Who Qualifies for SSDI? A Practical Guide to Disability Eligibility

Social Security Disability Insurance (SSDI) is a federal benefit for people who have worked and paid Social Security taxes but can no longer work full-time because of a serious medical condition. SSDI eligibility is based on both your medical condition and your past work history, not just one or the other.

This guide focuses on how eligibility works in practice, who decides it, what you need to prepare, and what to do first if you think you might qualify.

1. The Core Rules for SSDI Eligibility

To qualify for SSDI through the Social Security Administration (SSA), you typically must meet three main requirements:

1. You have a severe medical condition that has lasted, or is expected to last, at least 12 months or result in death.
2. You cannot perform substantial gainful activity (SGA) — in plain terms, you can’t hold a steady job where you earn over a certain monthly amount (SSA updates this dollar amount each year).
3. You have enough work credits from jobs where you paid Social Security (FICA) taxes, usually through payroll deductions.

SSA uses a strict legal definition of disability. Partial or short-term disabilities usually do not qualify for SSDI, even if they cause real problems.

Rules and thresholds can vary somewhat by age and situation (for example, younger workers need fewer work credits), so eligibility is always decided on a case-by-case basis.

Key terms to know:

• SSDI (Social Security Disability Insurance) — Federal disability benefit based on your work history and Social Security tax contributions.
• Substantial Gainful Activity (SGA) — SSA’s term for work that earns more than a set monthly amount; earning above this level usually means you are not considered disabled under SSDI rules.
• Work credits — Units SSA uses to measure your work history; you earn them by working and paying Social Security taxes.
• Residual Functional Capacity (RFC) — SSA’s assessment of what you can still do physically and mentally despite your medical conditions.

2. Where Eligibility Is Actually Decided (Real System Touchpoints)

Two main official entities are involved in deciding whether you meet SSDI eligibility:

• Social Security field office — This is your local SSA office. It takes your application, confirms your non-medical eligibility (work credits, insured status, basic income/work checks), and forwards your case for a medical decision.
• State Disability Determination Services (DDS) — This is a state-level agency (usually with a name like “Disability Determination Services” or “Disability Determination Bureau”) that reviews your medical evidence and decides if you meet SSA’s definition of disability.

In practical terms:

• The field office is where you interact with SSA staff, submit your initial SSDI application (online, by phone, or in person), and ask general questions about eligibility.
• DDS is mostly behind the scenes; you usually don’t visit them in person, but they may call or mail you to request more information or schedule a consultative exam (a medical exam paid for by SSA).

To find your official SSA contact point, search for your local “Social Security field office” on a .gov website, or call the national SSA customer service number listed on the government site, then ask for help with an SSDI disability claim.

3. What You Need to Prepare for an SSDI Eligibility Review

Before you apply, it helps to collect the main types of information SSA and DDS will use to judge eligibility. This doesn’t have to be perfect, but having it ready usually speeds things up and reduces the risk of incomplete forms.

Documents you’ll typically need:

• Medical records — Office visit notes, hospital discharge summaries, imaging reports (MRI, CT scans, X-rays), lab results, and treatment plans from all doctors related to your disabling conditions.
• Work history details — A list of jobs for approximately the last 15 years: job titles, duties, dates of employment, and hours/pay, so SSA can see what kind of work you were doing and whether you can still do it.
• Proof of identity and work — Items like your Social Security card, birth certificate, and recent W-2s or tax returns, which are often required to confirm your identity and work record.

Also gather:

• Names, addresses, and phone numbers of all medical providers (doctors, clinics, hospitals, therapists, mental health providers).
• A list of all medications, dosages, and side effects.
• A short description of how your condition affects daily tasks (standing, lifting, concentrating, interacting with others, etc.) since this can tie into your RFC.

One concrete next action you can take today is to start a written list (on paper or in a document) of every doctor, clinic, and hospital you’ve seen for your condition in the last few years, with dates if you can. This is exactly the kind of information SSA asks for on the forms, and DDS uses it to request your medical records.

4. Step-by-Step: How Your SSDI Eligibility Is Evaluated

Here is how the process typically works from your first action through the decision stage.

1. Contact Social Security to start your SSDI claim
   Use the official SSA online portal for disability claims, call the SSA national number, or visit your local Social Security field office in person.

   • If you call or visit, you can say: “I’d like to apply for SSDI based on disability and check if I meet the basic eligibility requirements.”

2. SSA checks non-medical eligibility first
   The field office staff will review your work history and insured status, verify your identity, and ask basic questions about your income and recent work.

   • If you don’t have enough work credits or you’re still working above the SGA earnings level, SSA may deny the claim at this stage without sending it for medical review.

3. DDS reviews the medical side of your eligibility
   Once non-medical requirements look satisfied, the SSA field office sends your case to your state’s Disability Determination Services.

   • DDS staff (disability examiners, sometimes with medical consultants) will request your medical records from the doctors and clinics you listed and may mail you forms about your daily activities and symptoms.

4. You may be asked for extra information or exams
   DDS often sends questionnaires about your daily functioning and, in many cases, may schedule a consultative examination with a doctor they choose.

   • What to expect next: You’ll receive appointment letters or requests for more information by mail; responding quickly and attending any exams is critical to keep the claim moving.

5. DDS makes a medical decision and sends it back to SSA
   DDS decides whether you meet or equal a listing in SSA’s “Blue Book” or are otherwise unable to do your past work or any other substantial work.

   • SSA then sends you a written notice: an approval with a benefit estimate and onset date, or a denial explaining why they found you not disabled under their rules.

6. If denied, you can appeal
   If you disagree with a denial, you usually must file an appeal within a strict deadline (commonly 60 days from the date on the notice).

   • Later appeal levels can involve a hearing with an Administrative Law Judge (ALJ) at the Office of Hearings Operations (another SSA unit that only handles appeals).

At every stage, you cannot apply or upload documents through an information site like HowToGetAssistance.org; you must use the official SSA channels (field office, toll-free line, or official SSA online portal).

5. Real-World Friction to Watch For

Real-world friction to watch for

A very common snag is that DDS requests medical records from your providers, but the doctor’s office is slow to respond or sends incomplete records, which can delay your eligibility decision for weeks or months. If you notice in your online SSA account or in your paperwork that records are still “outstanding,” you can call your doctor’s office directly, ask if they received the SSA request, and remind them that sending the records promptly is necessary for your disability claim to move forward.

6. Getting Legitimate Help and Avoiding Scams

Because SSDI involves money and your Social Security number, it attracts scammers and “consultants” who charge high fees for basic tasks. To stay safe and get real help:

• Use only .gov websites and official SSA phone numbers when applying or checking eligibility. Look for “Social Security Administration” or “ssa.gov” in the address.
• Avoid anyone who guarantees approval, promises a faster decision for a fee, or asks you to send Social Security numbers, bank information, or documents through unofficial email or text.
• Free help is often available from:
  • Local Social Security field offices (for forms and general questions).
  • Many legal aid organizations and disability advocacy nonprofits that help with applications and appeals.
  • Some state vocational rehabilitation agencies, which can explain how SSDI interacts with work attempts.

When you call an official SSA number, you can use a short script like: “I’m trying to find out if I might be eligible for SSDI and what I need to start an application. Can you tell me what information I should have ready and how to file?”

Once you’ve spoken with SSA or used their online portal and started your claim, your immediate next steps are to gather your medical and work documents, respond promptly to any DDS mail, and keep copies of everything you send. That combination—contacting the official SSA system and preparing your records—is what allows your SSDI eligibility to be evaluated as smoothly as possible.