Social Security Disability Insurance (SSDI) is offered to claimants with a severe health condition that is expected to last at least 12 continuous months and that does not allow the claimant to work or perform substantial gainful activity (SGA).
With millions of applicants applying for SSDI benefits each year, many applicants are denied, forcing them to fight months or even years through the Social Security Administration (SSA) appeals process. In an effort to avoid an SSDI denial, there are specific steps you can take that can improve your chances of winning SSDI benefits the first time you apply.
1. Understand the disability process
Understanding the disability process is the best way to improve your chances of winning SSDI benefits. For instance, do you know how the SSA makes their disability determination? Do you understand the type of medical information they need to make their decision? Do you know how much you can work and not be denied benefits? If you do not know the answers to these questions, it is important to talk to someone who understands the process.
Going to the doctor, making sure you have detailed information about your medical conditions, and not working or making too much money when you apply are key to your success. If your condition will not last at least 12 continuous months, if you are working and making too much money when you apply, or if you do not have sufficient medical evidence to support your SSDI case, you will be denied SSDI benefits.
2. Verify that you have sufficient work credits to qualify for SSDI benefits
Claimants may qualify for SSDI benefits if they have worked and paid sufficient taxes to earn work credits. Although the number of credits that you will need to qualify for SSDI benefits varies by age, most claimants who are over the age of 31 will generally need 40 work credits.
Another consideration is when the credits are earned. According to the SSA, you must have earned at least 20 of the credits in the 10 years immediately before you became disabled.
So how do you earn work credits for SSDI? The process for earning credits has changed since 1978, but according to the SSA, in 2016 workers must earn $1,260 in covered earnings to get one Social Security or Medicare work credit, up to the maximum of four credits per year.
If you have not worked and earned enough work credits, you will not qualify for SSDI benefits. Credits cannot be bought or borrowed from a spouse; they must be earned on your own work record. Claimants who lack only a few work credits may be able to return to work to generate them. Other claimants, who have not worked or who have not paid taxes, may have the option to apply for Supplemental Security Income, which is another disability program offered for claimants with low income and resources, and who are unable to work for at least 12 continuous months.
3. List all of your medical conditions
The third tip for winning benefits the first time you apply for SSDI is to list all of your debilitating health conditions. Although it may be easier to win SSDI benefits if you have one severe health condition, the SSA will consider all of your health conditions in their totality to determine whether you have the capability to perform work.
For instance, if you have diabetes, it can be severe enough to win SSDI benefits, but if you have severe diabetes with neuropathy, you are severely overweight, you have sleep apnea, and you have high blood pressure, all of these conditions will lower your ability to retrain for work and may be considered disabling.
4. Ask your medical health professionals to complete a Residual Capacity Assessment
Medical records will generally document a claimant’s prognosis, diagnosis and treatment actions, but what may not be stated is the mental or physical limitations of your conditions and whether or not you can work.
Some doctors may be willing to complete what is called a residual functional capacity assessment. These forms can be downloaded and printed from various websites, and can detail your exertional, postural, manipulative, visual, communicative and environmental limitations, as well as symptoms. This information, combined with other medical evidence, can substantially improve your claim and provide information about your remaining functional capacity and why the doctor believes you are not able to work.
5. Hire a social security disability attorney
Claimants often wonder why they need to hire a disability lawyer to win benefits that they are already entitled to receive. Unfortunately, without legal help, many disabled applicants are denied multiple times and flounder in the SSA system for years.
If you apply for SSDI benefits and you have medical evidence that your condition will meet or exceed a listing on the SSA Listing of Impairments, you should not need a disability lawyer. If, however, you have been denied SSDI benefits or you are trying to win SSDI benefits through a medical vocational allowance, you may need legal help.