How to determine whether I should apply for SSDI?
Disability is something that most of us don’t even want to consider. Unfortunately, it’s much more common than one might think. According to the Social Security Administration, a 20-year-old-worker has a 25 percent chance of developing a disability before they reach retirement age.
Fortunately, Social Security Disability Insurance (SSDI) can be an option for those who are experiencing a disabling condition that’s severe enough to interfere with their ability to work.
If you’ve recently found yourself unable to work due to a disability, you might wonder how to apply for SSDI. If so, you’ve come to the right place. Here, we’ll answer some frequently asked questions about applying for disability, including what factors determine if you’re eligible to receive disability benefits, how to apply, and what to do if you’re rejected.
Are you wondering if you should apply for Social Security Disability Insurance? If you feel that your medical condition disables you to the point where it interferes with your ability to continue working normally at your job, applying for SSDI could be the right decision for you.
SSDI includes two main components that you may benefit from. These include:
Cash benefits: Social Security will pay monthly payments to you and certain family members if you qualify.
Health coverage: Once you have been enrolled in SSDI for a 24-month period, you will automatically be enrolled in Medicare—even if you’re under the age of 65.
If you’re unable to work due to your health condition, having access to health insurance may be a good reason to apply for social security disability. Having health coverage for proper medical care can be a huge relief.
There are several scenarios where you should NOT apply for social security disability insurance. These include:
Your medical condition is expected to last less than a year and is not expected to result in your death.
Your physician does not believe your condition is severe enough to prevent you from working.
You can earn $1,350 per month, regardless of your health condition.
Am I eligible for SSDI?
Before you learn how to apply for SSDI, you must ensure you’re eligible to receive benefits. To qualify for social security disability benefits, you must meet two main criteria:
You have a mental or health condition that meets the Social Security Administration’s medical definition for disability.
You have worked long enough—and recently enough—to meet the SSA’s income qualifications.
What is the SSA’s medical definition for disability?
The Social Security Act has a very strict definition of disability. For a disability determination to be made:
You must be unable to do any substantial work because of your medical condition(s).
Your medical condition has lasted (or is expected to last) one year or longer, or is expected to result in your death.
The Social Security Administration defines “substantial work” in terms of “Substantial Gainful Activity” (SGA). SGA is based on how much money you can earn. In 2021, SGA was defined as earning more than $1,350 per month or $2,260 if you’re legally blind. (These numbers are subject to change every year).
Being unable to work means that your physical health condition or mental illness will cause you to be absent at least 10 percent of the time or unproductive at least 15 percent of the time. You would likely lose your job under either of these circumstances. Not being productive at least 90 percent of the time or missing more than a couple of days a month means Social Security will consider you disabled.
How much do you need to work to qualify?
One of the most important factors to consider when figuring out how to apply for SSDI is if you’ve worked enough hours to qualify. Unfortunately, there’s no “one-size-fits-all” answer.
The amount of time you must work to be eligible for disability benefits ultimately depends on your age. It is based on work credits received for every working year. For example, someone under the age of 28 may only need to work for 1.5 years to qualify, whereas a 60-year-old would need to work 9.5 years to qualify.
Check the Social Security website to find out how many hours you must have worked.
Other Factors Taken Into Consideration to Determine Eligibility
There are several other factors the Social Security Administration will consider to determine your eligibility. These include the following:
Current work status. If you’re currently working and your earnings average more than the defined SGA income range each month, you generally won’t qualify for disability. However, if you are no longer working or have cut down to part-time hours, you are more likely to qualify.
The severity of your health condition. For your medical condition to be considered severe enough to qualify as a disability, it must significantly impact your ability to perform basic work activities. These include standing, lifting, walking, sitting, and remembering.
Medical condition meets a listing. The SSA has a list of physical and mental health conditions the agency considers severe enough to prevent individuals from performing gainful activity. To qualify for disability, your health condition must fall under or be equal to the SSA’s guidelines for medical conditions that qualify for disability benefits.
Inability to perform past work. Another factor Social Security will consider is whether or not your medical disability prevents you from doing the work you did in the past. If you cannot do the work you did in the past, the agency will also consider if your age, past work experience, and education qualify you to perform any other type of work. If not, you will be considered disabled.
What is SSDI based on?
As you’re navigating how to apply for SSDI, you may wonder how much your benefits will be. Unfortunately, the amount of money you’ll receive from Social Security disability will not be equivalent to how much you earned at your job. The payments can range from $800 and $3,011 per month, with the average payment for an individual being $1,358 per month.
How is your disability income determined?
It’s important to note that the severity of your disability does not affect the amount of money you will receive each month.
The amount of disability benefits you’ll be entitled to receive is based on your work history. The Social Security Administration determines the amount based on your work credits and average lifetime earnings before your disability. It is based on the earnings at jobs you worked where your employer took money out for social security tax. (If you were self-employed, it is based on the self-employment tax amount).
Ssa.gov does have online calculators to help you determine how much you’re entitled to based on your work history.
Several types of income may reduce the disability benefits you’re eligible for. This includes:
- Workers’ compensation.
- Public disability benefits.
- Pensions (including government and foreign pensions).
Remember that your child may also be eligible for disability benefits. If your child developed a disability under the age of 22, they may be eligible to collect SSDI benefits. This is considered a “child’s benefit” because the amount they will be eligible to collect is based on your earnings.
What does the SSA consider a disability?
Before we tell you how to apply for SSDI, you might wonder if your condition qualifies as a disability. Although many conditions can make you eligible, some of the most common conditions that may lead to an approved disability determination being made include the following:
Blood disorders (bone marrow failure, hemophilia, and sickle cell anemia).
Cancer (stage 4 or terminal)
Cardiovascular illnesses (heart failure, congenital heart disease, and arrhythmia)
Chronic kidney disease (requiring dialysis treatments).
Cognitive and mental health conditions (autism, bipolar disorder, dementia, depression, intellectual disabilities, and schizophrenia).
Congenital disorders (Down Syndrome).
Digestive system disorders (bowel or liver disease).
Endocrine disorders (diabetes and thyroid disorders).
Immune system diseases (HIV/AIDS, lupus, and inflammatory arthritis).
Musculoskeletal system problems (amputation, chronic joint pain, and spinal disorders).
Neurological disorders (ALS, epilepsy, Multiple Sclerosis, Parkinson’s disease, and traumatic brain injuries).
Respiratory illnesses (asthma, COPD, and cystic fibrosis).
Skin disorders (burns, dermatitis, and ichthyosis).
Special senses and speech (impaired hearing, sight, or speech).
Remember that these are just some of the most common conditions that may qualify for disability benefits. Even if your health condition isn’t on this list, it doesn’t mean you’re not eligible to receive social security disability benefits.
If there’s enough medical evidence to prove that your condition is severe enough to prevent you from participating in gainful employment, it’s worth filing a disability claim.
What is the difference between SSDI and SSI? Can you get both?
Although these are both disability programs offered by Social Security, there is a difference in the requirements for eligibility.
To qualify for SSI, you must be at least 65 years of age, disabled, blind, and have limited income and financial resources. Unlike SSDI, you are eligible to receive SSI even if you’ve never worked.
How to apply for SSDI and SSI also differ. To apply for Social Security Insurance, you must go to your local Social Security office or apply over the phone.
Can you get both Supplemental Security Income and Social Security Disability Insurance at the same time? The answer is yes, you can. Social Security uses the word “concurrent” to describe a person who qualifies to receive benefits under both programs.
While it is possible to receive both SSI and SSDI at the same time, this is where things get complicated.
Social Security counts your SSDI payment towards your countable income. As of 2021, your income could not exceed $841 a month to qualify for SSI. Therefore, if your SSDI payment exceeded $841 a month in 2021, you wouldn’t have been eligible for Supplemental Security Income. (Keep in mind that these numbers change every year).
Since SSDI payments tend to be higher than SSI benefits, you might not qualify to receive both.
How do I apply for SSDI?
Are you wondering how to apply for SSDI? The good news is you don’t have to go to the social security office in your area or apply for benefits over the phone (unless you choose to do so).
Ssa.gov offers social security disability application forms online, meaning you can apply from the comfort of your own home.
You will need a few pieces of information when filing your claims. When you apply for disability benefits online, you will need to know the following:
Your birth date, place of birth, social security number, and contact information.
The name, birth date, and social security number of your current spouse or any former spouse, as well as dates of marriage, divorce or death (if applicable).
Names and birth dates of any minor children.
Your bank account information (routing and account numbers) if you want your payments to be delivered electronically.
Detailed information about the medical conditions you are applying for, including the names of any physicians, clinics, hospitals, and other public health care facilities, as well as patient ID numbers and dates of any medical treatments.
Be sure to include any facility where you received rehabilitation, vocational, or mental health services. Be sure to include any documentation from social services, human services, and child or adult protective services.
The names of any medications you are currently taking and the names of the physicians prescribing them.
A list of any medical tests you’ve had performed and the name of the physician(s) who ordered them.
The amount of money you have earned over the past two years.
The names and addresses of your employer(s) over the past two years, as well as a list of jobs you’ve had over the past 15 years before you cannot work.
A copy of your Social Security statement.
Information on any Workers’ Compensation or similar benefits you may have applied for.
In addition to having this information available when you apply for disability through the Social Security website, you may also be asked to provide copies of these documents:
Proof of United States citizenship or lawful alien status.
U.S. military discharge papers (if you served before 1968).
W-2 forms, self-employment tax returns for the previous tax year, and any other documents proving your income.
Recent medical reports, including doctors’ reports and test results. Test results may include lab work, CT scans, x-rays, ultrasounds, etc.
Proof of Workers’ Compensation or similar benefits.
Once you have figured out how to apply for SSDI and file online, your application will be sent to a Social Security disability determination service in your state, where an agency expert will review your claim. These experts will reach out to doctors and medical agencies for proof of your condition.
At some point, they will generally reach out to you to follow up for further information and documentation regarding your disability claim.
You will have a hearing with a disability hearing examiner. During your Social Security hearing, your case will be given further review. It’s important to keep the facts about your health condition consistent with whatever is in your medical records during this hearing.
There are several ways in which a Social Security disability hearing can be conducted: through a video chat platform called Microsoft Teams, over the phone or in person at your local Social Security office. One of the first two options is advisable, as in-person Social Security hearings take more time to schedule.
Once a disability determination has been made, you will receive a letter. If a rejection decision was made, you will receive a letter explaining why and how to proceed.
What should I know before applying for
There are several things to remember when applying for Social Security Disability Insurance. Here are some things to keep in mind:
- You should apply for coverage as soon as you become disabled. There is a five-month waiting period before eligible individuals will receive benefits, so you will not receive payments until the sixth month. The SSDI waiting period starts the first full month after your disability is determined to have begun. This means the sooner you figure out how to apply for SSDI and begin the disability application process, the sooner you will be able to receive benefits if you’re approved. If you have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), there is no waiting period.
Your doctor’s opinion isn’t enough to qualify you for disability. Medical eligibility is only one part of the process used to determine if you are entitled to disability benefits.
Having medical documentation is important. In fact, it is the most important factor in determining your medical eligibility. Before filling out your initial application, it’s important to have as much information as possible on the doctors you’ve seen, the medical facilities you’ve visited, and the procedures, tests, and treatments you have undergone with your condition.
The review process generally takes three to five months. The time it takes to decide on your eligibility for SSDI is based on how long it takes to receive medical records and any other evidence to confirm your condition.
What if my application is rejected?
It’s every disability applicant's biggest fear: you’re waiting patiently for application processing, and rejection worries are on your mind. The unfortunate reality is that rejections do happen. We know it can be frustrating to hear this, but the harsh reality is that your application will most likely be denied. In fact, an estimated 65 percent of first-time applications are denied.
Being rejected to receive disability benefits can be very discouraging. If you have been denied coverage, you might wonder how to apply for SSDI after being rejected. The good news is you can appeal the decision. This part is important. Filling out a second application will likely result in a second rejection— you must appeal the decision.
That being said, it’s important to understand some of the most common reasons Social Security denies benefits. Some of these include:
Not providing enough medical evidence. Having strong medical documentation confirming your medical condition prevents you from working is important.
Earning too much money. SSDI benefits won’t be approved for people who continue to work regularly, as this proves that the applicant can still work with their condition.
Not being compliant with medical treatments. If the applicant is not complying with a doctor’s medical determination for treatment, they will generally be denied from receiving any sort of disability benefit. Non-compliance makes it impossible to determine if the applicant is disabled.
Failing to cooperate. If the Social Security Administration is requesting more information or documentation and you don’t provide it promptly, your disability claim will be denied.
If you have received a rejection letter and make the decision to appeal the decision, it’s important to make sure that you correct whatever errors that prevented you from being approved for benefits. This generally means making sure the proper documents are provided.
Sometimes, a rejection is made because you simply are not eligible. For example, you will be denied coverage if your disability is not expected to last longer than 12 months. If you earn too much money, you will also be rejected. In these cases, how to apply for SSDI doesn’t matter since you are not actually eligible to receive disability benefits.
Although receiving a rejection letter can be frustrating, keep in mind that it is extremely likely to be denied on your first attempt to apply for social security disability. It might surprise you that disability appeals are more likely to be approved than initial applications.
What will give me the best chances of approval?
Are you wondering how to apply for SSDI and receive an approval? You can do several things to boost your chances of being accepted.
To increase the odds of an approved disability determination, it’s important to make sure that you have the correct medical documents. Social security wants to review all of the doctors, specialists, hospitals, and other facilities where you have received testing, diagnoses, and treatment. Your medical records should also be consistent with anything you state in a hearing or review of your case.
Claimants can also increase their odds of approval by making sure they meet the income requirements for receiving disability. If you haven’t worked enough hours in recent years, then the odds of receiving a rejection are higher.
Additionally, it’s important to consider your current work status. If you are still working and earning more than Social Security's income threshold for those receiving disability benefits, you should rethink your decision to apply. It’s ideal to apply after you’ve stopped working or drastically cut down on your work hours due to your disability.
Since a social security disability rejection decision can be devastating, it’s important to ensure you have all your ducks in a row before applying.
You might also consider hiring a disability lawyer. They can help you figure out how to apply for SSDI with enough medical documentation to ensure you will be approved to receive benefits. A disability lawyer can also help you appeal the decision if you've already been rejected.