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What is Social Security disability insurance, and who is eligible? What should I do if my SSDI claim is denied?

Social Security disability insurance, or SSDI, is a government safety net program designed to provide financial support to people who have suffered a severe and permanent injury or illness that leaves them unable to work. SSDI will provide monthly benefits equal to a portion of the recipient’s prior income, up to a certain limit. Every year the program gives about $143 billion dollars to over 11 billion Americans who can no longer support themselves. SSDI is funded primarily through payroll taxes.

Starting the SSDI Application Process

Before you begin, be aware that applying for SSDI is not a task to be taken lightly. The application process has been known to take months or even years, and a single missed deadline can restart the clock. A successful claim takes time and patience.

Your first step is to determine whether you may be eligible for SSDI at all. In order to qualify, you must be “unable to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

You must not only be unable to perform the duties of your previous job, but also be unable to participate in any other work, either. However, this does not actually prevent you from receiving relatively small amounts of money, such as from a part-time, low-wage job: the maximum SGA income limit for 2016 is $1,130 per month for non-blind individuals, and $1,820 per month for the blind.

You must also have worked and paid taxes for a number of years to achieve a minimum number of “work credits.” The exact number of credits you need to be eligible depends on your age and whether or not you are blind. The Social Security Administration (SSA) has a web page that outlines the basics of the credit system, or you can ask your SSDI attorney for more details.

Qualifying Disabilities

The SSA’s definition of “disability” may not necessarily be the same as your physician’s. The Social Security Administration maintains a list of conditions that it will accept as severe enough to warrant acceptance. There is also a new “Compassionate Allowance” program, which is a list of conditions that receive automatic approval and immediate processing. These conditions are typically either especially severe, or carry an extreme likelihood of imminent death, and includes such diseases as:

  • Childhood leukemia
  • Early-onset Alzheimer’s disease
  • Certain cancers
  • Lewy body dementia

If your condition is not on either of these lists—and many conditions are not—the Social Security Administration will want to make a determination about whether or not your condition is as severe as other conditions that are on the list. You’ll have to prove your case to the SSA in order to succeed with your claim.

Providing Evidence to Support Your Claim

When filing for a disability claim, you will want to provide the SSA with as much evidence as possible to support your position. Good records showing routine and ongoing medical care by qualified professionals are important. Your doctor’s opinion regarding your seriousness of your condition, your physical or mental limitations, and your long-term prognosis will also play a big part in the SSA’s determination. Sources of evidence that the Social Security Administration may use includes information from:

  • Licensed doctors, psychologists, optometrists, or podiatrists
  • Treatment facility records, such as Clinics, hospitals, or any other place you’ve sought help
  • Employer records
  • Information from social workers or other caregivers

This is not an exhaustive list of sources that the SSA will look to for evidence to support or deny your claim, but it’s best to be prepared ahead of time by having as much information as possible available. Even if you don’t need it now, you may need it later for a hearing, or an appeal if your initial claim isn’t successful.

Initial Claims Are Regularly Denied

Having an SSDI claim denied is extremely common: the SSA’s own data shows that only 36% of claims were approved in the 2004 to 2013 period. Only about one-quarter of claims were given benefits after the initial filing, and 2% were approved with appeal. A further 11% were approved with a hearing.

Don’t be discouraged if your initial claim is denied. Many people who have become disabled and unable to work still secure the benefits that they are owed. The process takes time, but when your claim gets approved, benefits are retroactive to the date of the initial filing.

Get Help With Your Claim Today

It’s important to know that if your initial claim is denied, you can get help with your appeal. A legal professional who is familiar with SSDI claims can help you figure out what you need to do so that you have the best chance to succeed. Wayne Wright LLP has been down this road many times before, and we know how to help you. For a free case evaluation, call us at 800-237-3334.