An Overview Of Social Security Disability Benefits
If you are considering applying for Social Security Disability Insurance benefits or if you are appealing a denial of benefits, it is important to understand the Social Security Administration’s adjudication process.
At Chermol & Fishman, LLC, many of our attorneys formerly worked for the SSA, and they have extensive experience helping clients file claims, appeal denials and obtain the benefits they deserve. We can help you understand the complex process of applying for or appealing a denial of Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Here, we will give an overview of Social Security Disability.
SSDI Or SSI: What Is The Difference?
Social Security Disability Insurance (SSDI) benefits are for people who have worked and paid taxes and who have a disability that prevents them from working. To qualify for SSDI benefits, applicants must have a sufficient taxpaying work history. This is because SSDI benefits are “earned” with the contributions applicants have made through their Social Security taxes.
Supplemental Security Income (SSI), on the other hand, is a needs-based program that helps disabled people with low income and few resources. These benefits are based on financial eligibility, not one’s taxpaying employment history.
To qualify for SSDI or SSI benefits, you must have one or more severe impairments that limit your ability to work.
Filing For Disability Benefits
The Social Security Disability Insurance and SSI disability application and appeal process can take a long time, so it is wise to make sure that your case is well-positioned for a potentially favorable outcome from the beginning. It is best to consult with an experienced Social Security Disability attorney before filing your claim to get a sense as to whether or not the timing of filing your claim is right at that moment or if it would be a good idea to undergo more treatment and/or testing before filing a claim.
The Decision Process
A Social Security Administration representative will review your application, which will be forwarded to the state Disability Determination Service, the agency that gathers your medical records and makes the medical decision on whether or not you are “disabled.” The state agency may need to gather more medical or vocational evidence, including possibly sending you for physical and/or mental consultative examinations by doctors contracted to do the examinations.
Social Security uses a five-step process to determine whether the applicant is eligible to receive benefits:
- Whether you are currently employed
- Whether your medical condition(s) is a “severe impairment”, meaning that the impairment (or impairments) would have a significant impact upon the ability to work
- Whether your impairment causes symptoms and limitations severe enough to meet one of Social Security’s listings of impairments for disability
- Whether you can perform the type of work that you’ve done in the 15 years prior to your cessation of work
- What other types of work you can perform notwithstanding your health problems
The state DDS agency will return the file to the Social Security Administration with its recommendation. The SSA almost always adopts the state agency’s disability determination, though SSA does engage in random quality review of medical decisions. Finally, once medical review has been completed, the SSA will mail you a notice of its decision.
Appealing A Denied Claim
If the SSA denies your claim, you have the right to file an appeal.
The appeals process can take many months and often over one year.
First, you must request a reconsideration, which entails the state DDS agency again reviewing the medical record and determining if the earlier denial was proper under the SSA’s rules and regulations. If reconsideration is denied, the next appeal is for a hearing with an administrative law judge, which is where the majority of appealed cases are won or lost. If the decision of the ALJ is unfavorable, the next level of appeal is to the Social Security Administration’s Appeals Council. Finally, you may appeal to the federal courts if the claim has been denied by the Appeals Council.
It generally takes about 2.5 to 4 months to get a decision at the initial and reconsideration levels and the wait for a hearing is generally about one year in most areas as of 2020, though certain regions and states are still more adversely impacted with longer waits for hearings, such as in New Jersey.
Speak With A Disability Attorney For Free
Each step of the Social Security Disability benefits application process can be time-consuming and complex. An attorney from Chermol & Fishman, LLC, can answer your questions and help you through the qualification and appeals process.
Call 215-795-4448 or send an email to get your free consultation. Our office serves the greater Philadelphia metropolitan area and eastern and south-central Pennsylvania. We also work nationwide with offices in New Jersey, Texas, Florida, Kentucky and Illinois.