Answers a range of questions about the Social Security Disability application process, eligibility, what medical records are needed, and which conditions can be Fast Tracked.
What is a “disability,” as defined by the Social Security Administration?
It’s a physical or mental condition—one that’s expected to last at least 12 months or result in death – that prevents a person from working at a level that is considered substantial gainful activity. The disability does not have to be work-related but benefits are not paid for short-term disabilities that last for less than twelve months (though the twelve-month period can be interrupted by unsuccessful work attempts) or disabilities that disabled a person only from working in a past occupation.
Is a letter from my doctor, stating that I’m disabled, good enough for the SSA?
Not by itself. You’ll still need to complete an application (claim) for SSDI benefits and also provide the SSA with personal data, medical records and other medical evidence that supports your doctor’s opinion. You may also be asked to go for a physical or psychological exam paid for by the SSA.
What information about my medical condition and my work experience do I send to the SSA?
You will complete extensive questionnaires about your medical condition and your work history. You’ll also need medical records from the doctors, hospitals, clinics, caseworkers, therapists, etc., involved in diagnosing or treating your disability.
How does my work history affect my qualifications to receive SSDI benefits?
You’ll need to have worked long enough and recently enough under Social Security (i.e., you’ve paid into the system) to earn the required number – it changes annually – of work credits. If you haven’t met these requirements, you’re not eligible for SSDI benefits. But you may be eligible for other types of benefits. Your work history and the transferable skills you gained from that work are considered in determining whether you can go back to previous work in an occupation that is new to you.
How long does it usually take the SSA to process a typical application for SSDI?
It usually takes from three to five months to process an application, or longer if any required data is incomplete or missing. If your application is denied, it will take additional months if you appeal the decision. Then, if your appeal is denied and you ask for a hearing, you can figure there will be an additional wait time of about 442 days!
I heard there’s a “Fast Track” that speeds up the process if someone has a serious medical condition that’s listed?
Yes. Another 25 medical conditions were recently added to the list of 200 – compiled in 2008 and 2012 – that clearly qualifies applicants for Compassionate Allowances. Applications for persons with any of these 225 conditions can usually get approved in just days – if they meet the other, non-medical requirements for SSDI benefits.
What’s involved when the SSA reviews my application for benefits?
A five-step process is used to make a determination as to whether or not you qualify for SSDI benefits. First, your application is studied to determine if you’ve provided all the information required and you have enough work credits to qualify. If so, it’s sent to the Disability Determination Services (DDS) office in your state. Their disability specialists ask your doctor(s) about your condition and how it limits your ability to do work-related activities.
If my application is denied do I get a second chance to apply?
For one reason or another, about 70% of all SSDI applications are denied the first time they go through the system. If yours is denied, you can appeal the denial, provide any missing information and explain why the decision to deny was incorrect.
What if I resolve whatever it is that caused them to turn me down, I apply again, and they turn me down again?
If you contest the decision within 60 days, you can request a hearing before a federal administrative law judge. If an SSDI-qualified attorney has not helped you up to that point, you may want to hire one to represent you in court. It’s really not a do-it-yourself procedure. You will owe attorney fees only if you are approved for benefits and the fees will be withheld and paid to the attorney from your back pay.
Can disabled children get government benefits?
Disabled children under age eighteen may be eligible for Supplemental Security Income (SSI) benefits if their income and their family’s income is within the SSI limits. Adult children who are unmarried and become disabled before age twenty-two may qualify for Childhood Disability Benefits (CDB) paid to disabled adult children of a parent who is either deceased or receiving Social Security Disability (SSDI) or Retirement benefits.
If my application is approved, when will benefits start?
It depends on the SSA’s determination as to when your disability began and on when you filed your claim. Your first benefit will cover the sixth full-calendar month after that date. For instance, if your disability officially began on July 15, 2019, your first benefit would be paid for the month of January, 2020, and you’d receive it in February, 2020. Payments are sent in the month that follows the month they’re for.
How long can I continue to get benefits for a particular disability?
If your case is typical, you’ll continue to receive benefits until your disability lessens (if that’s possible) and you’re able to resume work on a regular basis.
When I reach “retirement age,” can I still receive SSDI benefits?
If you’re still receiving SSDI benefits when you reach full retirement age, which ranges from age 66 to 67 depending on your year of birth, your benefits will be automatically converted to SSA retirement benefits, usually of the same dollar amount.
What do all the abbreviations and initials mean?
ALJ is an Administrative Law Judge. When you file a hearing appeal, the ALJ decides whether or not you are disabled.
CE is a Consultative Examination. You may be asked to take one to confirm the extent of your disability.
CSRS is the Civil Service Retirement System, which covered federal government workers up until 1983. It was replaced with the Federal Employees Retirement System (FERS) in 1984.
DDS is Disability Determination Services. After the SSA accepts your application, they send it to your state’s DDS office to review your disability report, to determine whether your disability meets their strict criteria.
DRB is the Decision Review Board, which reviews most ALJ decisions regarding SSD claims.
DSI is Disability Service Improvement. The SSA is rolling out DSI across the states to improve the speed with which applications are reviewed, accepted or denied, and appealed. Some states have not adopted the improvements as yet. As of this writing, DSI is being used in Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.
FedRo stands for Federal Reviewing Official. They are involved in SSD determinations.
FERS is the Federal Employees Retirement System, which started in 1984. It replaced the Civil Service Retirement System (CSRS).
SGA is Substantial Gainful Activity. Inability to perform SGA is part of Social Security’s definition of disability.
SSA is the Social Security Administration. It’s the U.S. department that determines eligibility for and authorizes the distribution of Social Security funds.
SSD is Social Security Disability. This is short for SSDI (see below) and applies to Social Security Disability benefits.
SSDI is Social Security Disability Insurance. SSD is not welfare. It is an insurance policy. If you’ve been working and paying FICA taxes, you have contributed to paying for this insurance. You will need to meet the minimum contributions required by SSA for your specific circumstances.
SSI is Supplemental Security Income. The SSI program makes payments to aged (age 65 or more) and disabled people with low income and assets. The Social Security Administration manages the SSI program. Even so, SSI is not paid for by Social Security taxes. It’s paid for by U.S. Treasury general funds, not the Social Security trust funds. Disabled or blind children also can receive SSI. The basic SSI amount is the same nationwide. However, many states add money to the basic benefit.
What are some of the things I’ll have to give Social Security for my claim:
To process your application, the SSA requires the following data (among others):
- Your full legal name and complete address
- Your Social Security number
- Your birth certificate or baptismal certificate
- The names, ages, and Social Security numbers of your children, spouse, and ex-spouse.
- The names, addresses, and phone numbers of the doctors, caseworkers, hospitals and clinics that took care of you, and the dates of your visits
- Medical records from your doctors, therapists, hospitals, clinics and caseworkers that you have in your possession
- Names and dosages of all the medicine you take
- Laboratory and test results
- A list of where you have worked in the past fifteen years and a description of your duties for each kind of work you have done.
- A copy of your most recent W-2 Form (Wage and Tax Statement) or, if you are self-employed, your federal tax return for the past year. You will need to fill out and submit other forms, too. One form collects information about your medical condition and how it affects your ability to work. Other forms give doctors and other health care providers who have treated you permission to send the SSA information about your medical condition. Do not delay applying for benefits if you cannot get all of this data together quickly; the SSA can help you get it.
What does the DDS office do?
This state agency completes the disability decision for the SSA. Your doctors are not asked to decide if you are disabled; however, SSA’s doctors and disability specialists ask your doctors for information about your condition, and then consider all the facts in your case.
They will use the medical evidence from your health care providers and will ask your doctors:
- What your medical condition is
- When it began
- How it limits your activities
- What the medical tests have shown
- What treatment you have received
- How your condition limits your ability to do work-related activities, such as walking, sitting, lifting, carrying, and remembering instructions. The DDS may ask for more medical information and/or ask you to go for a special examination (which the SSA would pay for).
How does the SSA make a decision in regard to my claim of disability?
It’s a five-step process, and requires the appropriate answers to these questions:
- Are you working? If you are, and your earnings average more than a certain amount each month, the SSA will generally not consider you disabled. The amount changes each year. The 2020 figure is $2,060 per month if you are blind, and $1,100 per month if you are not blind. If you are not working, or your average monthly earnings are the same or less than this figure, the DDS then looks at your medical condition.
- Is your medical condition “severe”? Does it significantly limit your ability to do basic work activities for at least one year? If not, the DDS will not consider you disabled. Otherwise, they proceed to step three.
- Is your medical condition on the official “List of Impairments”? This list describes medical conditions that are considered so severe—e.g., you have terminal cancer, are on a waiting list for a heart transplant, have lost the use of either legs, or other obvious disabilities—that they automatically mean that you are disabled as defined by law. It also lists severe impairments pertaining to the various parts of the body: musculoskeletal system, respiratory system, cardiovascular system, digestive system, endocrine system, neurological system, mental disorders, special senses and speech, skin disorders, etc. If your condition is not on this list, the DDS looks to see if your condition is as severe as a condition that is on the list. If so, they may decide that you are disabled. If not, they go on to step four.
- If your condition does not meet the listings, the four and fifth steps are applied. Can you do the work you did before? If you can, they will decide you are not disabled. But if your condition prevents you from doing that kind of work you have done in the past, they go on to step five.
- Can you do any other kind of work? The DDS evaluates your medical condition, age, education, work experience, and any skills you may have that could be used to do work in an occupation that is new to you. If you cannot do other work, they will decide that you are disabled. If you can do other work, they will decide that you are not disabled. (There are special rules for the blind, explained in SSA Publication #05-10052.)
How long does it take to get a decision?
Usually, it takes from three to five months. It depends, to some extent, on how long it takes to get your medical records and any other evidence needed to make a decision. It can also depend on the DDS’s workload at the time you initially apply (i.e., file a claim) for SSD benefits. However, if you’re in a state where the new Disability Service Improvement (DSI) process has been introduced, and the medical evidence provided shows you are obviously disabled, a favorable determination can be made in as little as 20 days after the DDS receives your claim.
If I appeal a second negative decision on my claim, what happens next?
Your claim file, request for review, and any additional evidence and comments you submitted are assembled into a case folder by the SSA. Then a hearings and appeals analyst (who is a paralegal specialist) reviews the case folder and prepares a written analysis of your claim and a recommendation. He or she also prepares a notice, order, or decision for the administrative appeals judge or appeals officer’s signature. This official considers the evidence, the hearing decision, the analysis, and the recommendation. If the official agrees with the recommended action, he or she will sign the notice, order, or decision. Otherwise, he or she will make appropriate changes or will return the case folder to the analyst for a different action. Ultimately, the judge or officer issues the Appeal Council’s action. The support staff then dates and mails it to you and sends a copy to your representative, if you have one.
The entire process can, and usually does, take many months — up to a year — unless you’re in a U.S. state where the new DSI process has been introduced. In that case, as noted in the answer above, a favorable determination can take as little as 20 days after the DDS receives your appeal. But no matter where you live, and whether or not there’s DSI, lengthy delays due to errors or omissi
ns can often be avoided by having an SSD attorney handle your case.
Do I need a lawyer to represent me?
The federal government does not require applicants to have legal representation — but it’s a good idea to have one if you have to appeal. SSA admits that claimants who have attorneys have a better chance of a successful result and, they state, “A representative who is familiar with the Social Security system may provide valuable service to you.” Attorneys who specialize in disability claims know exactly what is required and can have it ready to present to the examiner or judge.
How do disability lawyers get paid?
Attorney’s fees are paid on a contingency basis. If your claim is successful, the attorney receives one-fourth of back benefits (not to exceed a total of $6’000) and you receive the other three-fourths. Going forward, you get 100% of your benefits. If your claim is denied, the attorney receives no fee at all. Any fees paid will not affect your future monthly benefit.
Who pays these disability benefits?
The government’s disability benefits come from two sources:
- Social Security benefits, regardless of type, are paid from the Social Security Trust Fund, which includes the Social Security taxes paid by workers and the interest that comes from investing the fund.
- Supplemental Security Income (SSI) payments are paid from the general treasury, which is funded from income taxes paid by individuals and corporations.
Why would it take so long for the Appeals Council to act on my case?
The Appeals Council is understaffed to handle the number of cases to be reviewed. It is made up of about 68 administrative appeals judges and 42 appeals officers, who must review and sign each final action. Each year, the Council receives about 176,000 requests for review. The typical waiting time is 364 days (one year), down from a high of 505 days back in 2000.
Once I start receiving disability benefits, how long will I keep receiving them?
Benefits usually continue until you are able to work again on a regular basis (if that’s possible). There are also a number of special rules, called “work incentives,” that provide continued benefits and health care coverage to help you make the transition back to work. If you are receiving Social Security disability benefits when you reach full retirement age (as defined by the SSA, it ranges from 65 and two months to 67, depending on your date of birth), your disability benefits automatically convert to retirement benefits, but the amount remains the same.
Are there special rules for the blind?
Yes. The SSA considers a person to be legally blind if his/her vision cannot be corrected to better than 20/200 in the better eye (if there is one), or if the visual field is 20 degrees or less, even with a corrective lens. Many people who meet the legal definition of blindness still have some sight, and may be able to read large print and get around without a cane or guide dog. If you do not meet the legal definition of blindness, you may still qualify for disability benefits if your vision problems alone or combined with other health problems prevent you from working. There are a number of special rules for people who are blind that recognize the severe impact of blindness on a person’s ability to work. For example, the monthly earnings limit (in order to qualify for disability benefits) for people who are blind is generally higher than that for non-blind disabled workers. In 2018 the limit is $1,970.
If I receive disability benefits, can members of my family receive benefits, too?
Perhaps. Benefits may also be paid to your spouse, your divorced spouse, your children, and/or your disabled child if they qualify., even your parents if they live with you and you provide more than half their support. Each family member may be eligible for a monthly benefit of up to 50 percent of your disability rate capped by your family maximum benefit, which is usually between 150 and 180 percent of your benefit. However, if you have a very low benefit yourself, you may be receiving your full FMB resulting in no benefits payable to your family.
I worked for the federal government some years ago. Was I covered by Social Security and will my earnings help qualify me for their disability benefits?
It depends on when you worked. Up until 1984, employment by the federal government was covered under the Civil Service Retirement System (CSRS) and not by Social Security. If you worked for a federal agency during those years, you did not pay Social Security tax on your earnings and those earnings are not shown on your record. In 1984, a second retirement system—the Federal Employees Retirement System (FERS)—was introduced. People who began working for the federal government after 1983 are covered by FERS instead of CSRS. Also, some workers who had been covered by the CSRS program chose to switch to the FERS program when it became available. Work under FERS is covered by Social Security. If you stayed under the CSRS program after 1983 and do not have enough work in another Social Security-covered job, you will not be insured for Social Security. You will have Medicare coverage because you will have paid Medicare taxes on your federal earnings.