A work accident, car wreck, or a serious disease diagnoses can all result in a person’s inability to provide for their family through gainful employment. As a safeguard for these situations, the government has provided an income to take care of a family’s needs – Social Security Disability Insurance (SSDI). However, the process to qualify for this benefit can be complicated and intensive. Fortunately, the Social Security Administration has laid out steps to make the process as efficient as possible.
Preparing to Apply for Social Security Disability
The first step is confirming your income does not exceed the substantial gainful activity (SGA) limit set by the government. If it does exceed the SGA, you are ineligible for SSDI and will be automatically turned down. The current SGA amount can be found at http://www.ssdrc.com/disabilityquestionsmain2.html.
The second step is to find out if your health care provider will support your application for SSDI. If your claim is initially denied and goes to the appeal level (as most do), your application will be heard by an administrative judge. Your attorney or representative will need a statement from your physician confirming your disability prevents you from earning a substantial or gainful income. You need to make sure your doctor is willing to participate in this, sometimes time-consuming, process.
Before application, you need to gather your medical records, including medical history, medical conditions, dates and locations of treatment, and contact information for the physician who treated you. The most emphasis will be placed on the medical records dated for the previous three months. However, older records are also needed because they detail the onset date of your disability, when you will be eligible for Medicare, and the amount of disability back pay.
SSA will also need your employment history for the last 15 years, including job duties, so the SSA can determine if you can or cannot perform in your current medical condition. Supplying all this information upfront prevents your examiner having to devote the additional time to gather the documents. This allows your claim to move more efficiently through the system.
Initial Application Process
Once you gather all the information, you can apply for SSDI three different ways. 1) Complete your application on line by following the link https://www.ssa.gov/applyfordisability. The SSA will inform you of the decision by mail. 2) Call the toll-free number 1-800-772-1213. 3) Make an appointment at your local Social Security office to meet with a disability examiner.
If Your Initial Claim is Denied
The Social Security Administration denies 64% of all cases at the initial application level. However, the process provides you with an opportunity to appeal the denial. Details of how to appeal are explained on the denial notice. If the denial was based on the severity of your disability, you can appeal online at https://secure.ssa.gov/iApplsRe/start. If you were denied for non-medical reasons, contact your local SSA office to request an appeal.
The first step in the appeal process is the review of your claim by a SSA representative who did not participate in the original review. Fourteen percent of claims are approved at this level. If this step also results in a denial, you may ask for a hearing by an administrative law judge within 75 miles of your residence. At this hearing, the judge will question you and your witnesses either by phone or video conference. You and your representative/attorney should attend. The court will notify you of the judge’s decision by mail. These hearings result in a 62% rate of approval – the highest rate in the entire process.
If the claim is denied at the hearing level, you can ask for a review by Social Security’s Appeals Council. First, they have to agree to review your case. If the Appeals Council agrees to review your case, they will mail you the decision. The Appeals Council may also choose to send the case back to the administrative law judge. The success rate at this level is only 13%. The last chance to get a claim granted is the Federal Courts. This step involves filing a lawsuit in a federal district court. How to file this lawsuit will be detailed in the decision letter by the Appeals Council. Nationwide, 40% of cases at this level are approved.
“Tips to Prepare for Filing for Social Security Disability or SSI,” Social Security Disability SSI Resource Center
“Disability Planner: How You Apply, ”Social Security Administration
“Social Security Disability, SSI: What is the Rate of Approval” Social Security Disability SSI Resource Center
“The Appeals Process” Social Security Administration