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What SSDI is and How it Works
As a payroll tax-funded benefit program, Social Security Disability Insurance (SSDI) is administered by the Social Security Administration. You and certain family members can receive disability benefits if the SSA considers you “insured,” meaning you have worked and paid into the payroll tax system long enough. You must also have a medical condition or illness meeting the SSA’s definition of disability, preventing you from working for at least twelve months or expected to end in death.
How Can I Know if I am Eligible?
The SSA provides a Benefit Eligibility Screening Tool as a questionnaire to help you assess your eligibility, although this questionnaire is not the same as an SSDI application. The SSA also provides an SSDI Online Benefits Calculator to estimate your SSDI benefit amount. You will need your earnings by year from your online Social Security Statement. The best way to access this information is to create your personal my Social Security account that provides personalized tools.
First-Time Application Statistics
If you believe you are eligible for SSDI, the next best step is to speak with a disability attorney. Recent statistics range from 22 to 36 percent of first-time applicants receive approval, and any appeal process will add to your wait time while unable to work and in need of benefit assistance. An experienced disability lawyer will have helped file hundreds of applications and knows how to present an accurate and comprehensive filing to receive first-time benefits claim approval.
To be eligible for SSDI benefits, you must:
- Meet SSA’s definition of a disability
- Be younger than the full retirement age (FRA)
- Have a disability that is not partial or short-term
- Be unable to work due to a medical condition expected to last at least twelve months or result in death
- Be deemed insured by SSA standards through your work history
Family Member Eligibility
Once you begin receiving disability benefits, some family members may qualify for benefits based on your work history. These family members include:
- Divorced spouse
- An adult child who became disabled before age 22
There is a maximum allowable family amount. Qualifying family members may be eligible to receive a monthly benefit amount of up to fifty percent of your disability benefit. Totals vary depending on the original qualifying beneficiary’s benefit amount and the number of family members who qualify.
The SSA outlines eligibility rules and generalizes that you and your family may receive 150 to 180 percent of your disability benefit. Note that a divorced spouse who qualifies for benefits will not affect your family’s benefits. Any benefits available to family members will only occur after you receive your disability benefits.
Disability Application Process
The SSA provides an online checklist of information to gather and create a my Social Security account. This account allows you easy access to your Social Security information. However, before filing a paper or online disability application, talk to your lawyer to ensure the information you provide is correct and comprehensive. A disability attorney’s familiarity with the application process enhances your chances of first-time application approval.
After submitting your application, the SSA will review your claim for completeness and ensure you meet the basic requirements to receive disability benefits. A further review by a field office includes the following:
- Confirmation you worked enough years to qualify
- Evaluation of any current work activities
- Processing of your application and forward your case to the Disability Determination Services (DDS) office in your state
The DDS state agency is responsible for making your disability determination decision. This agency is federally funded but administered via state agencies.
Processing and Response Time
Processing time depends on the nature of your disability, the review of medical evidence and examination, and critical quality reviews. They will contact you if the SSA has questions or requires further documentation.
Once the state agency determines your case, you will receive a letter in the US Postal mail stating the decision. First-time applications can take three to six months before receiving an initial decision.
You may check your application status using your my Social Security account. If you cannot check your status online, you can call 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday from 8:00 am to 7:00 pm.
Appealing a Decision
You have the right to appeal whatever decision the SSA makes regarding your entitlement to benefits. All appeal requests must be in writing and within 60 days after you receive the notice of the decision. You have the right to representation to conduct an appeal and should seek the services of a disability attorney to ensure success. There are four levels of the appeal process, including:
- An administrative law judge hearing
- A review by the Appeals Council
- A federal court review
All government benefits programs tend to have complex rules and regulations which policymakers can amend at any time. As one of the largest payroll tax-based federally funded programs, SSDI is no exception to changes and updates.
The odds suggest about 25 percent of Americans will require some SSDI benefits as current studies project a twenty-year-old worker today has a one in four chance of becoming disabled before they reach full retirement age.
Before you begin your application for SSDI benefits, do some research and retain the services of an experienced disability lawyer. It will save you time and frustration and increase your chance of first-time benefits approval.
We invite you to contact our offices in Midway, Erie, and Franklin PA to learn more about your options.