What is the criteria for disability benefits in North Carolina?

by Tim Moore. Free Case Evaluation here.

The criteria for receiving disability benefits in North Carolina is the same as in all other states, simply because both SSD and SSI are federal programs administered by the Social Security Administration.

To meet the approval criteria, your case, through the medical and vocational evidence that is contained within it, must satisfy one basic thing: the Social Security definition of disability.

The Social Security definition of disability essentially states that you must have at least one severe medical condition, which may be physical or mental, and which lasts for a duration of not less than one year. During that time, it must prevent you from being able to engage in work activity that earns you what Social Security considers to be a substantial and gainful income, and may potentially result in death.

If the SSA definition of disability sounds fairly stringent, that is because it is. The way Social Security views disability is unlike many other programs.

To meet the criteria for SSD or SSI benefits, an individual must be considered to have a long term disability. Does this mean that the disability must be “permanent”?

More or less, yes. The assumption that is made is that if the person’s disability has lasted for at least a full year, it may potentially be permanent. That said, however, Social Security periodically reviews all claims after they have been approved at certain intervals.

When do CDR’s, or continuing disability reviews, of a claim take place? This can vary. It is not unusual for a person to have their first review just one year after they have been approved, particularly if their case was somewhat “on the line “.

In most instances, however, the first review of the case will occur approximately five years after the approval, and some cases are not reviewed for at least seven years after benefits have started (these cases are classified as m.i.n.e., which means “medical improvement not expected”). Keep in mind, also, that due to back logs and manpower limitations, sometimes a case may go quite a few years longer than this before being reviewed.

Can a person file on the basis of a temporary disability in North Carolina? This is a question that is asked repeatedly. However, it bears repeating that both SSD and SSI are not Temporary disability benefit programs.

If a person applies for disability, and a review of their medical evidence indicates that their condition will not last for the minimum one-year period, or if it is already improved to the point where they are considered able to return to work activity, they will receive what is called a “durational denial”.

Here is a short checklist of the things to keep in mind but if you are considering applying for disability in North Carolina or any other state:

1. Your condition must be severe versus nonsevere. This means that if your only condition is a sprained ankle, or sprained wrist, you will most likely be denied. Having said that, if you apply on the basis of headaches, your claim will most likely be investigated since headaches are often due to a variety of neurological and musculoskeletal problems.

2. You cannot be working and earning more than what Social Security considers to be “substantial and gainful activity” at the time you file for disability.

Keep in mind that this does not mean that you cannot be working when you apply for disability. It simply means that if you are working, your earnings must be under the SGA limit that is in effect for a given year. The current limit amount can be seen here: SSD and SSI gross monthly earnings limit.

3. You must have at least one medical condition that is disabling for a period of not less than one year.

However, it is important to point out that this does not mean you have to wait until you have had this condition for a full year before you actually file for disability. The disability examiner can look at your medical records and make a determination as to whether or not your condition will eventually last this long.