Social Security Disability

To qualify for the SSDI program, you must be “fully insured”, meaning you must have worked a certain number of years where you paid Social Security taxes (FICA). You must also have a “disability insured status” when you become disabled, meaning you need to have earned a certain number of work credits within a specified time period. Individuals who become disabled after the age of 31 must have 20 quarters of coverage out of the 40 calendar quarters before they become disabled. A calendar year has four “quarters of coverage” and you can earn up to four credits per year. The minimum amount of working wages necessary to earn a credit in a quarter usually changes annually.

An initial application for SSDI or SSI benefits must be submitted to the Social Security Administration. A state agency, Disability Determination Service (DDS), will evaluate your claim. Social Security Administration data published in 2017, current through June 2015, reported that for the period 1992 to 2014, only 28.4% of initial applications for SSDI and SSI were allowed. The initial denial should be appealed since the rate of award then increases to over 45%.

If your initial application is denied, you will have 60 days to file a request for reconsideration, which is an appeal. If your request for reconsideration is denied, you will have 60 days to file a request for a hearing before a Social Security Administrative Law Judge. The 60-day time limit commences from the date of receipt of a decision denying benefits. The Social Security Administration presumes that decisions are received five days from the date on the face of the decision.

At each level of the process, the Social Security Administration applies a five step “Sequential Evaluation Process” requiring the applicant to prove:

1. Applicant is not engaging in work involving significant and productive physical or mental duties done for profit or pay (Substantial Gainful Activity); and

2. Applicant has a severe impairment, one which interferes with basic work-related activities; and

3. The impairment meets or equals one of the impairments described in the Social Security regulations known as the “Listing of Impairments”; or

4. Considering the applicant’s “residual functional capacity” (RFC), that is, what the applicant can still do even with his or her impairments, the applicant is unable to do “past relevant work”; and

5. Other work within the applicant’s RFC, considering age, education and work experience, does not exist in the national economy in significant numbers.

More disability claims are approved at the hearing level than at the initial application or request for reconsideration levels. A hearing before a Social Security Administrative Law Judge is your best opportunity to present evidence about your medical condition and work history and obtain benefits.

If your claim is denied at the hearing level, you can appeal to the Appeals Council. A successful appeal at this stage will result in your case being sent back to the Social Security Judge for a new hearing, likely with specific instructions to the Judge to eliminate errors made at the first hearing.

It is not uncommon for the process, from initial application to approval of disability benefits, to take many months. Since you will likely not be approved initially, your best chance to be approved for disability benefits is a hearing before the Social Security Administrative Law Judge.

An experienced attorney can help to expedite the process, making sure multiple forms concerning a variety of issues such as your medical history, medical diagnoses, work history, educational history and physical and/or mental limitations, are completed timely and in a manner to increase your chances of obtaining disability benefits as quickly in the process as possible.

An attorney familiar with Social Security Disability Law and Regulations can determine what evidence is needed and how to best prepare and present your claim at every level of the process.

Qualifying for either Social Security disability program, SSDI or SSI, requires medical evidence establishing the nature and extent of your physical and/or mental disability. An experienced attorney can work closely with your doctors to make sure that the medical evidence is complete and supports your claim.

An experienced attorney can make sure the Social Security Administration has your correct work and educational history as well as all other relevant information concerning the physical and mental requirements and skill level of work you have performed in the past.

An experienced attorney can guide you through the process by preparing you for the hearing before the Social Security Judge, reviewing with you the types of questions you will be asked during the hearing and by handling the cross examination of the Vocational Expert and/or Medical Expert who may provide expert testimony at your hearing.

An experienced attorney will have the ability to fight back against any attempts to minimize the impact your physical and/or mental impairments have on your ability to work or to mischaracterize your impairments in a manner that hurts your chances of obtaining disability benefits.

Once approved for benefits, an experienced attorney can then make sure that you receive the full amount you are entitled to under Social Security Law and Regulations.

When approved for SSDI benefits, you may be paid SSDI back pay starting with the sixth month after your disability began (“onset date”) as determined by the decision-maker granting SSDI benefits. But you cannot be paid SSDI benefits for more than one year prior to the date of your initial application.

After you are paid any SSDI back pay, you will get a disability check each month. The amount of the monthly SSDI check is based on your earnings record and work history. You can keep receiving SSDI benefits as long as your medical condition prevents you from working. Your family members may also be eligible for a partial monthly benefit. You will be eligible to receive Medicare after 24 months of receiving monthly SSDI benefits.

Your monthly SSDI benefits may be reduced if you are receiving workers’ compensation income benefits. This reduction of monthly SSDI benefits is referred to as an “offset.” Your monthly SSDI benefit is reduced to the extent that your monthly SSDI benefit plus the monthly workers’ compensation income benefit (usually paid on a weekly basis) exceeds 80% of your “average current earnings.” The Social Security Administration has three methods for determining the “average current earnings”, each based in some manner on your work history. The Social Security Administration will use the method that provides the highest “average current earnings” since the higher the “average current earnings” the less the reduction, or “offset”, against your monthly SSDI benefit.

As with SSDI, SSI benefits are only available for those with a severe, long-term total disability.

Medical Eligibility Requirements are the same as SSDI benefits (see above)

Non-Medical Eligibility Requirements

The SSI program is for those who do not have a sufficient work history and/or have not paid enough quarters into Social Security. To qualify for the SSI program, your assets and household income must be below certain limits.

How the Process Works for SSI Disability Benefits is the same as SSDI (see above)

Once Approved for SSI Disability Benefits

When approved for SSI benefits, you may be paid SSI back pay starting with the date your disability began (“onset date”) as determined by the decision-maker granting SSI benefits. Also, you cannot be paid SSI benefits prior to the date of your initial application. Receipt of workers’ compensation income benefits will likely disqualify you from receiving SSI benefits since only disabled individuals with limited financial resources may qualify for SSI benefits.

After you are paid any SSI back pay, you would get a disability check each month. You can keep receiving SSI benefits as long as your medical condition prevents you from working and you continue to meet the non-medical eligibility requirements. You could also be eligible to receive Medicaid starting with entitlement to SSI monthly benefits.