Why You Can and Should Apply for Social Security Disability Now
Don’t be intimidated — the main talent you need is patience
I worked as a Disability Examiner for years, and currently moderate an online board answering questions about SSI and SSDI. Let me back up: SSI stands for Supplemental Security Income. Its fraternal twin, SSDI, is Social Security Disability Insurance.
Those two acronyms are important, but so are a slew of others.
Have you ever wondered why there are a boatload of online sites explaining SSI and SSDI?
Because it’s a monumentally complex process with tons of rules, not unlike the volumes of official fire safety code that have been written since the first horrible multi-story structure fire.
Thousands of Americans apply for benefits every day and they want fast answers.
Currently, slightly less than 5% of the US population receives SSDI, which are payments to disabled workers. Numbers vary greatly by region: in Alaska, SSDI recipients make up 2.8% of the population, whereas in Arkansas it’s 8.3%. The average benefit is around $1300 a month.
SSI, which is a welfare program for someone who is disabled and has few resources and virtually no income, provides monthly checks to over 8 million individuals, about half of whom are under 65. Average benefits are a little over $500 a month.
If you are disabled due to any medical condition, you should apply because you are entitled to government help, whether it’s due to your past work history, or because you’ve fallen on hard times.
The disability process is somewhat intimidating. The purpose of this article is to demystify it and break down the fundamental steps.
How you qualify
If you have a medical impairment that makes it difficult to work, you may be approved.
You can’t estimate this outcome ahead of time, however, and the process is slow. Knowing these two bits of information can save you a lot of headaches.
One in three people who apply are approved on the first round, or the “initial” stage, which takes about six months. SSI/SSDI are federal programs that are administered at the state level, so the decision-making is uniform in every state but benefits may vary.
To get going, your responsibility is to make an appointment at your Social Security Administration (SSA) office and speak with a rep there — or go to the SSA website and walk yourself through the steps of an online application.
The online application can save you work. Talking with a Claims Representative, however, is comforting because you can schedule an appointment and query an experienced person with any question that comes up.
Qualifying or being “allowed” depends on two screening factors:
(1) You have a work history (work credits), which makes SSDI a possibility OR you are low in resources (little income, no savings but it’s okay to own one car and a house), which makes SSI possible, OR both.
(2) You are deemed medically disabled.
The SSA definition of disability is, paraphrased:
The presence of a medical condition which is severe and will last for a full year, or lead to death, and which precludes substantial gainful activity (working).
The application and approval process involves the SSA field office running the numbers and determining whether you are eligible based on work credits or income/resources (or both), then sending your claim, electronically, off to a separate office where specialized claims examiners and doctors review the medical portion.
To summarize: the first hurdle is at the SSA office, which decides if you qualify based on work history or money. The second hurdle is medical.
Once the medical office (Disability Determination Services, or DDS) reviews your medical records, they spit out a decision: can you work, based on the severity and duration of your impairments — or not? It’s all or nothing, and that’s why a lot of folks don’t qualify.
You must have a severe illness that has lasted a year (or is projected to) or is predicted to lead to your death.
You have about a 50–50 shot of gaining approval, but not right away. Your odds go up if you stick around.
How they decide if you can work or not
In the disability universe, work is called “substantial gainful employment” or SGA. The SSA field office and DDS are tasked with figuring out if you can perform SGA or not, through a series of exclusionary steps:
1. Are you currently employed, and do your earnings exceed their limit of 1,170 per month? (Field Office)
If so, you are NOT disabled. Obviously — you are working.
2. Is your medical condition so severe it meets or equals an SSA listing? A listing is a pre-determined level of severity based on specific medical tests; for example, if you have COPD and your spirometry hits certain numbers, or if you have anemia and have a certain number of blood transfusions within X months. (DDS)
If you do not meet or equal a listing, you are evaluated for whether your less severe condition prevents SGA.
3. Can you do your usual work? This is gauged by a form called a Residual Functional Capacity (RFC) that a doctor at the DDS fills out, indicating how much you can still lift, stand, kneel, etc. Its twin is the MRFC, for mental impairments.
If your RFC or MRFC shows you have the capacity to do past work, you will be denied.
If you’ve performed sedentary work like shuffling papers, you are less likely to be considered disabled at step 3.
4. If you can’t do your usual work, can you adapt to other, less strenuous work? (DDS)
If you can adapt, you are denied.
At step 4, being over 55 and especially over 60 means in the eyes of the DDS you won’t be able to adapt. An old dog doesn’t learn new tricks.
This series of exclusions is why being older (it’s tougher to adapt to new work!) and having a history of strenuous work (steelworker, fireman, etc.) are big plusses. There are a few other factors, like having a low education level, that can work in your favor.
Reconsideration (Recon)
Within about six months, you’ll receive a denial or approval letter. If approved, you’ll get funds in a pre-arranged account.
But for those who are denied — about two-thirds of applicants — the appeals process begins. The determined applicant marches back into the SSA office and reapplies within 60 days. If you aren’t able or willing to march, the online Reconsideration, or Recon application, is ready and waiting.
Maybe you have more medical records because you recently saw your primary care doc or a specialist? Maybe your income is now gone and so are your remaining resources?
The Recon stage yields few approvals, but if your condition has worsened, or showed more signs of enduring, you might get approved here and this stage requires little effort. Mainly, it’s about submitting the Recon application under the deadline. A new Disability Examiner and a new set of doctors at the DDS will review your claim this time.
The payoff for disability comes with patience because by the time you’ve muddled through denials at the initial and Recon stages, your odds of approval go way up. This is because a new person enters the scene, and he or she won’t just review your file but will see you face-to-face.
The person deciding your fate after reconsideration is a judge, not a medical doctor.
The ALJ, or going before a judge
The Administrative Law Judge (ALJ) has more incentive to approve claims than deny them because writing up a denial is a more arduous process in their office. They follow the same SSA rules but have more leeway and usually more sympathy.
It takes a year or more before you’ll ever see a judge, but for many people, this is the best chance of approval. By now, you’ll have more medical evidence. You’ll be more comfortable with hoop-jumping. You might have picked up a disability attorney or non-attorney rep along the way.
You certainly are more knowledgeable.
The hearing before the judge is typically short, sometimes as little as 15 minutes. It’s often done these days by video feed. You can have a representative with you.
When your ALJ hearing is done, you’ve might have reached the end of the road. Some people will choose to continue fighting if they get a denial, and go to the federal level.
If you are denied by an ALJ, you’ve spent a year or more of your life trying. It can be discouraging, but if you truly cannot work you can start over or do what many others before you have done — accept that the system has decided you aren’t disabled and take on part-time work.
None of this means you aren’t actually disabled, just that the all-or-nothing Social Security Disability system thinks you can still work.
Your earnings from most part-time jobs aren’t that different from what you’ll receive from SSI or SSDI, anyway, which is typically between $600 and $1200 a month.
With 50–50 odds, why not go for it? If you are aware going in that the process is slow and tedious, you are ready. If you are willing to put in some work and can accept the decision no matter what happens, take the first step.
