Social Security Disability Attorney

Do I Qualify for Social Security Disability Benefits?

There are two requirements to qualify for Social Security Disability (SSD) benefits: work credits and medical disability.

Work credits are earned by paying Federal Insurance Contributions Act (FICA) taxes, which are usually deducted from your paycheck. FICA taxes fund Social Security programs.

Regarding medical disability, the Social Security Administration (SSA) has five basic qualifying questions.

They are:

• Are you working?
• Is your condition severe?
• Is your condition disabling?
• Can you do the work you previously did?
• Can you do any other type of work?

Other qualifications include:

• Are you 65 years old or younger?
• Are you disabled to the point that you are unable to work OR only able to earn $1,470/month or less?
• Have you stopped working in the last 10 years?
• Do you have a work history of 10 years or more (younger individuals may qualify with less) AND have worked at least 5 out of the last 10 years earning a paycheck?

You can qualify for SSD benefits for physical and/or mental medical conditions, so be sure to disclose all of your medical issues fully.

Read Do I Qualify for Social Security Disability Insurance? to learn more.

What is the Claims Process?

The claims process to receive SSDI benefits can feel intimidating, so the more prepared you are, the better.

First, you should apply for SSDI benefits as soon as you become disabled and unable to work. This is important due to the five-month waiting period for payment of benefits. You can apply online, by phone, or at your local Social Security office.

The information you will need to provide when applying for SSDI benefits includes:

• Your Social Security number and proof of your age
• Names, addresses, and phone numbers of medical providers that took care of you, along with dates of your visits
• Names and dosages of all medications you are taking
• Medical records
• Laboratory and test results
• Work history summary of where you worked and the kind of work you did
• Your most recent W-2 form or a copy of your federal tax return if you were self-employed

Once you submit your application, the Social Security Administration checks to see if you meet the non-medical requirements for SSDI benefits (age, work credits, and substantial gainful activity or SGA eligibility).

If those requirements are met, your application goes to the Disability Determination Services (DDS) office in your state of residence. Examiners and medical staff in the DDS office look at the medical evidence of your disability claim to decide if you meet the legal requirements to be considered disabled.

Finally, you are notified whether your claim is approved or denied.

How does the Social Security Administration Define "Disabled?"

Federal law requires a strict definition of disability to qualify for Social Security Disability Insurance (SSDI) benefits.

The Social Security Administration, under federal regulations code 404.1505, defines disability as "the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months."

A more straightforward way to say this is that an individual is disabled if they cannot engage in any substantial gainful activity (SGA) because of their mental or physical medical condition.

The monthly SGA limit used to determine disability for 2023 is $1,470 for non-blind individuals and $2,460 for statutorily blind individuals. The SGA limit changes annually, so be sure to keep up with new limits.

Read How Does the Social Security Administration Define "Disabled"? to learn more.

Do I need a Mental Consultative Examination for SSDI Benefits?

Depending on the specific nature of your disability claim, you may be required to participate in a Mental Consultative Examination to provide the evidence necessary to receive your SSDI benefits.

The exam is administered by a medical professional and may include descriptions of your appearance, behavior, judgment, memory, mood, speech, and/or thought content. Whether or not you are required to have the exam, as well as the exact areas covered, depends on the medical condition or disability prompting your claim.

When required, a Mental Consultative Examination is a vital component of the disability claim decision process. As such, it is often beneficial to have a Social Security Disability attorney on your side to help you navigate the process.

Read Do I Need a Mental Consultative Examination for SSDI Benefits? to learn more.

What Is A Consultative Examination For Social Security Disability?

A Consultative Examination (CE) is a medical exam conducted by an independently contracted, non-biased medical professional to gather sufficient medical evidence to base a decision on an SSDI benefits claim.

A CE is most commonly ordered when there is insufficient medical evidence available. Consultative examinations are also often ordered in cases where the claimant has not seen their doctor in a long time or only saw their doctor sporadically.

The exam is performed at the request of the Social Security Administration, and there is no cost for the claimant.

Read What is a Consultative Examination for Social Security Disability? to learn more.

What are the Steps for Submitting my Social Security Disability Application?

The steps for submitting your Social Security Disability application are fairly straightforward. However, you should apply as soon as possible once you become disabled due to the five-month waiting period before payment of benefits can begin.

The first step in the application process is gathering all the information required. This includes:

• Your Social Security number and proof of your age
• Names, addresses, and phone numbers of medical providers that took care of you, along with dates of your visits
• Names and dosages of all medications you’re taking
• Medical records
• Laboratory and test results
• Work history summary of where you worked and the kind of work you did
• Your most recent W-2 form or a copy of your federal tax return if you were self-employed

Then, you can apply for benefits online, by phone, or at your local Social Security office.

How does my Work History Affect my Application?

When applying for SSDI benefits, your work history is used to prove you have earned enough work credits to qualify for benefits and calculate your benefit amount. Your work history must also show that you have paid the appropriate SSDI taxes to qualify for SSDI benefits.

The Social Security Administration keeps records of every year you pay SSDI taxes, and you can access your work history earnings records through your Social Security account at https://www.ssa.gov/myaccount/.

What are Common Reasons for Claimants to be Denied?

Unfortunately, of the millions of people who file for SSDI benefits each year, only about 30% have accepted claims. Some of the common reasons for initial claims by claimants to be denied include:

• The claimant’s medical condition will not last long enough or is not severe enough
• The disability is primarily due to alcohol or drug abuse
• The claimant lacks medical evidence
• The Social Security Administration (SSA) is unable to contact the claimant, or the claimant did not appear for their disability hearing
• The claimant is incarcerated
• The claimant refuses to cooperate with the SSA
• The claimant has committed fraud against the SSA
• The claimant’s benefits would exceed the Substantial Gainful Activity (SGA) threshold

An experienced Social Security Disability attorney can help you decrease your risk of SSDI denial. If your disability case has been denied, they can help you appeal the decision.

Read Common Reasons for SSDI Denial to learn more.

What is the Appeals Process Like?

If your claim for SSDI benefits is denied, you have the right to appeal the decision. The appeals process must be started by submitting a request in writing to the Social Security Administration within 60 days of receiving your denial letter.

There are four levels of appeal. They are:

• Reconsideration
• Hearing by an administrative law judge
• Review by the Social Security Appeals Council
• Federal Court review

You have 60 days to appeal the decision at each process stage.

A Social Security Disability attorney can represent you during the appeals process and help you get the benefits you deserve.

How Long do Social Security Appeals Take?

There is no standard of expectation set for how long Social Security appeals should take. States with smaller populations have shorter wait times, while people in states with higher populations will wait longer.

It can take several months to over a year or more to receive a ruling at each level of the appeals process. So, if your claim is denied, you will want to file your appeal as quickly as possible to avoid adding any additional time to the process.

What are my Chances of Success?

Historical data shows that about 30% of SSDI claims are accepted yearly. This means that 7 out of every 10 claims get denied.

Understanding why claims get denied can help you turn those odds around and increase your chances for success, as can working with a Social Security Disability attorney.

Read Common Reasons for SSDI Denial to learn more.

If I Win my Appeal, Will I Get Back Pay?

If you win your appeal, you are entitled to back pay, or what the Social Security Administration refers to as “past-due benefits.”

Once the claim is finally approved on appeal, Social Security typically pays these past-due benefits within 60 days. Your back pay will include all of the SSDI benefits you would have received had your claim been approved from the start.

What You Need to Know About Social Security Disability Insurance

Social Security Disability Insurance (SSDI) is a federal program that allows disabled workers to receive monthly cash benefits. It was created under the Social Security Act of 1935.

The U.S. Social Security Administration (SSA) administers this program, using strictly defined criteria to determine whether an applicant qualifies for SSDI benefits.

Read What You Need to Know about Social Security Disability Insurance to learn more.

Representative Payees and SSDI

When someone receives SSDI benefits but is unable to manage their finances alone, the Social Security Administration can assign a Representative Payee (RP) to receive the individual’s SSDI benefits on their behalf in order to make sure that their basic needs are met.

Two of the most common situations in which an RP is appointed are when SSDI benefits are being received by a minor or an adult who has been declared “legally incompetent.”

The RP may be assigned by a disability examiner or administrative law judge, or the SSDI recipient may request a payee be appointed. Either way, there are rules concerning the use and management of the SSDI benefits that the RP must comply with.

Read Representative Payees and SSDI to learn more.

What are Work Credits?

You earn work credits for each quarter you earn wages and pay Federal Insurance Contribution Act (FICA) taxes into the Social Security system. The credits are then banked and used to prove your eligibility for SSDI benefits if and when you need to claim them.

You can earn a maximum of four work credits per year. The maximum you will need over your lifetime is 40. The minimum you need to be eligible for SSDI benefits varies according to your age.

Read FICA Work Credits and Social Security to learn more.

Will the SSA Access my Medical Records?

You need the Social Security Administration (SSA) to review your medical records to verify that you are disabled and approve your claim for SSDI benefits. A lack of evidence proving your medical condition is one of the fastest ways for the SSA to deny your claim.

The most reliable way to be sure they have the medical records — the evidence — they need to approve your claim is by you providing them as part of your application.

The SSA does have an obligation to make a “reasonable effort” to look at your complete medical history and to assist you in obtaining the parts of your medical records that you do not have access to. However, these “reasonable efforts” are usually limited to an initial request for the records and a single follow-up.

And the SSA is permitted to make a decision on your claim even when medical records are missing or incomplete.

So, do not count on the SSA obtaining your medical records. Obtain and keep them yourself to give them the proof they need to approve your social security disability claim.

Read Medical Records and Your Social Security Claim to learn more.

What is Supplemental Security Income?

Supplemental Security Income (SSI) is a federal program that provides monthly benefits to disabled workers who do not have enough work history to qualify for Social Security benefits.

You can be eligible for SSI if you:

• Have a sparse employment history
• Have never held a job
• Once qualified for SSDI benefits but are no longer eligible to receive them

You must provide your medical records to show evidence of your disability status.

Read What is Supplemental Security Income? to learn more.

What is the Difference Between SSI and SSDI?

One of the differences between SSI and SSDI is how they are funded. General fund taxes fund SSI, while SSDI is funded by Federal Insurance Contribution Act (FICA) payroll taxes.

Another difference is how eligibility is determined. SSDI is earned through a disabled person’s work history, while SSI eligibility depends on their economic resources.

The waiting period is different, too. SSI has no waiting period, while SSDI has a five-month waiting period before benefits begin to be paid.

SSDI benefits are paid solely and directly to the disabled individual. On the other hand, SSI benefits can sometimes be paid to their dependents.

Another difference is the type of medical benefits attached to each. When you receive SSDI benefits, you become eligible for Medicare two years after being deemed eligible for SSDI. If you receive SSI benefits, you automatically qualify for Medicaid.

Read Distinguishing Between SSI and SSDI to learn more.

Is it Important to Hire an Experienced Attorney?

Yes! The Social Security Administration (SSA) can be a challenging federal agency to work with, so hiring an experienced attorney who has prepared and represented cases specifically involving disability appeal can make a huge difference.

When researching Social Security Disability attorneys, it is important to consider their years of experience, their proven track record, and their understanding of the Social Security system.

When obtaining legal advice regarding Social Security Disability law, you want to know that your law office has the dedication and commitment to help you get the benefits you deserve and the experience to back it up and obtain that positive outcome you need.