disorders
Endocrine disorders are usually evaluated as adrenal gland disorders, diabetes, hyperglycemia, parathyroid gland disorders, and thyroid gland disorders. These conditions often result in cognitive impairments such as anxiety, depression, and mood disorders; changes in blood pressure and heart rate; dehydration and insulin deficiency; gangrene and amputation; osteoporosis with fractures; and seizures or loss of consciousness.
Musculoskeletal Disorders
Musculoskeletal disorders are evaluated based on functions of the skeletal system in the body. These disorders may be congenital or acquired and may lead to physical amputations, deformities, or other abnormalities. Disorders typically involve the bones or major joints, ligaments, muscles, tendons, and soft tissues. The List of Impairments includes abnormality of major joints, amputations due to any cause, lumbar spinal stenosis, musculoskeletal impairments, and skeletal spine disorders.
Neurological Disorders
Neurological disorders are evaluated based on communication impairments, motor function impairments, and limitations in physical and mental abilities. Common impairments include brain tumors and traumatic brain injury, Cerebral palsy, epilepsy, Friedrich’s ataxia, Huntington’s disease, myasthenia gravis, multiple sclerosis, muscular dystrophy, peripheral neuropathy, post-polio syndrome, and spinal cord disorders.
Under Part B (Childhood Listings), the above listings as well as other listings are based on the child’s age and prognosis for future recovery or improvement. Special listings that apply to children under the age of 18 include:
- Congenital Disorders that affect multiple body systems
- Low Birth Weight and Failure to Thrive
- Genitourinary Disorders
- Hematological Disorders
- Malignant Neoplastic Diseases
- Skin Disorders
What Are the Non-Medical Requirements for SSDI Benefits?
In addition to submitting medical evidence for SSDI benefits, you must also submit nonmedical information, which is required to determine who is eligible for Social Security Disability. The following nonmedical evidence must be submitted to DDS:
Personal Information
Your name, address, phone number, and the phone number of an available contact who knows about your medical condition and can help with your application. This can be a family member or a social security disability lawyer who is helping you through the process.
Work Information
Your work history and details about your job duties are required to verify your taxable income and work credits. SSDI pays disability benefits to workers who have worked long enough to pay Social Security taxes and accumulate a sufficient number of work credits. Specific work information required includes:
- The name and address of your employers for this year and last year
- The amount of money you earned this year and last year
- A list of your jobs (up to five) that you had in the 15 years before you became unable to work, and the dates you worked at those jobs
- The beginning and ending dates of any active U.S. military service you had before 1968
- Any information related to your temporary or permanent workers’ compensation benefits, black lung benefits, Longshore and Harbor workers’ compensation benefits, state or local government disability insurance benefits, and any military disability benefits (excluding VA benefits).
- Information related to Civil Service disability retirement, Federal Employee’s compensation, and Federal Employee’s retirement
In addition to your personal information and work information, you may also be asked to provide documents to determine whether you are eligible for disability benefits. Additional documents may include your birth certificate or other proof of birth; proof of US citizenship or legal alien status if you were born in another country; US military discharge papers; and W-2 or self-employment tax returns for the previous year.
If you received any type of disability payments related to your work in the past, you should talk to a lawyer to find out how long term disability lawyers can maximize your benefits.
How Many Work Credits Do I Need to Qualify for SSDI?
If you’re filing for SSDI benefits, you will need a certain amount of work credits that determine who is eligible for Social Security Disability. Work credits are earned when you work and pay Social Security taxes. You must earn at least 40 work credits to qualify for SSDI benefits. Without enough work credits, you can’t collect Social Security Disability.
Work credits are based on your total wages and self-employment income for the year. Depending on your work schedule, you may work a full year to earn 4 credits, or you may earn 4 credits quicker. However, you can only earn a maximum of 4 work credits per year, and you must earn at least 40 credits to qualify for SSDI benefits.
The amount of total credits earned depends largely on your work experience and the number of years you work. For example, if you are 25 years old with only 5 years of work experience, you have likely earned only 20 work credits. If you are 55 years old and have worked for 30 years, you have likely earned 40 or more work credits.
Since 1978, you’re allowed to earn a maximum of 4 work credits per year. However, your required earnings to earn a work credit can change yearly. In 2023, you can earn 1 Social Security and Medicare credit for every $1,640 in covered earnings each year. You must earn at least $6,560 to get your maximum 4 work credits for the year.
If you need to file for SSDI benefits, it’s essential to understand the filing process and filing timeline for a disability claim. When you file a disability claim in Illinois, it can take from 3 to 6 months for the DDS to review and evaluate your claim and make a decision of approval or denial. If your claim is approved, it may take several months or longer to receive your disability benefits. If your claim is denied, you can request a Reconsideration, an Administration Hearing, or an Appeals Council Review within 60 days, and DDS will take another look at your application and make another decision.
