Social Security Disability Insurance (SSDI)

People who are physically or mentally disabled can receive Social Security Disability Insurance, or SSDI. This provides monthly income to people with medical conditions that prevent them from obtaining or sustaining gainful employment. The SSA decides if someone is qualifies for SSDI benefits with seven criteria:


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Social Security Disability Insurance (SSDI)

People who are physically or mentally disabled can receive Social Security Disability Insurance, or SSDI. This provides monthly income to people with medical conditions that prevent them from obtaining or sustaining gainful employment. The SSA decides if someone is qualifies for SSDI benefits with seven criteria:

  • The applicant must be either unemployed or earning less than $1,010 a month.

  • The disability prohibits the applicant from successfully completing the job-related tasks usually does.

  • The applicant cannot find new work due to the disability, age, education, experience or skills.

  • The condition is on the Social Security Administration's list of disabilities.

  • If the condition is not on the list, it is severe enough to be the sole cause the applicant's inability to work.

  • The condition will last at least one year or is expected to result in death.

  • The applicant has been disabled for at least five months before applying.

Work Credits

Beyond medical qualifications, potential beneficiaries must meet age and work credit guidelines. People who are 22 or 23 must have earned at least six work credits before the disability began. Applicants who became disabled between ages 24 to 30 need to have worked at for at least half of the years between 21 and the onset of their disability. People age 31 to 42 need 20 work credits to qualify to SSDI benefits. The number of work credits needed increases by two each year until age 62, where it levels out at 40 credits. Adults who became disabled before age 22 and disabled children can qualify for SSDI benefits if their parent or legal guardian earned enough credits, according to their age.

Applying

Most of the application process for Social Security Disability Insurance can be completed online. Similar to the process for other Social Security benefits, the online SSDI application requests potential beneficiaries' names, birth days, Social Security numbers, marital status and spouse and dependent information. Applicants must then describe their condition in detail on the Adult Disability Report.

The final step of the SSDI application process requires the applicant to print out, fill out and sign the Authorization to Disclose Information form, which gives the Social Security Administration permission to access the applicant's medical records. The completed form must be mailed to or handed in at the nearest Social Security office to complete the application process.

The Social Security Administration requires applicants to provide detailed medical records to back their claim. However, potential beneficiaries are not required to turn in their medical documentation with the application. Part of the application involves filling out a form that lists all doctors, specialists and health care facilities from which the applicant received care for their condition. He must then sign a medical release form giving the SSA permission to request all medical record from the sources directly.

Once the Social Security Administration has the information they need, it can still take three to five months for it to make a decision. This is due to the detailed and thorough nature of the investigation and should be expected in most cases. However, the SSA will provide benefits very soon after application for people with certain conditions, including Amyotrophic Lateral Sclerosis (ALS), Tay Sachs Disease and pancreatic cancer. These exceptions are called compassionate allowances and are provided to people who require more immediate assistance.

Appealing a Denial

Jim Sokolove, an attorney specializing in Social Security disability claims, explains that while over 60 percent of SSDI application are denied, many appeals are ultimately successful. "In fact," he states, "about half of those who are initially denied and make the decision to appeal ultimately receive monthly SSDI cash payments." Most often, the denial is a result of insufficient evidence of a condition severe enough to prevent the applicant from working. The appeal process has four levels, and a successful appeal requires preparation and knowledge of how each one works.

Reconsideration

For the first appeal, applicants must file the Request for Reconsideration, Authorization to Disclose Information and Appeal Disability Report forms. Each of these forms is available on the Social Security Administration's website or at a local SSA office. On the Request for Reconsideration form, applicants provide information about their denied claim, and the reason they are appealing the decision. The Authorization to Disclose Information form simply reauthorizes the SSA to examine your medical history. The Appeal Disability Report is where applicants detail their condition and how it has hindered their ability to work. You must complete and mail the appeal documents to the local SSA office within 60 days of the denial notice.

Hearing

If the first appeal is unsuccessful, the next step is a hearing with an administrative law judge. Applicants can download the Request for Hearing by Administrative Law Judge form, the Claimant's Recent Medical Treatment form and Claimant's Medications form from the SSA website. As with the previous appeal, applicants must complete and mail the forms by the 60-day deadline. Many applicants opt for legal representation at this stage and for any subsequent appeals to ensure they are getting the full protection and benefit of the law. At the hearing, the judge will examine the evidence and make a decision. Some cases require continuances to gather more documentation or to give the judge time to further explore some aspect of the case.

Appeals Council

The third level of the appeal process is a review of the judge's decision by the Appeals Council. Applicants can download the Request for Review of Decision/Order of Administrative Law Judge form from the SSA website. As with the previous appeal paperwork, the form requires the claimant to provide a reason for their appeal and any additional evidence. Again, the SSA must receive the appeal within 60 days of the judge's decision. The Appeals Council sends decisions by mail, and it can take from 30 to 60 days to receive an answer.

Federal Court

The final appeal option is filing a civil action suit in federal court. This step requires the expertise of a knowledgeable attorney to ensure all evidence and other documentation is in order. The attorney will file the suit at the district court house in the jurisdiction in which the applicant resides, but the applicant does not have to actually go to court.

During a federal review, the judge does not make a determination of disability and applicants are not allowed to enter any new evidence of their disability. Instead, the judge reviews all previous evidence and documentation of the previous appeals. He then decides if the SSA followed the proper procedures during the appeal process and determines if the previous decision was correct. A federal judge's decision is the final say on the matter.

Supplemental Security Income (SSI)

SSDI recipients and people over age 65 who live in low-income households may also qualify for Supplemental Security Income, or SSI, benefits. SSI provides additional monthly payments to help beneficiaries make ends meet. It also automatically qualifies them for state-run programs such as Medicaid.

Potential SSI recipients do not have to meet any work credit requirements, but their total household income and assets must be below the SSA's thresholds. Single SSI beneficiaries must not have more than $2,000 in assets such as cash, jewelry, artwork, investments or bank account funds. Married recipients can have up to $3,000 in assets. The SSA excludes vehicles worth up to $4,500 and primary residences. People who receive SSI must also have an annual household income that falls below the poverty level in their state.

The Social Security Administration requires applicants to appear in person at a local SSA office to apply for benefits. All SSI applications must include income verification documents for all members of the household. These include paystubs, benefit statements from social service programs, tax forms, bank statements, house deeds and car titles.

Losing Benefits

Disability benefits are not permanent. The Social Security Administration performs continuing disability reviews, or CDRs, every one, three or seven years to determine if beneficiaries require continued assistance. These reviews are similar to the initial application process, requiring forms such as the Adult Disability Report and the Authorization to Disclose Information forms. Failure to respond to the SSA's request for this documentation can result in the loss of benefits. If the SSA finds that the beneficiary's condition has improved enough to allow him to go back to work, it will provide up to three additional months of unrestricted assistance to give the beneficiary time to find work.

SSDI recipients can appeal the SSA's decision to stop benefits. The appeal process is the same as an initial application appeal and beneficiaries must present evidence that their condition still prevents them from working. The SSA will continue to pay benefits during the appeal process. However, if a beneficiary loses the appeal, he will be responsible for returning all benefit payments made during that time.

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