When are you eligible for US disability benefits?

07.25.2023

Check if you are sick and unable to work. It often happens that suddenly, due to illness, we cannot work and are left with no means of subsistence. We forget that by working professionally, we acquire the privileges of Social Security over time. In crisis health situations, when the disease excludes us from professional life, it is worth checking whether we are entitled to a disability pension - Social Security Disability.

You can apply for it after meeting certain conditions. The most important of them is the required number of years of work at the time of incapacity for work (it varies depending on the age of the person who became incapable of work due to illness). Another condition is the mandatory amount of accumulated credits, which depends on the amount of earnings and employment history. Of course, it must also be demonstrated that the incapacity for work is due to illness and not the inability to find suitable employment. And although federal law defines incapacity for work rigorously, many diseases qualify for its recognition.

You can apply for an invalidity pension yourself. However, it is a multi-stage process, with the need to collect many documents and complete multi-page questionnaires. It is necessary to precisely define the disease and its impact on the ability to undertake any work.
It may take three to five months to process your application. Errors in submitting the application or lack of required documents may result in refusal to grant the disability benefit. Documents and all forms should be meticulously completed and completed accurately.
Social Security first checks seniority and current employment. If these essential criteria are met, in the following stages, the office will examine the patient's health condition, the course of the disease, its impact on the patient's fitness, the test results presented, and the treatment history.

In order to make this complicated qualification process more understandable, we present its individual stages below. There are five of them.

1. First, the board checks whether the claimant is working at the time the claim is made. If so, the office will additionally check the amount of earnings she earns. If their amount exceeds a certain amount (this amount is updated every year), the office will consider the applicant as fit for work and refuse to grant the pension. However, if the amount of earnings is equal to or lower than the set amount, the office proceeds to the second stage, i.e., checking the patient's health condition.
2. A certificate of incapacity for work is granted to persons whose disease significantly limits the ability to perform basic activities related to work, i.e., such as walking, sitting, or remembering. In addition, this condition must be maintained for at least one year. If the condition turns out to be that serious, Social Security moves on to the next stage of verification.
3. Here, the office checks whether the applicant's condition is on the list of disabilities that are considered so severe that they make it impossible to perform work, regardless of age, education, or vocational training. If the applicant's illness is not on the list of recognized medical conditions, Social Security checks whether it is equally severe and prevents work. If the condition is considered serious, the application goes to the next stage of verification.
4. At this stage, it is checked whether the applicant can perform the current job. If so, Social Security denies disability benefits. If the patient has limitations that prevent him from performing his current job, then in the next stage, it is examined whether he can perform any other work.
5. The Office assesses the applicant's health, age, education, professional experience, and any skills in terms of professional possibilities and suitability for any job. If, at this stage, it is determined that the sick person is unable to do any work, Social Security will consider the claimant unfit for work and issue a disability pension determination. However, if it turns out that there is work that this person can perform despite the illness, he or she will not be granted a disability pension.

As you can see, the decision of the Social Security office depends on many factors. Notification of the outcome of this complicated procedure is sent to the applicant by post. It should be remembered that at any stage of the application process, the office may request the patient to supplement the documentation. If the office's decision is favorable, it shall specify the amount of the benefit granted and the date of commencement of its payment in the letter sent. The amount of the disability pension is calculated on the basis of the claimant's previous average earnings, and its first payment is made after the sixth entire month after the occurrence of the ability to work. However, if your claim for disability benefits is denied, the letter from Social Security will contain the reason for the denial of benefits and how to appeal the decision.

Of course, a person who receives a disability pension may return to work at any time if he or she feels able. However, you must notify Social Security immediately of your start date, job responsibilities, working hours, and salary.

It is worth knowing that Social Security has the right to verify the patient's health from time to time and check whether he can return to work. If, during such verification, it turns out that the incapacity for work persists, the office continues to pay the pension. However, if the health condition of the patient has improved and the pensioner is able to take up work, the benefit may be suspended. The same will apply if the applicant has provided untrue information in his application for a disability pension, does not follow the doctor's instructions, or does not cooperate with the office without a valid reason. Verification of the office may also concern a number of other issues, e.g., whether the pensioner has benefited from additional training or treatment and is, therefore, able to take up employment, and if so, what is his earnings and whether he is still entitled to a disability pension.

As you can see, the application process for a disability pension is long and complicated. And although you can apply for it on your own, it is very easy to overlook something and assert the rights due to the patient for a long time. In addition, the appeal process against an adverse decision requires a detailed explanation of the reasons for the appeal and the provision of additional evidence confirming the patient's right to a disability pension.

Law firms provide great assistance in submitting applications and appealing against negative decisions. Their experience allows you to avoid many basic mistakes and ensures that you can count on their help in appealing the decision if you are wrongly denied a disability pension.