Skip to main content

This content was last updated on 3/7/2022

 

What is Social Security Disability Insurance (SSDI)?

If you are a disabled worker and you paid enough money into Social Security over enough work quarters, you can get Social Security Disability Insurance (SSDI) benefits. The SSDI program pays benefits if you can’t work because you have a serious medical or mental health condition that keeps you from working full-time for at least a year.

Who Can Get SSDI?

You and certain family members (might include a spouse, divorced spouse, children, disabled child or adult child disabled before the age of 22) are eligible if you are ‘insured.’ This means that you worked long enough – and recently enough - and paid Social Security taxes on your earnings.

Social Security pays benefits to people who can’t work because they have a serious medical or mental health condition that’s expected to last at least one year or result in death. Social Security does not pay benefits to people with partial or short-term disability.

Are there rules about how much earnings I need to get Social Security Disability Insurance benefits?

Yes. The rules are very complicated and depend on:

  • how old you are
  • when you worked; and
  • how long you worked

When you first apply for disability, Social Security looks at many things to decide if you are eligible and if you have enough earnings to qualify for SSDI benefits.

How do I apply for disability benefits?

There are 3 ways you can apply for disability benefits. You can:

The disability claims interview lasts about 1 hour.

If you schedule an appointment, Social Security sends you a Disability Starter Kit to help you get ready for your interview. The Disability Starter Kit also is also online at https://www.ssa.gov/disability/disability_starter_kits.htm

When should you apply for disability?

Apply for disability benefits as soon as you become disabled. Processing an application for disability benefits can take many months.

What information do I need to apply for disability?

You need the following information: 

  • Your Social Security number
  • Your birth or baptismal certificate
  • Names, addresses, and phone numbers of the doctors, caseworkers, hospitals, and clinics that took care of you, and dates of your visits
  • Names and dosage of all the medicine you take
  • Medical records you have from your doctors, therapists, hospitals, clinics, and caseworkers
  • Laboratory and test results
  • A summary of where you worked and the kind of work you did
  • A copy of your most recent W-2 Form (Wage and Tax Statement) or, if you’re self-employed, your federal tax returns for the past year

Besides the basic application for disability benefits, you also need to fill out other forms. One form collects information about your medical condition and how it affects your ability to work. Other forms give doctors, hospitals, and other health care professionals who have treated you, permission to send in information about your medical condition.

To see a checklist of what you need to apply for disability, go here:

https://www.ssa.gov/hlp/radr/10/ovw001-checklist.pdf

How does Social Security decide if I am eligible for disability benefits?

Social Security uses a 5-step evaluation process to decide if you are disabled.

Step 1: Are you working?

If you can’t do the work you did in the past, Social Security looks to see if there is other work you can do even with your medical and mental health conditions. They look at your age, education, past work experience and any skills you have that could be used to do other work.

If they decide you can do other work, Social Security decides you are not disabled. You get a letter telling you your application for disability is denied.

If they decide you can’t do other work, Social Security decides you are disabled. Social Security sends you a letter.

At this step, Social Security decides if your medical or mental health conditions keep you from doing any of your past work.

If they decide your health conditions don’t keep you from doing any of your past work, Social Security decides you are not disabled. You get a letter telling you your application for disability is denied.

If they decide your medical or mental health conditions do keep you from doing any of your past work, Social Security goes to Step 5.

 

Step 2: If your medical condition “severe”?

To be considered disabled by Social Security, your medical or mental health problems must be “severe.” And your condition seriously limits your ability to do basic work activities. Things like lifting, standing, walking, sitting and remembering.

If your medical or mental health problems aren’t severe, Social Security doesn’t consider you to be disabled. You get a letter telling you your application for disability is denied.

If your condition is severe, Social Security goes to Step 3.

 

Step 3: Does your medical condition meet or medically equal a “listing”?

Social Security has a list of impairments called “the listings.” Each listing describes a medical or mental health condition that is seen as severe enough to keep a person from doing gainful activity, no matter their age, education or work experience. Within each listing, experts identify the objective medical and other finds required to satisfy the criteria of that listing.

For each listing experts have laid out details about what is needed to meet the “criteria” of the listing. In other words, to use that listing to show disability you need to fit the description the experts created.

If Social Security decides your medical or mental health conditions meet or medically equal the criteria of a listing, Social Security decides that you are disabled.

If they decide your medical condition doesn’t meet or medically equal the criteria of a listing in this step, Social Security goes to Step 4.

 

Step 4: Can you do the work you did before?

At this step, Social Security decides if your medical or mental health conditions keep you from doing any of your past work.

If they decide your health conditions don’t keep you from doing any of your past work, Social Security decides you are not disabled. You get a letter telling you your application for disability is denied.

If they decide your medical or mental health conditions do keep you from doing any of your past work, Social Security goes to Step 5.

 

Step 5: Can you do any other type of work?

If you can’t do the work you did in the past, Social Security looks to see if there is other work you can do even with your medical and mental health conditions. They look at your age, education, past work experience and any skills you have that could be used to do other work.

If they decide you can do other work, Social Security decides you are not disabled. You get a letter telling you your application for disability is denied.

If they decide you can’t do other work, Social Security decides you are disabled. Social Security sends you a letter.

 

 

After I go through the application process, how do I know what the decision is?

Once Social Security makes a decision on your case, you get a letter from them.

If your application is approved, the letter shows you the amount of your benefit and tells you when your payments start.

If your application is denied, the letter explains why and tells you how to appeal if you disagree with the decision.

If I disagree with the decision – can I appeal?

Yes, you can appeal the decision about your disability. Appealing the decision means that you can ask Social Security to look at your case again.

What are the steps in the Appeals Process?

 1. Reconsideration

 If your application is denied, the first appeal you ask for is reconsideration.

A reconsideration is a complete review of your claim by someone who didn’t take part in the first determination. If you file for a reconsideration, social security looks at all the evidence sent in for the original determination as well as any new evidence you give them.

Ask for reconsideration within 60 days of the date you get the written denial notice. You have to ask for a reconsideration in writing.

You can ask for reconsideration online at:

https://secure.ssa.gov/iApplsRe/start

Once Social Security makes a decision on your reconsideration, they send you a letter.

 

2. Administrative Law Judge hearing

If you ask for reconsideration and get denied but you want to appeal again, you must ask for a hearing before an administrative law judge (ALJ).

Ask for a hearing before an administrative law judge within 60 days of the date you get the notice of reconsideration. You have to ask for a hearing in writing.

Find out how to ask for an ALJ hearing online at:

https://www.ssa.gov/appeals/hearing_process.html

It takes many months before a hearing is scheduled. Make sure you let Social Security know your new address if you move.

At this point, you should think hard about getting a lawyer. Contact the legal aid office in your area to see if they can represent you. If legal aid can’t help you, look for lawyers who specialize in Social Security disability cases. Social Security has a special process where your lawyer’s fee can be paid with some of your back benefits if you win. But always go to legal aid first.

After your hearing, the Administrative Law Judge (ALJ) makes a decision. They send you a copy of the ALJ decision.

 

3. Appeals Council

If the ALJ denies your disability case, you can ask that the Appeals Council review your case.

Ask for the Appeals Council to review your case within 60 days of the date you get the ALJ decision. You have to ask for review by the Appeals Council in writing. Find out how to ask for a review by the Appeals Council at: https://www.ssa.gov/appeals/appeals_process.html

The Appeals Council looks at every case that asks for a review, but it may deny a review if it thinks the hearing decision was correct. If the Appeals Council decides your case can be reviewed, it makes a decision about your case itself or returns it to an ALJ for further review. When the Appeals Council reviews your case, it may look at the issues considered by the ALJ, including ones that were decided in your favor.

Before granting a review, the Appeals Council usually looks for mistakes in the ALJ decision, and your chance of winning in those cases is very low.  The main reason to file a request for review with the Appeals Council is to meet all the requirements which you have to do before you are allowed to sue Social Security in federal court.

Once the Appeals Council makes a decision, they send you a copy of the decision.

It takes many months before a hearing is scheduled. Make sure you let Social Security know your new address if you move.

 

4.   Federal Court Review

If you disagree with the Appeals Council's decision, or if the Appeals Council decides not to review your case, you can file a civil lawsuit in a Federal district court. This is the last level of the appeals process.

File the civil lawsuit in a federal district court within 60 days after you get notice of the Council's action in the case. You need to have a lawyer during this process.

The federal judges hear disability cases without juries. While the judge reviews the case for legal errors, many judges also base their decision on factual questions as well.

Note that suing Social Security in federal court can be expensive and time consuming. It can take years to reach this level of the appeals process.

Find more information about the appeals process here: https://www.ssa.gov/benefits/disability/appeal.html

Was this info helpful?

Please include your email if you want us to follow up with you.