SSDI Social Security Disability: Eligibility, Benefits, Filing Claims & Appeals

  1. This article answers the most frequent questions about the Social Security benefits application and appeals processes. It covers SSI, SSDI and SSA procedures. The Social Security SSDI & SSI Benefits FAQ covers questions about child benefits, payment determination, working while receiving Social Security benefits and more.

    What is the difference between SSDI and SSI?

    SSDI (Social Security Disability Insurance) is funded by the workers. The Social Security taxes that have been paid by workers, their employers and self employed people are used to make the SSDI program possible. SSI (Supplemental Security Income) Supplemental Security Income is not funded by Social Security taxes. SSDI is a Federal income supplement program that is paid for by general tax revenues that are collected from taxpayers. SSI is usually a program designed to assist people with a significantly low or no income level.

    What is the Social Security Administration (SSA)?

    The United States Social Security Administration is an independent agency of the United States federal government that administers Social Security programs. The Social Security program is “insurance” that covers retirement, disability, and survivors' benefits and qualification (and funding) is provided by workers who pay Social Security taxes on their earnings as well as their employers who make contributions. The SSA handles both applications and appeals for Social Security benefits eligibility.

    What is the “Disability Determination Services” (DDS)?

    The Disability Determination Services (DDS) consists of divisions located across the United States which work with the SSA to process disability claims for benefits such as SSDI (Social Security Disability Insurance) and (SSI) Supplemental Security Income Disability Programs. The DDS follows federal laws and regulations to make decisions on eligibility for disability programs based on the following criteria:
    • Medical Criteria
    • Medical and Psychological Evidence
    • Vocational Criteria
    • Consultative Evaluation
    • Continuing Disability Review

    A DDS may request information from your treating physician. They may approve or deny your application for Social Security benefits.

    At what time can I or should I apply for SSDI?

    Once you feel you are disabled and believe that you qualify for SSDI, you can and should apply for SSDI. While a requirement is that the disability is expected to last 12 months, you do not need to wait this entire time before filing an application. It is only necessary that the disability is expected to last for at least 12 months or result in death.

    What impairments and disabilities do Social Security programs cover?

    The SSA Listing of Impairments is a comprehensive list of impairments, illnesses, diseases and disabilities which qualify for Social Security disability benefits. Merely being afflicted by an ailment does not automatically qualify you – a mental and/or physical impairment is considered significant only if it prevents you from undertaking “substantial gainful employment”. Other requirements may be required in order to be eligible for Social Security disability payments.

    How can Social Security deny my SSDI application when Workers’ Compensation determined that I am disabled?

    Each disability program and organization may define the term “disability” differently. Qualifying for one group may not be sufficient for another. The Veterans Administration has the most liberal definition for “disability” while Social Security has the strictest. Many workers’ compensation and private disability programs have a definition of “disability” that falls somewhere in the middle of the spectrum.

    What can I do if my application for disability benefits was declined?

    Many people are declined for benefits the first time they apply. Instructions on how to appeal are on the back of the notice of the decision to deny you benefits. Many people turned down for benefits will consider using an experienced Social Security Disability Lawyer for the appeal.

    What is the job of the Administrative Law Judge?

    An Administrative Law Judge (ALJ) is a lawyer who is employed by the SSA (Social Security Administration) to act as a judge on hearings that have not been resolved by the processes of the SSA.

    What steps might I be required to take, including appeals, before being approved for SSDI?

    The first step is to apply for benefits. After your application is received it will either be approved or denied. Even if approved at this early stage it could be denied after being reviewed by the Quality Review Board or sometimes called the Disability Quality Branch (DQB). The DQB randomly samples decisions to ensure that Social Security's disability rules and regulations are being implemented properly by various state agencies. This process is also known as Quality Control. You should begin to receive your benefits soon after you are approved (assuming you’ve completed the waiting period of five months for SSDI).

    If your application is denied then you could apply for reconsideration of the decision. The state agency that handles disability claims for the SSA will review your application again – it might also be subject to a Quality Control review by a DQB. The DQB or the agency might deny your reconsideration request.

    If you are still denied, then you would then need to apply for a hearing before an administrative law judge (commonly referred to as an “ALJ”). The ALJ would make a decision to approve or deny your application, also potential subject to a Quality Control review. If the ALJ denies your application, you may appeal the decision of the ALJ by making an appeal with the Social Security Administration Appeals Council. IF the SSA Appeals Council denies your application, any appeal would need to be filed in a United States Federal District Court.

    Will my SSDI be reviewed and if so when? Might I lose the benefits I have been receiving?

    Periodically, all SSI and SSDI cases are reviewed to determine whether the recipient has encountered medical improvement. The Continuing Disability Review process is usually done by a DDS office. The review period varies between at least once every three to ten years. The longer period of time is usually used when someone’s condition is likely permanent and not expected to improve, e.g. a quadriplegic person. If a review determines that the medical condition of the SSI or SSDI recipient has significantly improved so that he or she could obtain “substantial gainful employment”, the Social Security benefits will be terminated. In the event your Social Security benefits are terminated, you can appeal this decision within ten (10) days. You may request the continuation of your benefits through the entire appeals process, including a hearing in front of an ALJ (Administrative Law Judge.) The disadvantage of making such a request is that you will need to pay back the benefits you’ve received if you your appeal is unsuccessful.

    What do I do if my Social Security benefits are terminated?

    You should have received written notification of why the SSA stopped your benefits along with instructions on how to appeal. If you think this decision is wrong then you should appeal the decision. You may wish to consult with a Social Security Disability Lawyer.

    How much should I expect to pay an attorney for a disability benefits case?

    In most SSD cases, an attorney who represents a disability benefits client should expect to receive 25% of back pay up to a maximum amount, currently around $5,000. In certain special instances, a Social Security Disability Lawyer might file a petition to obtain additional fees.
    Health, Medical & Social:
    Social Security - SSDI - Social Security Disability Insurance

    Michael M. Wechsler

    Michael M. Wechsler
    Michael M. Wechsler is an experienced attorney, founder of TheLaw.com, A. Research Scholar at Columbia Business School and of-counsel to Kaplan, Williams & Graffeo, LLC. He was also an SVP and chief Internet strategist at Zedge.net and legal consultant at Kroll Ontrack, a leading service e-discovery and computer forensics service provider.

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