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When you have a mental illness, you may find it impossible to obtain gainful employment. SSA provides disability benefits to qualified individuals through Social Security Disability Insurance (SSDI) and Social Security Income (SSI) if their mental illness significantly impairs their ability to work.
Like a physical disability, to qualify for these federal programs, the mental illness must be severe enough to prevent the person from performing substantial gainful activity (SGA) for at least 12 months or result in death. The SSA has strict guidelines for evaluating mental illnesses, and not all individuals with a mental illness will qualify for disability benefits. A Social Security disability attorney can discuss the available options for obtaining benefits.
SSA’s Criteria for Mental Illness Disability
The Social Security Administration evaluates mental illness using a five-step process to determine if an individual meets the criteria for disability.
1. Substantial Gainful Activity (SGA)
The SSA first evaluates whether the individual works and earns more than a certain annual adjusted income. If they earn more than the SGA amount, the SSA determines the individual doesn’t have a disabling mental illness.
2. Severity of Impairment
If the individual is not engaging in SGA, the SSA evaluates the severity of their mental illness. The mental illness must be severe enough to significantly impair the person’s ability to perform basic work activities to meet the criteria for disability.
3. Listing of Impairments
The SSA maintains a Blue Book listing medical conditions and impairments, including mental disorders, that may qualify an individual for disability benefits. Some mental illness is considered so severe they qualify automatically.
4. Past Relevant Work
If an individual’s mental illness doesn’t meet the criteria in the Listing of Impairments, the SSA asses whether the person can perform any of their past relevant work. If they can still perform past work, they won’t qualify for disability benefits.
5. Other Work
If the individual can’t perform their past work, the SSA evaluates whether there are other jobs the person can perform in the national economy despite their mental illness. If they can perform this work, they won’t be found disabled.
All individuals with mental illness who receive Social Security disability benefits must meet the criteria established by the SSA for their disability.
How Difficult is it to Qualify?
Qualifying for SSDI or SSI due to a mental illness can be challenging but not impossible. One of the biggest hurdles to overcome is diagnosis and treatment. Symptoms can be hard to quantify or subjective, making it difficult to provide sufficient medical evidence to support a claim for disability according to the SSA’s strict guidelines.
Another hurdle is the five-step process described above, which can be complex and time-consuming. The process involves reviewing medical evidence, work history, and other factors determining a person’s benefits eligibility. Even if the individual meets the mental illness criteria, the process can take several months or years, and many claims receive a denial on their first application.
Despite the challenges, it’s possible to qualify for SSDI and SSI based on a mental illness with the help of an experienced Social Security disability lawyer. An attorney can gather and present relevant medical evidence, navigate the appeals process, and advocate for your rights and interests.
What are Some Specific Mental Illnesses that Qualify?
There is a range of mental illnesses the SSA considers, including:
- Schizophrenia and other psychotic disorders
- Bipolar disorder and depression
- Anxiety disorders, including generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder (OCD)
- Personality disorders, such as borderline personality disorder
- Intellectual disability and developmental disorders, such as autism spectrum disorder
- Trauma and stressor-related disorders such as post-traumatic stress disorder (PTSD)
The mental illness must be severe enough to prevent you or your loved one from performing SGA for at least 12 months or result in death. The mental illness must also meet the criteria established by the SSA for disability to qualify for SSDI or SSI benefits.
Qualifying for disability benefits and the evaluation process can be complex. It’s highly recommended to consult with an experienced Social Security disability attorney to discuss options and potential for success.
What About Minor Children?
The SSA has an SSI program that covers children up to the age of 18. To qualify for these SSI benefits, minor children must meet the same qualifiers for 12 months of mental illness that causes “marked or severe functional limitations.” The family of the child must be very low-income with limited resources. When the child turns 18, the SSA will determine if they continue to qualify for SSI benefits as an adult.
Claim Denials and Appeals
Most first-time claims receive a denial, and most claimants will file an appeal. A properly filed appeal prompts a hearing before an administrative judge. Many claimants receiving first-time denials for benefits obtain benefits upon appeal. However, successful claim appeals require navigation through complex hearings and appeals processes that require the legal expertise of a Social Security disability lawyer. It often takes about 22 months from applying for benefits until an appeal hearing.
Social Security disability benefits for mental illness can help to cover financial obligations, including everyday living expenses, medical bills, and more. Mental illness is challenging to prove. A Social Security disability attorney will know what medical evidence requirements can support a claim for disability under the SSA’s strict guidelines. To ensure success, meet with a disability attorney to discuss your case before applying for SSDI or SSI. If you have questions or would like to discuss your personal legal matters, with a Florida Estate Planning Attorney please don’t hesitate to contact us at (321) 729-0087.