Social Security Disability Insurance (SSDI)
what is it?
Social Security Disability Insurance (SSDI) is a program funded by the U.S. Social Security Administration (SSA) and provides financial assistance to adults unable to work due to a long-term medical condition. It is a federal program where individuals who qualify have paid a sufficient amount into the social security system. Recipients receive Medicare coverage.
The SSA requires a great deal of paperwork and personal information from individuals applying for SSDI benefits. Required documentation includes details of the applicant’s medical condition and work history, description of medical care providers, medications, and lab results, and copies of W-2 forms and tax returns. In addition, most SSDI applications are initially denied and proceed through an appeals process that can last for several stages of review.
how can we help?
Guynn Waddell is knowledgeable of the federal rules and regulations that govern the Social Security Disability Insurance program, and skilled at navigating the process appealing SSDI applications to the Social Security Administration. When an SSDI application is denied, we are here to help clients walk through the appeals process in order to greatly improve their chances of successful outcomes.
Please note that in order for us to assist in the appeals process, we must have a copy of your application with denial letter, and be contacted within 60 days from the date of your denial letter.
who is eligible for ssdi benefits?
The Social Security Administration has a narrow definition of disability and only provides SSDI benefits to those who meet specific requirements:
- Become disabled and cannot work for a minimum of 12 months
- Meet the SSA’s definition of a disability
- Do not have a partial or short-term disability
- Have worked long enough and recently enough in a job(s) covered by Social Security, and paid a sufficient amount of payroll taxes into the social security system
- Have not reached retirement age
In addition to the above requirements, the Social Security Administration must also find the individual unable to engage in substantial gainful activity (SGA). A person who works and earns more than a certain monthly amount is ordinarily considered to engage in substantial gainful activity and therefore ineligible to receive SSDI benefits. The amount of monthly earnings considered as SGA depends on the nature of a person’s disability and generally changes every year with the cost of living adjustment.
Certain family members of disabled workers may also be eligible to receive benefits from Social Security. They include:
- Spouse, if he or she is age 62 or older
- Spouse at any age, if he or she is caring for a child of yours who is younger than age 16 or disabled
- An unmarried child, including an adopted child, or, in some cases, a stepchild or grandchild. The child must be younger than age 18 (or younger than 19 if still in high school)
- An unmarried child, age 18 or older, if he or she has a disability that started before age 22. The child’s disability must also meet the SSA’s definition of disability for adults.
Note: In some situations, a divorced spouse may qualify for benefits based on your earnings, if he or she was married to you for at least 10 years, is not currently married, and is at least age 62. The money paid to a divorced spouse doesn’t reduce your benefit or any benefits due to your current spouse or children.
overview of ssdi application and appeals process
Individuals must submit a Social Security Disability Insurance application to the Social Security Administration. Below are the five stages for submitting and appealing a SSDI application. Generally speaking, applicants have a 60-day time limit to appeal a denial during any of these stages.
- Initial Application – disability application submitted to the Social Security Administration that contains documentation of applicant’s medical condition and work history
- Request for Reconsideration – if initial application is denied, applicant can appeal for reconsideration
- Hearing with an Administrative Law Judge (ALJ) – a brief, informal hearing before a judge during which the applicant may present additional testimony and other evidence to strengthen his or her application
- Appeals Council – if claim not approved during ALJ, it may be submitted for review by the Appeals Council which is made up of members of the Social Security Administration. The applicant does not appear before them in person.
- Federal Court – the final step in the appeals process if application denied by the Appeals Council
