Social Security Disability Insurance

The Social Security Disability Insurance program or SSDI is a disability program which provides disability payments to workers who have a severe mental or physical health condition which is expected to last for at least 12 continuous months and who are no longer able to work or to perform work at a “substantial level”. SSDI benefits may also be paid to the widow, widowers and children of insured and disabled workers.

In addition to the medical criteria established by the Social Security Administration (SSA), workers must also have worked long enough and paid enough in payroll taxes to be considered “insured” by the SSA. The Social Security Administration determines the number of work credits which must be accumulated by disabled workers to qualify for SSDI, and the number of credits needed to qualify for Social Security Disability Insurance can vary if you become disabled at a young age.

Below we have compiled a great list of SSDI information.

If you are disabled and can no longer perform substantial work you may be considered insured by the SSA if you have paid sufficient FICA taxes for a specific number of quarters. What is your SSDI benefit? The SSDI benefit amount varies by individual, and it is calculated based on your earnings record and your age. For an estimate of your SSDI payment amount you can review your most recent Statement of Earnings which is sent to you annually by the SSA or you can call the SSA at 1-800-772-1213.

SSDI benefits are paid after you have been disabled and unable to work for at least five months. This is called the waiting period. Should you wait five months to apply? No, you if you are disabled and unable to work, you should submit your SSDI application immediately due to the length of time it will take to process your SSDI claim.

Are you entitled to SSDI back payments? Many claimants do receive back pay due to the length of time it takes the SSA to process SSDI claims. Back pay can be paid retroactively up to 12 months prior to your application date, less the 5 month waiting period.

SSDI disability lawyers, if you choose to hire one, will be paid 25% of the back pay amount up to the federal maximum amount allowed, which is currently $6,000. Even if you file your SSDI claim immediately after you become disabled, due to the processing time, most SSDI claimants do have back pay.

Not all workers will qualify and be eligible for SSDI benefits. To qualify for SSDI you must meet requirements which are determined by the Social Security Administration. Workers must be:

  • Determined disabled by the Social Security Administration.
  • Disabled prior to your full retirement age
  • Disabled for at least 12 months or your disability is expected to result in death
  • Legally allowed to work in the United States
  • A United State’s citizen
  • If you are 31 or older you must have paid payroll taxes and worked for 5 of the last 10 years. If you are younger than 31 there may other qualifications.

The Social Security Administration defined “substantial gainful activity” (SGA) as performing significant physical or mental activities. Note the SSA may consider your work “substantial” even if it is not full-time or you do not receive pay or profit, as long as it is generally done for pay or profit.

To determine if you are performing SGA, the Social Security Administration will generally use earnings guidelines. If you are blind the SSA will allow a higher SGA amount. Blind individuals may not make more than $1,640 in 2011. If you are disabled but not blind, the SSA will consider your activity substantial if you earn more than $1,000 per month.

The Social Security Administration will use your work history to determine if you are eligible for SSDI. In 2012, the SSA will give you one credit for each $1,130 of earnings, up to the maximum of four credits per year. When you’ve earned $4,520, you’ve earned your four credits for the year (amount is periodically updated).

So how many work credits do you need to qualify for SSDI? The amount of credits you need will be based on your age at the time you become disabled. For example, if you become disabled prior to 24 years of age, you will need approximately 6 work credits which were earned in the 3 years immediately before you became disabled.

If you are 31 years or older, you will need 20 work credits which were earned in the 10 years immediately before you became disabled. Keep in mind the older you are the more work credits you will need. For example, workers age 50 years old will need approximately 30 work credits and workers 62 years and older will need approximately 40 work credits.

There are certain employees who are not covered by Social Security. For example, some state and local governments have chosen not to participate in Social Security and these employees may not be covered be eligible to receive SSA disability benefits if they are injured or disabled and unable to work. If you have questions about whether or not you qualify for SSDI benefits you can talk to a SSDI disability lawyer, contact the SSA or review your most recent Statement of Earnings.

Children of qualifying workers may receive SSDI benefits if they are the dependant of a wage earner who is currently receiving SSDI benefits. SSDI payments may be paid to the non-disabled child until they are 18 years of age (or later if they are a full-time student). Disabled children who were disabled prior to the age of 22 may continue to receive SSDI benefits after they are 18 years of age.

To determine if you are disabled the Social Security Administration will use what they call the “sequential evaluation process”. This is a series of questions they will review to determine if you qualify for SSDI benefits:

  • Are you engaged in “substantial gainful activity”? Do you earn a gross wage income of more than $1010 per month (for the nonbline) or $1640 (for the blind)? If you are earning more than $1,010 in wages the Social Security Administration will determine you are engaging in “substantial gainful activity” and you are not disabled.
  • Is your condition severe? The Social Security Administration will review whether your condition allows you to perform your current job. If it does, they will consider you not disabled. If it does not, they will proceed to step 3 in the sequential evaluation process.
  • Is your condition on the Social Security Administration’s Listing of Impairments or “Blue Book”? The SSA maintains a list of all of the major body systems and medical conditions which they consider automatically disabling. If your condition is on the list and it meets the level of severity as the listed condition, they will consider you disabled. If not, they will proceed to step 4.
  • Can you perform the work you performed in the past? Maybe your condition is so severe that you cannot perform your current job, but does your condition interfere with your ability to perform work you did in the past? If it does not, the SSA will deny your SSDI claim. If it does, they proceed to step 5.
  • Can you be retrained for new work? If you cannot perform your current job or other jobs in the past, the SSA will determine if you could be retrained for new work. To make this determination, the SSA will review your education, work history and skills, your age, and your residual capacity to work. If the SSA determines you could not retrain or adjust to other work, they will award SSDI benefits. If they determine you could retrain for new employment, they will deny SSDI benefits.

Prior to making their SSDI disability determination the SSA will gather medical evidence from all of your medical sources. The Social Security Administration’s office of Disability of Determination Services (DDS) has a medical team (doctors, analysts and clinical psychologists). This team will review your medical files, your diagnosis, your residual functional capacity to work, and determine if you meet mental or physical health condition meets their definition of disabled as determined by the sequential evaluation process.

If you are awarded SSDI benefits you will be notified by letter. Your SSDI benefits award letter will tell you the amount of SSDI benefits you will be paid, your amount of back pay and the date your SSDI payments will begin.

If your SSDI benefits are denied, do not be discouraged. Statistically, 65-75% of disability claimants are denied SSDI benefits at the initial application level. If you are denied SSDI benefits you will have 60 days from the date of the SSDI denial letter to file an appeal with the SSA. The first step in the SSDI appeals process (in most states) is the Reconsideration.

If you are denied SSDI benefits at the Reconsideration level you will have 60 days from the date of that denial to file another appeal and request an administrative hearing before a Social Security Disability Administrative Judge.

SSDI hearing give claimants the best chance they have to win SSDI benefits. SSDI hearings are the first chance you will have to give a first-hand, personal testimony about the limitations caused by your disability.

SSDI claimants, who have not hired a SSDI lawyer prior to a SSDI hearing, generally choose to do so at this point. SSDI lawyers will increase your chances of winning SSDI benefits at every stage of the process. SSDI attorneys become even more helpful at the SSDI hearing level because they can present your SSDI case to the Administrative Law Judge. The SSDI attorney also understands how to prove, given your current mental and physical residual functional ability to work, why you cannot work your current job or be retrained for new employment.

If you qualify for Social Security Disability Insurance benefits, you may be eligible to receive Medicare after 24 months. Some SSDI claimants may be eligible sooner if they have permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Information concerning your Medicare coverage should be provided to you by the Social Security Administration within 3 months of your eligibility date, but if you have not heard from the Social Security Administration after 24 months you need to contact them at 1-800-772-1213.

If you are disabled and out of work, you most likely do not have extra money to pay for legal assistance. Most claimants do not realize, however, that SSDI lawyers work on a contingency fee basis. This means that the SSDI attorney will not get paid unless they win your SSDI case.

Under Social Security Disability law, Social Security Disability Insurance lawyers are only allowed to charge 25% of the total amount of back pay you receive for SSDI up to maximum amount of $6,000 (this amount is periodically adjusted).

Disability lawyers may also charge some additional fees if they incur expenses for your case gathering medical records from your medical sources. Many Social Security Disability lawyers will not charge their clients for these expenses.

When does your SSDI lawyer get paid? The Social Security Administration will send your SSDI attorney their payment prior to sending your SSDI back pay benefit payment.

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