Are you seeking information and tips to help you maximize your chances of winning your Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI) claim?
The information on this site is written by Nick A. Ortiz, a Social Security Disability Attorney in Pensacola, Florida. He represents Social Security Disability claimants across the United States.
Here he answers some of the most frequently asked questions about Social Security Disability claims, denials, and appeals.
There are many reasons to apply for Social Security Disability. In addition to cash benefits, you also qualify for medical health insurance benefits. SSI recipients qualify for Medicaid right away, and SSDI recipients qualify for Medicare after two years of receiving benefits.
If you have a disability and are either (1) unable to work or (2) no longer able to work full time, you should file an application for disability with the Social Security Administration.
We help qualified claimants apply for Social Security disability, but we do not handle initial applications for Supplemental Security Income (SSI).
The SSA is required to consider your age, education level, work experience over the past 15 years, and the specific disabling conditions you are suffering from.
There is no age limit to qualify for Social Security disability. In fact, under the right circumstances, one may qualify for Social Security disability from childhood until retirement age.
A number of factors go into the decision, including your age, education, work history, type of disabilities, earnings record, medical evidence submitted, and the Judge assigned to your claim.
You must prove your condition keeps you from working, regardless of whether there are such jobs in your immediate area, and regardless of whether a specific job vacancy exists.
There are at least five types of Social Security disability benefits claims: Disability Insurance, Disabled Widows or Widower’s, Disabled Adult Child, Supplemental Security Income, and Child SSI.
You can use your My Social Security online account to get your Social Security Statement, to review estimates of your retirement, disability, and survivors benefits, plus your earnings record.
This notice may mean that your records show a misspelled name, nickname, or alias. Be sure to respond to Social Security with any requested information so your application moves forward.
Alleged Onset Date is more of a legal term than a medical one. What Social Security is really asking is, “When did you need to stop working full time due to your medical condition or disability?”
You, as a responsible US citizen, can use the SSA’s online form to report allegations of fraud, waste, and abuse in SSA disability programs.
The Social Security Administration (SSA) uses a step-by-step process involving five questions:
- Are you working?
- Is your condition severe?
- Is your condition found in the list of disabling conditions?
- Can you do the work you previously did?
- Can you do any other type of work?
For Disability Insurance, Disabled Widow’s or Widower’s, or Disabled Adult Child benefits, it doesn’t matter how much money you have. For SSI, you will need to go through a financial screen.
To be eligible for disability benefits, a person must be unable to engage in substantial gainful activity (SGA). The amount of monthly earnings considered as SGA depends on a person’s disability.
If you don’t have enough work credits and have limited income and assets should apply for SSI. Anyone who has enough work credits (quarters of coverage) should apply for Social Security disability.
Disability benefits may be payable to a widow or widower if they meet all of the requirements:
- They are between ages 50 and 60;
- They meet the definition of disability for adults; and
- The disability started before the worker’s death or within seven years after the spouse’s death.
A person can receive benefits as a surviving divorced spouse on the Social Security record of a former spouse who died fully insured if he or she:
- Is at least age 60, or age 50 and disabled;
- Was married to the former spouse for at least 10 years; and
- Is not entitled to a higher Social Security benefit on his or her own record.
You may also qualify for a “lump sum” back payment and Medicare (however, there may be an additional wait time before Medicare starts).
There is no time limit to file an application for SSD or SSI benefits, but any appeals must be filed within a certain amount of time, usually 60 days.
If your application or appeal for Social Security Disability is approved, then you may be eligible for state or federal health insurance, which may pay some of your medical bills.
Under certain circumstances, special extra earnings for your military service from 1957 through 2001 can be credited to your record for Social Security purposes.
Even after scouring the internet and reading up on claims, the vast majority of SSDI and SSI claimants will have no idea how to thoroughly and properly prepare a disability claim for a hearing.
A lawyer may be able to help you turn things aground if you left out important information in your application; however, there is no guarantee.
For Social Security lawyers, the fee is only 25% of the “past-due” benefits you are awarded. The maximum fee is set at $6,000. The attorney will be paid only out of your back pay, or past-due benefits.
Submit any and all medical records you have in your possession to Social Security when you first apply, continue to get ongoing medical treatment and try not to go more than 3 months between visits.
When you file a claim in person or by phone, an SSA representative will interview you and complete the application for disability benefits and the Adult Disability Report. You can also file online.
You must have earned a certain number of work credits and meet Social Security’s definition of disability to qualify for SSD benefits.
The steps in the SSD application and appeal process are:
1. Apply for Benefits
2. File a Request for Reconsideration
3. File a Request for Hearing
4. Request a Review by the Appeals Council
5. File a Lawsuit in Federal Court
The most common abbreviations in Social Security Disability claims are SSD/SSDI, AOD, and CE: Social Security Disability Insurance, Alleged Onset Date, and Consultative Exam
You can collect early retirement while applying for the disability income. Once found disabled, you can collect disability pay until full retirement age when you will collect full retirement.
You can collect these benefits at the same time, but there may be set-offs of each other where the total benefit amount typically cannot exceed what you were made before you went out on disability.
SSD claims are subject to a 5-month “waiting period” wherein the Social Security Administration (SSA) does not pay the claimant any disability benefits until the 6th month after the onset date.
The first tip to help give you the absolute best chance of winning is to make sure you submit ALL relevant medical records to Social Security or give them to your attorney to give to Social Security.
Generally, you have 60 days after you receive the notice of our decision to ask for any type of appeal. The SSA presumes you received the letter 5 days after it is mailed.
Generally, you need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled. However, younger workers may qualify with fewer credits.
The Social Security Administration manages the SSI program. SSI makes monthly payments to people who have low income and few resources and are:
- Age 65 or older;
- Blind; or
Supplemental Security Income (SSI) benefits are available to anyone who is disabled and has limited income, limited resources, files an application, and meets certain other requirements.
Under SSI, income includes cash, checks, and other things you get that can be used for food or shelter. A single person can have resources worth up to $2,000 and still get SSI.
If you are the surviving spouse, you may be eligible to pursue the claim and receive payments. For an adult SSI claimant, only the claimant’s spouse is eligible to receive payments.
Social Security advises that it may take up to 180 days to issue a decision on a Social Security Disability Insurance (SSDI or SSD) or SSI claim.
Social Security has a backlog of cases. There are so many open disability cases, it takes a long time for the SSA to process all of the claims.
You can request a quicker decision with a “dire need letter.”
You can check the status of your claim at www.ssa.gov. If you do not have online access or are otherwise unable to check the status of your application online, you may also call the SSA.
Most SSD or SSI claims are initially processed through your local Social Security Administration (SSA) field office and State agencies (usually called Disability Determination Services or DDS).
Social Security Disability claims examiners make the initial decision on an applicant’s medical eligibility for Social Security Disability (SSD) and Supplemental Security Income (SSI) claims
A Claims Representative (CR) works in the District Office and assists individuals in establishing entitlement to disability benefits under the SSA’s SSDI and SSI programs of benefits.
Most Social Security Disability claims are initially processed through a network of local SSA field offices and State agencies usually called Disability Determination Services (or DDSs).
The Virtual Screening Unit is a stage between Reconsideration and a Hearing. A Senior Attorney will review the claim and determine whether a decision can be made “on the record” without a hearing.
The number-one mistake claimants make is failing to appeal in a timely manner as you only have sixty (60) days from the date of the denial to appeal. You can appeal by mail or on the SSA website.
You can appeal online at https://secure.ssa.gov/apps6z/iAppeals/ap001.jsp or you can request the appeal paperwork by mail by calling 1-800-772-1213.
There is no set time limit to process an appeal and there is no way to know exactly how long a Social Security disability appeal will take.
The SSA’s three levels of administrative appeal are Request for Reconsideration, Request for Hearing Before an Administrative Law Judge, and Request for Review by the Appeals Council.
The judge, and then your attorney, will ask you questions about your limitations. If a medical or vocational expert is present, the judge or your attorney may ask questions of the expert as well.
You and your lawyer may discuss ways to demonstrate your abilities and limitations. You might also examine medical records and work history to prepare for the hearing.
You have the right to file an appeal with the Appeals Council or to start a new claim.
If you disagree with the Appeals Council’s decision you would then have to go to the last level of the appeals process which would be to file a civil suit in a federal district court.
Your impairment must have prevented you from doing SGA for at least 12 months or will be expected to prevent you from doing SGA for at least 12 months.
There are no “automatic” wins in disability. Some conditions are more likely to win than others, and some conditions are more likely to win earlier in the disability review process than others.
Your residual functional capacity, or RFC, is the most you can still do despite your limitations. Social Security will assess your RFC based on all the relevant evidence in your case record.
It is common for mental health specialists to make notes about office visits that are not very detailed, or there may be a lack of medical records altogether if you don’t see a mental health doctor.
As a matter of fact, Social Security must evaluate all of your conditions in making a disability determination, including those that are not categorized as severe.
Having diabetes by itself usually will not qualify you for Social Security Disability, but most diabetic applicants suffer from related medical problems and symptoms that limit their ability to work.
Cancer claims are often denied based on the “one year rule”, which states that the condition must be expected to remain severe enough to prevent work activity for at least 12 continuous months.
Social Security continues to uphold that a migraine headache disorder will rarely prevent a person from working for a continuous 12 months but that there are exceptions.
If Lyme disease keeps a Social Security disability claimant from being able to work eight hours a day, five days a week, such individuals may be eligible for Social Security disability.
Because you cannot see Fibromyalgia on an X-Ray or MRI, many judges (and doctors for that matter) are skeptical as to the existence and severity of the impairment.
Failure to follow a doctor’s orders or prescribed mode of treatment is an easy way for your claim to be denied. Your non-compliance will be noted in the medical records.
A medically determinable impairment results from anatomical, physiological, or psychological abnormalities which can be shown by medically acceptable clinical and laboratory diagnostic techniques.
Documentation of impairment must come from medical professionals as defined by SSA regulations as “acceptable medical sources”, then other evidence is considered in assessing impairment severity.
Per CFR § 404.1513, subsection (a), acceptable medical sources are licensed physicians, licensed or certified psychologists, licensed optometrists, licensed podiatrists, and qualified speech-language pathologists.
Drugs and alcohol are a problem because the Social Security Administration may deny benefits where it finds such use is a “material contributing factor” to the disability.
The Baker Act provides legal procedures for mental health examination and treatment, including voluntary admission, involuntary examination, and involuntary inpatient or outpatient placement.
The SSA is not bound by the VA determination and has separate rules and regulations as to how to qualify for SSD benefits.
The best place to find an estimate of your monthly benefit would be to download your personal Social Security Statement. You can go to SSA.gov to download a copy of Your Social Security Statement.
If you file an individual federal tax return and your total income is greater than $25,000 or you file a joint return and the income of you and your spouse is greater than $32,000 then yes, you must pay federal income taxes on your Social Security Disability benefits.
There are a number of circumstances in which the Federal government can garnish “regular” Social Security benefits. SSI benefits can never be garnished.
Our list of acronyms and abbreviations used by the SSA may also help you understand key terms in a Social Security Disability claim.