Disability May Not Mean What You Think It Means
The word “disability” has a very specific legal meaning under the Social Security laws. To the average person, this can be confusing because Social Security’s definition may be different than the definition of disability under other disability laws and programs, such as worker’s compensation, temporary disability programs, long term disability insurance, special education programs, the Americans with Disabilities Act (“ADA”), the Department of Veteran Affairs, or the Division of Motor Vehicles definition when you obtain a handicapped plate. In fact, what your treating doctor or therapist thinks is a disability may not be the same as Social Security’s definition.
In other words, even if you are considered disabled by another government agency, insurance program or medical professional, this does not always mean you are disabled for Social Security benefits. If you are considering applying for disability benefits, you should not be discouraged by this information though because the fact that you were found disabled under some other program or by your own doctor may still be useful as partial evidence of your disability.
There are also non-medical and financial eligibility requirements for Social Security Disability Insurance (commonly referred to as “SSDI”, “SSD”, “Disability Insurance Benefits”, or “DIB”) and Supplemental Security Income (commonly referred to as “SSI”) benefits. The requirements are detailed and are beyond the scope of this article. This article is specifically only meant to address the medical eligibility requirements.
The Less Legal Explanation of Disability
Generally, Social Security will consider you disabled for both SSDI and SSI benefits if you meet all of the following criteria:
- you are not working or you are working but your earnings are limited (the earnings limit is set by the Social Security Administration, and for 2011, the limit is $1,640 if you are blind and $1,000 if you are not blind);
- you have severe medical conditions that are expected to last for 12 months or more, or are expected to result in death;
- your severe medical conditions significantly interfere with your ability to work;
- you can not perform the jobs you used to have; and
- you can not learn how to perform other less physical jobs, even if you never had any other jobs in your life (for example, even if you never worked in an office before, if Social Security thinks you are able to meet the physical requirements of a file clerk and they think you can be retrained to work in an office, then you will not be considered disabled.).
You generally have to meet all of the criteria listed in order to be found disability. However, depending on the type of medical condition you have and its severity, you may be eligible for disability benefits even if you have the skills to perform certain types of jobs as long as your earnings are limited.
Below are some rules-of-thumb that may help make Social Security’s definition of disability more meaningful to you.
Scenarios where you may be found disabled
- You may be found disabled based on having only one medical condition or on the combined effect of multiple medical conditions.
- You may be found disabled based on having a physical and/or psychiatric medical condition.
- You may be found disabled even if you have a poorly understood medical condition, such as fibromyalgia, migraines, or chronic fatigue syndrome. However, in these cases, there is probably a higher chance of being denied on the initial application, but with the right evidence, you may still be able to be found disabled on an appeal.
- You may be found disabled, even if your medical conditions do not prevent you from working, but the treatments to control your medical conditions prevent you from working. Treatments like radiation therapy or chemotherapy with debilitating side effects, surgery with a very long rehabilitation time, pain medications that cause drowsiness or difficulty concentrating, or treatments that require regular overnight hospitalizations can all be considered by Social Security to find you disabled.
Scenarios where you probably will not be found disabled
- You probably will not be found disabled, if your medical condition(s) will prevent you from working for less than 12 months. This is because Social Security disability was designed to cover only long term or permanent disabilities.
- You probably will not be found disabled, if your medical conditions are under control with treatment and your treatments do not cause side effects that would prevent you from working. The Social Security system is concerned with the severity and frequency of the limitations caused by your medical conditions and treatments, not just having a medical condition, so if you are still able to work with proper treatment, you are not disabled.
- You probably will not be found disabled, if you are able to work but you are having a hard time finding a job because of high unemployment. This is because Social Security was not meant to be a substitute for the unemployment insurance system. However, if you have significant impairments caused by severe medical conditions and you or your doctors are not sure if you are able to work, you may want to file an application for disability benefits or have your case evaluated by a Social Security disability lawyer.
Facts that are commonly (but incorrectly) thought to automatically prove disability
- You are not automatically disabled if your medical conditions limit you to work that will pay less than your old job, even if your disability benefits would be higher than what you could earn in a lower paying job. When the Social Security Disability Insurance laws were first enacted in 1956, a fundamental concept was that a disability should be “totally” disabling. If you are still able to earn some money and it is over the earnings limit, then you would not be totally disabled. However, this analysis can be complicated and other factors, such as your age, past work experience and education, could still lead to an award of disability benefits.
- You are not automatically disabled if you can not obtain health insurance. Unfortunately, the laws did not include the availability of health insurance as a factor to consider when Social Security makes a disability determination.
- You are not automatically disabled if your medical conditions prevent you from driving. Under current interpretations of the law, the ability to drive may be considered as a factor when evaluating your case, but the inability to drive is not absolute proof of disability because there is typically a presumption that if you are still able to walk to work or to use public transportation, you are able to make it to work. However, why you are unable to drive is something Social Security will consider when evaluating how severe your limitations are
Although this is not a strict legal interpretation of Social Security’s definition of disability, hopefully, this will give you a general idea about what Social Security is looking for.