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SSDI: What do I need to know before applying?

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Q:

SSDI: What do I need to know before applying?

A:

Social Security Disability Insurance (SSDI) is available to certain workers who become disabled and who are unable to continue to work for at least 12 continuous months. Unlike Social Security retirement benefits, which are given to retired workers with sufficient work credits, SSDI benefits are only awarded to claimants who meet very specific medical and nonmedical criteria.

Currently up to 60–70% of disability applicants are denied benefits the first time they apply. Before you decide to apply for SSDI benefits, it is important to understand certain aspects of the disability process.

1. Not all workers will qualify for SSDI benefits.

As mentioned above, there are very specific medical and non-medical requirements to qualify for SSDI benefits. Claimants must have a condition which is severe, which will last 12 continuous months, and which will not allow the worker to perform substantial gainful activity (SGA).

For example, workers who are working too many hours or making more than $1,090.00 gross monthly earned income (before taxes) when they apply for SSDI will be considered not disabled.

If you are denied SSDI benefits, you will have 60 days from the date of the denial to file an appeal. The first appeal (in most states) is called a reconsideration. If you are denied a second time, you will have 60 days from the date of the denial letter to request a hearing before an Administrative Law Judge.

2. Proving disability without medical care is tough.

The Social Security Administration (SSA) will make their medical disability determination almost exclusively based on the medical evidence from your medical record. Although you will not have to gather your medical records and send them to the SSA (the SSA will be responsible for doing this with the contact information you supply to them), if you have not seen a doctor or do not have recent medical data that clearly documents your disability and your physical or mental limitations to work, the SSA will have a difficult time making a disability determination.

Claimants who have insufficient medical evidence may be required to go to a doctor for a consultative medical examination, but unfortunately, most claimants have complained that these exams are cursory at best and do not benefit the claimant’s case.

3. You must have sufficient work credits to qualify for SSDI.

Workers must have worked and earned sufficient work credits to qualify for SSDI. According to the SSA, “Most workers will need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled.”

One work credit is earned for each $1,220 of wages or self-employment income, and workers can earn a maximum of four credits each year. Workers who do not have sufficient work credits will be denied SSDI benefits.

NOTE: Work credits cannot be purchased or borrowed from a spouse, but must be earned by each worker on their own work record.

4. You may not get much help from the Social Security Administration.

One of the most common complaints from SSDI applicants is that the SSA has very poor customer service. Not only can it take hours to reach someone on the phone, SSA workers may offer very little support or be unwilling to answer questions.

If you have questions about how to apply for SSDI benefits, you can schedule a meeting with the SSA by calling 1-800-772-1213. Keep in mind, however, that there are millions of disability applicants each year, and the SSA will not be able to provide personalized help to each applicant. If you feel like you need more personalized help, you may need to talk to a friend or family member, or consider hiring a SSDI lawyer.

5. You may need to hire a lawyer.

Why do you need a lawyer to help you get benefits that you have paid into for years? It’s a great question. Unfortunately, as with many governmental programs, the process can be difficult and tedious, even for the most healthy and patient individuals. Claimants who are disabled and finding it difficult to complete the most basic daily tasks simply may not have the fortitude to fight the system on their own.

Disability lawyers are paid on a contingency fee basis and will only receive payment if you win your case. If you win your SSDI case, the lawyer will be entitled to 25% of your back pay up to a maximum of $6,000.00. Almost all claimants will have some back pay due to the length of time it will take the Social Security Administration to process their SSDI claim.

Some lawyers may also charge for incidental expenses such as postage or the cost of gathering updated medical records. If they do charge for these expenses, it should be clearly outlined in the fee agreement.

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