Social Security Disability Insurance (SSDI) is a program for replacing some of the income that long time workers have lost by becoming disabled. SSDI is an earned right, with basic eligibility based on having worked enough time in a job that was covered by Social Security. The program is funded by payroll taxes during the time you work. There are no limits on the resources you can own, although there are limits on what you can earn while receiving SSDI benefits.
Disability has a very specific meaning for purposes of SSDI. You may be disabled for purposes of some other program, like the VA, and various doctors may have considered you disabled in a general sense, but neither means that you meet the criteria for SSDI eligibility.
The basic SSDI determination is a 5-step process in which the Social Security Administration (SSA) analyzes whether, based on the evidence you have submitted:
- You cannot perform “substantial gainful activity” (SGA)
- You have a “severe” impairment which is medically determinable
- Your impairment meets one of the impairments in the official “Listing of Impairments” contained in the Social Security regulations
- Your residual functional capacity” (RFC) does not allow you to perform your “past relevant work” (PRW)
- You are unable to perform other work that exists in significant amount in light of your work experience, age, education and RFC
These criteria actually form two distinct groups. If the answer to number 1-3 is yes, you are disabled for purposes of SSDI. If one or more of the answers is no, you proceed to numbers 4 and 5; if the answer to both 4 and 5 is yes, you are still SSDI eligible.
Substantial Gainful Activity Standard
This standard encompasses two separate criteria. In some cases, work is not deemed substantial if the only reason you can perform it is that the employer makes considerable accommodations to suit you.
For 2015, the income limits for SGA are $1,820 a month for the statutorily blind, and $1,090 a month for others. For purposes of determining whether you exceed those limits, SSA reduces that are related to your impairment.
The analysis of substantial gainful employment can be complicated for people who are self-employed, since it’s common for self-employed people to work at a loss, and many self-employed people have some control over when they realize income. To account for these factors, the SSA determines how much “value” your work has. That’s the kind of issue on which the help of an experienced SSDI attorney can be invaluable.
Duration of Disability Requirement
Even if you meet the criteria for disability, SSDI benefits are only available if the disability is, at least is expected to be, long term: a period of at least 12 consecutive months. Shorter periods of disability are expected to be handled by other means (savings, workers’ compensation, etc.).
Although some conditions cause intermittent periods of disability, with the disabled periods adding up to more than 12 months, SSDI won’t allow non-consecutive disabilities to be tacked together. If there is no consecutive 12-month or longer period, SSDI benefits are not available.
Stages of SSDI Claims
All SSDI claims start with an initial application. Many applicants file without getting an attorney to help. Whether that’s wise depends on your point of view. It avoids some expense. On the other hand, almost two thirds of initial claims are denied.
There are four potential stages after a claim denial:
- Hearing with an Administrative Law Judge (ALJ)
- Appeals Council review
- Federal court
When Your Initial Claim is Denied
First, make sure you understand why the claim was denied. Keep in mind that claims may be denied for failure to meet any of the criteria for eligibility. The denial may be based on insufficient severity of the impairment, on the ability to still work, on the likelihood of the impairment improving, etc. There is no point in proceeding further until you really understand exactly why the claim was denied.
That can be pretty technical, since the denial will be phrased in the jargon of the SSD program. If you don’t have an attorney at that point, it’s a good time to get one. An experienced SSD attorney will have no trouble interpreting the denial.
Once you know why the claim was denied, you can focus your effort on appeal (or reconsideration) to rebutting the reasoning of the denial.
Get Legal Help in Filing Your SSDI Claim
Whatever stage you have reached in your SSDI claim—even if you have yet to file one—the attorneys at the Jabar Injury Law firm can help. The language, the procedures and the concepts can be daunting to anyone who isn’t intimately familiar with them. We’ve been helping SSDI claimants for decades. We can greatly improve your chances of success, while you focus on your health. Call Jabar Injury Law today.