Social Security Disability Insurance

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 What Is Social Security Disability Insurance?

Social security refers to a broad program which uses public funds to provide a small amount of economic security for the public as a whole. In the United States, employers and employees are required to pay social security taxes. The money that accumulates from these taxes would then provide benefits for those who have reached retirement age, or are otherwise eligible to receive such funds. The intention of such a program is that when everyone retires, they will have some type of funds available in order to keep the economy flowing.

Social security also refers to a government program in place to provide financial support for the disabled. Over the course of an employee’s working life, they may pay a certain percentage of their income to the government in the form of social security taxes. Once they retire, or become disabled, the government sends them monthly payments based on how much they paid in social security taxes while working.

Social Security Disability Insurance, or SSDI, is a government program offering monthly cash benefits to those who meet specific qualifications. This generally includes people who are under the age of 65, and who have both a qualifying disability and sufficient work credits. Work credits refers to work history in which they paid into the Social Security system.

Supplemental Security Insurance, or SSI, is a different program which maintains different eligibility criteria. Low-income people who have a qualifying disability, but have little to no work credits, are the most common recipients of SSI. Some recipients are those who have never actually worked before. Both SSDI and SSI are assistance programs overseen by the Social Security Association, or SSA.

To put it simply, the major difference between SSDI and SSI is that eligibility for SSI is primarily determined by age and disability, in addition to limited income and other resources. SSDI, alternatively, bases its eligibility criteria on disability and accumulated work credits.

What Disabilities Qualify for Social Security Disability Insurance (SSDI)?

There is a relatively wide range of disabilities that could qualify a person for receiving SSDI. When the SSA is determining whether a person’s disability qualifies for receiving benefits, they consider four different factors:

  • If the applicant’s inability to earn enough money is due to their disability. If a person can no longer work, or cannot work enough in order to make a liveable income, they may qualify for SSDI;
  • The severity of the disability as it relates to work-related tasks. The disability must be permanent, and be so severe that a person cannot perform basic work-related tasks. This qualification is further discussed below;
  • Whether there is medical documentation of the disability, and how that affects a person’s ability to work. Some disabilities will automatically qualify for SSDI income without proof of other measures. Generally speaking, applicants must provide substantial medical documentation from their doctor; and
  • Administration of a work test. The SSA will also conduct a work test in order to determine if a person can perform the same kind of work or profession as they did before the disability occurred. If they cannot, SSA will then determine whether the applicant could perform a new job given their age, education, and work experience.

As previously mentioned, whether a disability is total or partial will determine if an applicant receives benefits. Partial disability is defined as any type of disability in which the person is unable to perform a job at full physical capacity. This is common in cases involving an on the job injury, or because of illness. Alternatively, a total disability is one in which the employee is prevented from performing any work at all as a direct result of the injury or condition.

This is generally defined as the loss of the use of both:

  • Legs;
  • Arms;
  • Hands;
  • Eyes; and/or
  • Impairment due to a serious occupational disease.

Disabilities that qualify for SSDI are grouped according to the body system, such as digestive system, skin disorders, etc. They are also grouped according to whether the disabled person is an adult or a child. A comprehensive list of qualifying disabilities, as well as updated information regarding evidentiary requirements and the like, can be found on the SSA Gov Website.

How Do I Apply for Social Security Disability Insurance? How Much Money Will I Receive from SSDI?

The Social Security Administration maintains local offices in most major cities. There are three ways in which you may apply for SSDI:

  1. Call the SSA’s toll-free number, listed on their website, in order to apply over the phone;
  2. Apply online at the SSA website; or
  3. Visit your local SSA office to apply in person.

The SSA website also provides a toolkit of sorts for educating yourself about SSDI, as well as the application process.

No matter how you choose to begin the application process, you should ensure that you have all necessary and relevant documents readily available. For those applying in person at their local SSA office, there is a much better chance of your questions being answered if you are unable to find necessary documentation. Over the phone or online applications will require the most preparation on your part.

Knowing when to apply for SSDI is just as important as knowing how to apply for benefits. It is recommended that you apply as soon as you become disabled. This is partially because SSDI monetary benefits do not begin until the sixth full month of disability, per their website. The SSDI waiting period begins with the first full month after the date in which SSA determines your disability began.

How much money you will receive from SSDI will vary greatly according to many different factors. The SSA uses its own formula to determine the cash amount distributed to each recipient, each month. Such factors include a person’s work history, and whether they are receiving income from any other sources. In 2021, the average monthly SSDI payout was $1,277. Generally speaking, most applicants receive between $800 and $1,800.

What Could Cause an SSDI Claim to Be Denied? What Happens if the Claim is Denied?

It is not at all uncommon for SSDI claims to be denied. There are several reasons why an SSDI claim could be denied. The most common examples include:

  • The applicant makes too much money, or technically has enough income, even if it is not as much as they made prior to their disability;
  • The applicant failed to submit substantial medical documentation of their disability;
  • The SSA determined that the applicant can perform another type of job; and/or
  • The applicant does not have enough work credits with the SSA needed to receive benefits, and would therefore need to apply for SSI.

Denied applicants may be entitled to an appeal. Generally speaking, there are four steps to contesting the denial of your benefits once you have received notice of your denial:

  1. A Written Request for Reconsideration. The SSA will review your claim; however, the officials responsible for denying your claim from the beginning will not be the party reviewing the claim. There must be a medical consultant as well as an examiner that reviews the claim. At this stage, there are a few claims that may get overturned, and you will begin to receive benefits. Most claims will be denied again. If denied at the reconsideration stage, you should receive another written notice of the denial and a description of the next steps to appeal;
  2. A Hearing With an Administrative Law Judge (“ALJ”). ALJs are specific attorneys who hold a hearing, in which the applicant must appear in order to have their claim heard. The ALJ determines whether the benefits denial should stand. If not, they will overturn the denial and the applicant can begin receiving their due benefits. Roughly half of those who have a hearing with an ALJ will receive benefits;
  3. The Appeals Council. If your claim was still denied after an ALJ hearing, you can appeal to the SSA Appeals Council. However, the council is not obligated to hear your case; they may choose to do so if the ALJ made an error or otherwise mishandled the case. Getting heard by the council may be difficult, and winning a case with the council is unlikely; and/or
  4. Filing a Lawsuit Against the SSA in Federal Court. This last option is only available after going through the first three. This is a time consuming and expensive process; however, a few cases may be remanded to an ALJ for reconsideration. It is worth pursuing if you genuinely feel that you are being wrongly denied SSDI benefits.

Do I Need an Attorney for Assistance with Social Security Disability Insurance?

If you have applied for SSDI and were denied, you should consult with a local social security disability attorney. An experienced local government attorney may be able to represent you at no cost. They can also assist in preparing your case for an ALJ hearing, so that you have the best possible chance of a favorable ruling.

For all stages of the SSDI appeal process, there are firm deadlines which must be met. Should you fail to follow the requirements for the appeal, or fail to meet any deadlines, your claim will be denied and you could be prohibited from seeking an appeal. An attorney can also inform you of your legal rights and options, as well as the process and what to expect.

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