Applying for Social Security Disability Insurance can seem like a daunting task. Who gets approved and why often seems mysterious, random and sometimes unfair. This article will attempt to break down both the application and appeals processes into manageable and understandable steps.
There are two types of disability benefits available through the Social Security Administration (SSA):
• Social Security Disability Insurance (SSDI) - Pays benefits if you have worked long enough and have paid Social Security taxes within the past five years.
• Supplemental Security Income (SSI) - Pays benefits based on your financial need.
If you're unsure which program you qualify for, use the Benefits Eligibility Screening Tool to see which program you may be eligible for. The steps and information in this article apply only to SSDI. For more information about applying for SSI, see: Supplemental Security Income Home Page
How SSA Decides If You Are Disabled
In determining whether or not you are disabled, SSA ask five questions:
Are you working? If you are working and earning an average of more than $980 a month, they do not consider you disabled.
Is your condition "severe"? Your condition must interfere with basic work-related activities.
Is your condition found in the list of disabling conditions? The SSA has a list of conditions they consider so severe, they automatically mean you are disabled. If your condition is not on the list, they have to decide if it is equal in severity to another condition on the list. To check the SSA list of disabling conditions, see: Listing of Impairments If your condition is not on the list or equal in severity, they move to question four.
Can you do the work you did previously? If the SSA determines that your condition does not interfere with the work you previously did, your claim will be denied. If it does interfere, they then proceed to question 5.
Can you do any other type of work? It's not enough just to be unable to do your previous job. They also look at your medical conditions, age, education, past work experience and transferable skills to determine if you could adjust to doing other types of jobs.
For answers to frequently asked questions about how the SSA determines the answers to questions four and five, see: Work and Education Information the SSA Needs
The SSDI Application Process
If after answering the five questions you feel you would qualify for disability benefits, it's time to file your application. The SSA provides a Disability Starter Kit to help you. The kit includes a fact sheet of basic information, a checklist of the information and documents you'll need to gather, a worksheet to help you prepare for your disability interview, and a link to an online application. If you prefer not to apply online, you can call the SSA at 1-800-772-1213 to request an application or visit your local SSA office. If you have any problems filling out your application, you can request help from your local SSA office.
SSDI benefits will not be paid until you have been disabled for at least five continuous months. After being disabled for two years, you will qualify for Medicare. But don't put off applying because the longer you wait, the longer it will be until you can start receiving benefits. As soon as you know you won't be able to work for at least a year, file your application.
Here are some tips to remember when applying for SSDI:
• There are only two things you have to prove: 1) that you are unable to do any substantial work due to your medical condition; and 2) that your condition must be expected to last at least one year or be terminal.
• When filling out forms or answering questions during your disability interview, be honest, but only answer the questions you're asked. Don't give additional information. It may be tempting to stress what a hard worker you were, what a good education you've had, or how successful you've been. Resist that temptation. Remember, they're going to be looking for any kind of work you may be able to do. Volunteering unasked for information will only give more potential options for denying your claim. It might be good to apply part of the Miranda Rights statement here, "Anything you say can and will be used against you..." (Note: I'm not suggesting you try to cheat the system. If you're able to do some kind of work, then you should do so. I'm just saying not to make things harder on yourself by creating more things you have to prove you can't do.)
• Be sure to list all your symptoms and medical conditions. You may be more likely to be approved for something other than your primary diagnosis. For example, I know of a number of fibromyalgia patients who were approved for SSDI based on their Migraines or depression rather than their fibromyalgia.
• The SSA will request your medical records from your doctor(s). The fact that your doctor says you're disabled is not enough to qualify you to receive SSDI benefits. Your medical records will need to show a history of your symptoms, diagnoses, test results, and treatments as well as physical limitations and dysfunctions. It's best if you've been seeing one doctor for a long period of time. This provides an easily traceable record of the progression of your condition, tests done, treatments tried, etc.
• You need to be seeing your doctor on a regular and fairly frequent basis to show that you're seeking treatment for ongoing problems. Just going to the doctor once a year is probably not going to be enough to convince them that your condition is severe enough to prevent you from working.
• The kind of notes your doctor has made in your file can make a big difference in the SSA's decision. Unfortunately, just noting that you have a herniated disk or fibromyalgia is not enough. They want to know how your condition has affected your ability to function and do your job. Pain is subjective and difficult to prove. What carries more weight is comparisons between what you used to be able to do and what you can do now. Help your doctor make good notes by being clear about the physical limitations your condition has caused you and how it has impacted both your daily functioning and your work. For example, "My old job required me to sit at a computer all day. Now I can't sit for more than 20 minutes before the pain is so bad I'm not able to concentrate."
• Get copies of your medical records and submit them with your SSDI application. Although this is not required, it can speed up the processing of your claim significantly. One of the main reasons SSDI claims take so long to process is because they are waiting to receive your medical records from your doctor. Applications that come in complete with medical records are processed much more quickly. It also helps ensure the SSA has all of your information to consider. If enough time passes and the SSA hasn't been able to get your medical records, they will make a decision based on the information they have. In order for you to have the best chance of being approved, they need to have all of your records.
Once you have submitted your application, the SSA may request that you be examined by one of their consulting doctors. This generally happens if they don't feel they have adequate information from your regular doctor(s) to make a determination. If you're asked to do this, be sure to keep the appointment, cooperate fully with the doctor, and answer any questions honestly.
According to the SSA, it usually takes about three to five months from the time you submit your application to get a decision. Approximately 35% of claims are approved at this stage. If your claim is denied, don't give up. Most claims are not approved without going through the appeals process and being heard by an Administrative Law Judge.
The Appeals Processing
There are four possible steps to the appeals process:
• Reconsideration - If your initial SSDI application is denied, you have 60 days to file an appeal. At this point, you need to complete a Request for Reconsideration and an Appeal Disability Report. Both forms can be filled out online or you can request them from your local SSA office. Someone at the State Disability Determination Services office will review your medical records (not the same person who made the initial determination) and make a new determination. Only about 15% of appeals are approved at this level.
• Hearing - If your appeal is denied, you have 60 days to request a hearing before a judge. Again, you'll need to complete two forms: a Request for Hearing by Administrative Law Judge and an Appeal Disability Report. As before, both forms can be filled out online or you can request them from your local SSA office. At this point, most people seek representation by an attorney or other qualified representative. Although you can get a representative at any point in the process, it's highly recommended when you're preparing for a hearing. Lawyers take SSDI cases on a contingency basis - if you don't win, they don't get paid. If you do win, fees are set by the SSA. Your legal representative will receive either 25% of the back benefits you receive or $5,300, whichever is less. The good news is that nearly 70% of claims are approved when heard by a judge.
• Appeals Council Review - If the judge denies your claim, you can request a review by the Appeals Council. Whether to appeal the judge's decision or start the process over with an entirely new SSDI application is something you should discuss with your SSDI attorney. Since your chances of approval dwindle at this point, you'll need to decide which course would be your best option. If you decide to appeal, you'll need to complet a Request for Review of Decision/Order of Administration Law Judge. This cannot be done online. You'll have to get the form from your local SSA office. Your request will be sent to the Office of Disability Adjudication and Review, where someone will review your records and make a decision.
• District Court Case - Finally, if the Appeals Council denies your appeal, you can have your attorney file a case against the SSA in District Court. Your case will be heard by a district judge, who will make the decision.
Applying for and receiving SSDI is not an easy or quick procedure. It can easily take a couple of years to go through the entire process. But if you're unable to work because of your medical condition, don't hesitate to file. SSDI is not charity. It's insurance that you've paid for with your Social Security taxes. If you're disabled, you're entitled to it.
(2009, April 2). Disability Programs. Retrieved May 29, 2009, from Social Security Web site: http://www.ssa.gov/disability/
Morre, Tim Social Security Disability SSI Benefits. Retrieved May 29, 2009, from Disability Secrets Web site: http://www.disabilitysecrets.com/
Matallana, Lynne (2005, July 27). How to Apply for Social Security Disability Insurance Benefits . Retrieved May 29, 2009, from National Fibromyalgia Association How to Apply for Social Security Disability Insurance Benefits Web site: http://www.fmaware.org/site/News2?page=NewsArticle&id=6245