Social Security Disability Insurance

What is SSDI?

Social Security Disability Insurance (SSDI) is a wage replacement program which provides benefits to disabled workers, dependent children, and widows and widowers. Under some conditions, an adult child may also qualify for SSDI benefits on the parent’s earnings record if the child becomes disabled prior to the age of 22.

Not all disabled workers will qualify for SSDI benefits. To qualify for SSDI benefits a claimant must be under the age of sixty-five years of age, must have worked and earned sufficient work credits to be considered “insured” by the Social Security Administration, and have a physical or mental health impairment which is expected to last for at least 12 continuous months and does not allow a claimant to work or perform what the SSA terms substantial gainful activity or SGA.

The Social Security Administration currently defines “gainful activity” as the ability to work and earn more than $1,180 per month for non-blind individuals and $1,970 per month for the blind. Substantial work is defined as significant mental or physical activities which are performed even if a claimant is not paid. For example, if you are able to volunteer 40 hours per week the SSA would consider you not disabled because they would assume you are also capable of performing work for pay.

How do I earn work credits for SSDI?

SSDI applicants will only qualify for SSDI benefits if they have worked and paid employment taxes, specifically FICA taxes which have been deducted from a claimant’s paycheck and deposited into the Social Security Trust Fund. In 2018, a worker must earn $1,320 to get one Social Security work credit. To receive the maximum of four credits per year, a worker must earn $5,200.

To qualify for SSDI benefits a claimant must have worked recently enough and worked long enough to accumulate sufficient work credits. The number of work credits needed will also depend on the age when the claimant became disabled. For example, a claimant who is 31 years of age must have worked five of the last ten years or have earned 20 credits within the 10 years immediately preceding the date they became disabled to qualify for SSDI benefits. Older claimants will need more credits to qualify for SSDI benefits. In general, most claimants will need at least 40 work credits, 20 of which were earned in the last 10 years before they became disabled and unable to work.

What do I do if I do not have enough work credits for SSDI benefits?

Social Security Disability Insurance (SSDI) work credits must be earned by the individual applying for SSDI benefits. They cannot be borrowed or bought. Claimants who have not worked and paid sufficient employment taxes will not qualify for SSDI benefits, regardless of the severity of their health condition.

If you do not have enough credits to qualify for SSDI benefits you do have several options. First, you can continue to work and earn more work credits. If this is not possible, you may also apply for Supplemental Security Income (SSI) benefits. Unlike SSDI, which requires workers to work and earn work credits, SSI benefits are awarded to the aged, disabled, or blind and who are not able to work for at least 12 continuous months. Unfortunately, however, SSI benefits are only awarded to claimants who have very limited resources and income.

How can Higgins and Associates help with SSDI?

One of the most common questions claimants ask is, “Why do I need a disability lawyer to get the SSDI benefits that I paid for and deserve?” Unfortunately, millions of workers apply for disability benefits each year, and 60 to 70 percent of those claimants are denied disability benefits the first time they apply.

Can Higgins and Associates guarantee that you will get SSDI benefits the first time you apply? No, but they can help expedite a claim at each step of the disability process. At the application level, they can ensure a claimant understands how to fill out their application and answer questions about how the SSA makes their disability determination. They can also ensure a claimant sees the right medical professionals, and if necessary, file disability appeals.

Often claimants will not contact a disability lawyer until their claim has been denied. The good news is a claimant may have their best opportunity to win SSDI benefits by attending an administrative hearing and arguing their case before an administrative law judge. At the administrative hearing level Higgins and Associates can provide legal assistance to help you prepare for your hearing, they can answer your legal questions, and they can argue your case before the Administrative Law Judge.

If you are denied at the hearing level, Higgins and Associates can file another appeal with the Appeals Council. The Appeals Council may decide to uphold the Administrative Law Judge’s decision, remand the case back to the lower court, or refuse to review the case. Further legal options can be discussed with your disability lawyer if the case is not overturned or reviewed.

Approval Process for SSDI Disability Benefits

The SSDI application and approval process can be very confusing. Below are the following steps:

  1. Claimants submit their SSDI application to the SSA. This can be done online, by appointment, or over the phone.
  2. The application is reviewed. If the claimant meets the non-medical requirements for SSDI benefits, the application is transferred to a state agency where a disability examiner will review the case.
  3. The state agency requests medical records from all the treating doctors listed on the SSDI application. After the records are received, which could take weeks or months, the disability examiner will review the records. If the claimant does not have sufficient records to make a disability determination, they may be required to see a consultative examiner.
  4. The disability examiner will follow strict SSA standards, referred to as the “Sequential Evaluation,” for determining whether a claimant is disabled.
  5. If the disability examiner determines the claimant is disabled, they will be approved for benefits. An awards letter will be sent via mail. The awards letter will include the date in which the claimant is entitled to receive disability benefits, the amount of the payment, and the date the payment should arrive.

Note, there is a five-month waiting period to receive SSDI benefits. If you are approved immediately you will have to wait five months to receive payment. If you are not approved for at least six months or more, however, you will receive disability back pay beginning with the sixth month after the onset date of your disability.

If you are denied disability benefits, you will receive a denial letter. Appeals must be filed within 60 days from the date of the denial letter.