The Social Security Administration’s disability benefits programs provide financial assistance to individuals with qualifying disabilities. For a person’s medical condition to qualify for Social Security disability benefits, the condition must meet the SSA’s 12-month duration requirement.
What Is the 12-Month Duration Requirement?
Under the 12-month duration requirement, an applicant for Social Security disability benefits must have a medically determinable condition that has lasted or will likely last for at least 12 months or that will cause the applicant’s death. The 12-month duration requirement applies to both Social Security Disability Insurance and Supplemental Security Income claims. The 12-month duration refers to the current or expected duration of the applicant’s disability, not how long the applicant has remained or will remain out of work.
Why the Requirement Exists?
The Social Security Administration’s disability benefits programs were established to provide financial assistance to individuals with long-term or permanent severe disabilities. The 12-month duration requirement, therefore, ensures that approved claimants have a prolonged or permanent disability or a terminal condition. The requirement also excludes individuals with temporary disabilities who might seek financial assistance through short-term disability benefits provided by private insurance or state-run public benefits programs. Due to the requirement, the Social Security Administration denies many SSD applications because claims reviewers determine that an applicant’s condition will improve within 12 months.
Proving the 12-Month Duration
The Social Security Administration reviews various kinds of medical evidence to determine whether an applicant’s condition meets the 12-month duration requirement. Specifically, claims reviewers will examine the evidence for:
- Consistent medical documentation
- Ongoing treatment and compliance with recovery plans
- Statements from treating medical providers about expected recovery time or prognoses
- Hospital records, diagnostic tests, and specialist evaluations that establish the likelihood of recovery or improvement
The SSA will review an applicant’s treatment history for evidence that their symptoms have persisted or improved. Furthermore, the SSA will also see whether an applicant has sought ongoing treatment for their condition. Gaps in treatment may lead the SSA to conclude that an applicant’s condition does not meet the 12-month duration requirement.
What If Your Condition Improves within 12 Months?
When an applicant’s condition has improved within 12 months of the onset of symptoms, the Social Security Administration typically denies disability benefits. However, should symptoms return or worsen, an applicant can file a new disability benefits application, or if the appeal deadline on their previous claim has not expired, pursue an administrative appeal to present new medical evidence of their worsening symptoms. Furthermore, if an applicant has a terminal condition (a condition expected to cause death in the short term), the Social Security Administration may waive the 12-month duration requirement.
How an Attorney Can Help
A Social Security disability lawyer can help an applicant by:
- Assisting with the filing and submission of the applicant’s paperwork
- Demonstrating that the client meets the 12-month duration requirement by gathering comprehensive medical records that support a finding that the applicant has a long-term or permanent disability
- Working with an applicant’s treating physicians and other medical experts to obtain opinion testimony regarding the expected duration or permanency of the applicant’s condition
- Appealing the denial of an applicant’s claim due to the 12-month duration requirement by pursuing further review and presenting additional evidence and expert testimony demonstrating that the applicant’s condition will not improve or resolve in the short term
Contact Our Firm Today
The Social Security Administration’s 12-month duration requirement is meant to ensure that disability benefits go to individuals with severe, prolonged, or permanent disabilities. However, it can also serve as a bureaucratic barrier to people with debilitating conditions. The attorneys of Crowe & Shanahan are dedicated to helping people like you secure the benefits they’re entitled to by law. Contact us today for a free, no-obligation consultation with a Social Security disability lawyer, and let’s discuss your situation in detail.