Understanding whether you qualify for Social Security Disability can feel overwhelming. This page explains, in plain terms, how the Social Security Administration (SSA) decides a claim — and what that means for you. It is the background behind every one of our condition pages.
SSDI, SSI, and private disability
- SSDI (Social Security Disability Insurance) pays benefits if you worked long enough and paid Social Security taxes. It also brings Medicare.
- SSI (Supplemental Security Income) pays based on financial need, and can help when the window for SSDI has passed.
- Private / long-term disability (ERISA) often has a broader definition — sometimes paying if you simply can’t do your own job. Many people pursue an SSDI and a private claim together so there is no gap in income. We handle both, frequently charging only for the SSDI side.
How SSA decides whether you can work
At its core, SSA asks one question: can you sustain full-time work — eight hours a day, five days a week — reliably, for at least twelve months? Winning a claim means showing your symptoms make that impossible. In practice, sustaining a job means being able to:
- Stay on task about 85% of the day. Fatigue, pain, and cognitive symptoms that pull you off task beyond that will preclude work.
- Miss no more than about one day a month. Flare-ups, bad days, and treatment that cause more absences than this rule out competitive employment.
- Meet the demands of even sit-down work — sitting six hours, standing/walking two hours, lifting up to ten pounds, and using your hands for most of the day. If you can’t, even sedentary jobs are off the table.
Some conditions are severe enough to meet one of SSA’s medical “listings,” which can qualify you without weighing your work capacity. But most people qualify the other way — by documenting, in detail, why they can’t sustain a job.
Check your Social Security insured status (DLI and PIA)
For SSDI you must be “insured” — generally you need to have worked and paid Social Security taxes for about 5 of the last 10 years. That coverage does not last forever after you stop working: it ends on your date last insured (DLI), and you must show your disability began on or before that date. The my Social Security portal at ssa.gov does not display your DLI, so the most reliable way to confirm it is to call Social Security directly.
Call SSA at 1-800-772-1213. When the automated system answers, say “verify date last insured” or “speak to an agent.” Then ask:
- “Am I currently insured for SSDI?” — this confirms you have enough recent work credits (generally 5 of the last 10 years).
- If yes: “What is my date last insured (DLI)?” and “What is my primary insurance amount (PIA)?” — your estimated monthly benefit.
- If you are not currently insured: “When was I last insured?” — the last date on which you could still qualify.
Knowing these numbers up front tells you whether you are eligible and how much time you have to file.
Your age can change the outcome
SSA’s rules become more favorable with age. At 50, and again at 55, someone limited to lighter work can be found disabled even when a younger person with the very same limitations would not. Many people don’t realize this — and it can be decisive. We look at it in every case.
Income limits
To qualify, your earnings from work must fall below the “substantial gainful activity” limit SSA sets each year. We can tell you quickly whether your situation fits.
Our fee
There is no fee unless you win. Fees are set by Social Security — 25% of past-due benefits, capped at $9,200. If there are no back benefits, there is no fee.
Not sure if you qualify?
We are happy to talk through your specific situation at no cost. Start your free case review → or call (720) 301-9708.
