Applying for social security disability insurance can be a daunting process. After all, there are rules and regulations that are confusing to most people. However, if you’re in need of SSD benefits, you probably don’t want to spend hours researching what social security disability benefits are.
That’s why we’ve put all the relevant information in one place. There’s a lot of twists and turns when it comes to SSDI, but we’ll try and make a smooth ride.
Here’s what we’ll cover:
- What is SSDI?
- What is the difference between SSI and SSDI?
- How to apply for Social Security Disability Insurance
- Determining disability eligibility
- Appealing denied social security disability application
- Family eligibility and children with disabilities
- Social Security Disability work incentives
- SSDI FAQs
Social Security Disability Insurance (SSDI) pays benefits to people who cannot work because of certain disabilities or medical conditions. SSDI is funded by FICA Social Security payroll taxes. Workers earn SSDI by accumulating enough work credits throughout their working life. In order to qualify for SSDI, a person must be under 65 years old and have a qualifying severe disability as designated by the Social Security Administration (SSA).
Also, federal law has a very strict definition of disability that requires the medical condition be one that’s expected to last one full year or more, or result in death. Social Security does not grant benefits to people with partial or short-term disabilities.
There is some confusion about the difference between SSDI and SSI (Supplemental Security Income), so let’s clear up that confusion next.
SSI eligibility is determined based on age, disability and available resources, while SSDI is based on a person’s disability and work credits.
For most people, medical requirements that will allow you to receive disability payments are the same for both, and disability is determined using the same process. Both SSI and SSDI are managed by the Social Security Administration as well.
|Eligibility Determination||Disability and work credits||Age, disability, income/resources|
|Medicaid/Medicare Benefits||Eligible for Medicare after 2 years||Qualified for Medicaid|
|Waiting Period||5 months||1st of the month after approval|
|Payout Determination||Location and monthly income||Record of earnings|
The most notable difference between SSI and SSDI is that SSDI is only available to people who have accumulated enough work credits, while SSI is available to low-income individuals who have not accumulated enough work credits or who have never worked. In addition, SSDI is based on your work history, but SSI is strictly based on a financial situation of considerable need.
Additionally, SSI benefits begin on the first of the month that a social security disability application is submitted and approved, but for SSDI there is a five-month waiting period. People who qualify for SSI can also receive Medicaid benefits. After receiving SSDI benefits for two years, a disabled person will be eligible for Medicare benefits. The amount of SSI benefits depend on where a person lives and what their monthly income is, while SSDI benefit amounts are dependent on a person’s earnings record.
There are three ways to apply for SSDI:
- You can apply online Online. As part of this process, you will need to print and review SSA’s Adult Disability Checklist. It will help you gather the information you need to then complete the Disability Benefit Application.
- Over the phone by calling 800-772-1213.
- In person at your local Social Security office. Find your local office here.
SSDI application process
As soon as you become disabled, you should apply for SSDI benefits. There is a five month delay from the time you apply until the time you receive your first SSDI payment. Generally, it takes three to five months to process disability applications. In addition, if your Social Security Disability application is rejected for any reason, you will experience further delays if you decide to go through a multi-step appeals process.
After applying for disability benefits, the Social Security Administration will evaluate your employment history, length of work history and current work activity to determine if it meets their basic work requirements. Should these requirements be met, the application will be sent to your state’s Disability Determination Services (DDS) office to evaluate the medical case and application.
If the claim is approved, a letter will be sent with the approval information, amount of monthly benefits and date effective. In general, monthly cash benefits are paid until you are able to work again on a regular basis.
The amount of a Social Security Disability Benefits is based on average lifetime earnings. The first benefit will be paid for the sixth full month after the date the disability began.
Those who have received disability benefits for two years will receive Medicare coverage automatically after that time period.
Additionally, certain family members might also qualify for benefits based on the applicant’s work, but it’s important to note that other government benefits may be affected.
Information needed to apply for Social Security Disability benefits
Processing claims for disability benefits can take anywhere from 3-5 months. Gathering required information prior to filing a claim may expedite the process. You will need the following information to apply online:
- Social Security number (or permanent resident card if you are not a U.S. citizen)
- Basic spousal information
- Basic information for any children under the age of 18 or those who became disabled before the age of 22
- Military service, education or training
- If you are self-employed, business type and total net income
- If you are not self-employed, name of employer, start and end dates of employment, total earnings for the past two years
- Direct deposit information
- Medical information including conditions, doctors, hospitals, clinics at which you’ve received examinations, tests, treatments, etc.
- Names, dosages and information of all medications
- Employment history for the 15 years prior to becoming disabled
To apply over the phone or in person, you will need the majority of the above as well as:
- Medical records already in your possession
- “Medical and Job Worksheet – Adult,” which can be found here.
Disability application starter kit
To assist you in creating your application, Social Security has developed a Disability Starter Kit that provides information about the documents and information that you will be requested to provide. Because an application can be complicated and lengthy, this is a good place to start and to keep you organized. The kit also explains how Social Security’s disability programs work and what decision-making processes are used to determine your eligibility.
After you’ve applied for SSDI, the federal government will have to determine if you meet the work requirements necessary to receive benefits. Work requirements look at both recent work and the duration of your work. If you meet both, the severity of your disability will then be determined.
SSDI work requirements
One of the major factors for disability is whether or not you have had recent employment and have worked long enough to qualify for social security disability insurance.
The federal government answers this question by determining a person’s Social Security credits. Credits are basic units of measurement that determine whether a worker is insured under the Social Security program.
The number of work credits you need to meet the work requirements for disability benefits depends on your age on the date you became disabled.
Younger workers may qualify with fewer credits, but generally a worker needs 40 credits to qualify. Twenty of those credits must be earned within the last 10 years before becoming disabled.
What is a Quarter of Coverage (QC) or Social Security Credit
A credit, legally termed a Quarter of Coverage (QC), is essentially a building block or gauge of accumulated work based on total yearly wages or self-employment income.
The credits allow the Social Security Administration to determine if a person has put in enough time to receive benefits.
One credit is given when a certain amount of money is earned. In 2015, $1,220 in wages equals 1 credit. In 2016, $1,260 will equal one credit. You can receive up to four credits per year.
Note: the earnings Social Security uses to calculate your credits are only earnings on which you pay Social Security taxes as indicated on your tax return. Interest on savings or investments do not count toward earning a credit.
What does “recent employment’ mean?
According to the SSA, you must complete a certain amount of work during a determined time frame in order to meet the “recent work” requirements. The time frame takes into account the age at which you became disabled.
Time frames are based on the calendar quarter in which you turn a certain age:
- First Quarter: January 1 – March 31
- Second Quarter: April 1 – June 30
- Third Quarter: July 1 – September 30
- Fourth Quarter: October 1 – December 31
Next, to determine the amount of work that must be completed, follow the chart below:
|If you become disabled…||Amount of Credits Needed|
|In or before the quarter you turn 24||6 credits or 1.5 years of work over the 3-year period before the disability started|
|In the quarter after you turn 24 but before the quarter you turn 31||Credits for half of the years between your 21st birthday and the quarter you became disabled|
|In the quarter you turn 31-42||20 credits|
|At 42-62||Credits that equal your age subtracted by 12.|
|At or after 62||40 credits|
Note: Blind applicants typically do not have to satisfy the recent work test
Example: John becomes disabled at 29 and is no longer able to work. John adds up the years between his 21st and 29th birthday- 8. John then halves that number to determine the amount of credits needed to qualify for SSDI- 4. Because you can only earn 4 social security credits a year, John then multiplies his year number, 4, by 4. John needs 16 work credits to qualify.
Determining employment duration
You must have worked long enough in the federal government’s eyes to receive Social Security Disability Benefits. Work does not need to fall within a certain time period. Below is a sample of ages and the average amount of work needed to qualify.
|Age You Become Disabled||Average Years of Work Needed|
|Before age 28||1.5 years|
|Age 30||2 years|
|Age 34||3 years|
|Age 38||4 years|
|Age 42||5 years|
|Age 44||5.5 years|
|Age 46||6 years|
|Age 48||6.5 years|
|Age 50||7 years|
|Age 52||7.5 years|
|Age 54||8 years|
|Age 56||8.5 years|
|Age 58||9 years|
|Age 60||9.5 years|
SSDI pays only for total disability, not short-term disabilities.
According to the SSA, disability is based on a person’s inability to work. Their definition is very strict, but you qualify if you meet the following criteria:
- You cannot do the work that you once did.
- Social Security decides that you cannot adjust to other forms of work because of this medical condition.
- Your disability has lasted or is expected to last for at least one year or to result in death.
The reason why no short-term disability is provided through Social Security is because the federal government assumes that working families will have access to workers’ compensation, insurance, savings and investments for support during short-term disability periods.
Once the Social Security Administration completes your employment evaluation, the application will be sent to the Disability Determination Services (DDS) to complete the disability assessment.
The DDS considers all facts in your case and inquires about your medical condition: when it began, how it limits your activities, what medical tests have shown, and what treatment you have received.
Note: The DDS uses doctors and disability specialists in the state agency to request information from your doctors about your condition.
Social Security disability determination process
Social Security uses a 5-step process to determine if your disability is severe enough to qualify for benefits.
Step 1. Current work status
Generally, Social Security will not consider you disabled if you are working and earning more than a specified monthly amount—in 2015, that amount is $1,090 per month. (The Social Security Administration publishes the specified monthly amount each year.)
If you’re not working or earning less than the specified amount, the DDS will use steps 2-5 to make a decision on your medical condition.
Step 2. Severity of condition
To be considered severe, the disability must significantly limit the ability to perform basic work activities—lifting, standing, walking, sitting, or remembering—for at least 12 months.
If this qualification is satisfied, the DDS will move on to step three.
Step 3. Is the condition listed?
The Social Security Administration maintains a comprehensive list of medical conditions and circumstances that automatically mean a person is disabled.
For a list of Social Security’s blue book of qualifying adult medical conditions, click here.
If the condition is listed, you will be found disabled.
If a condition is not listed, the DDS must decide if the severity is equal to a medical condition on the list. If that is not determined, the DDS will continue to steps 4 and 5.
Step 4. Can you reasonably perform your previous work?
If your condition is not on the list and is not equally as severe as one on the list, the DDS must establish that it prevents you from performing any of your past work. If that interference is determined, then the DDS moves on to step 5.
If your medical condition does not interfere with your ability to do the previous work, your qualification claim will be denied.
Step 5. Can you perform any other type of work?
The agency will consider your age, education, past work experience, and any special skills you may have to determine if you can do other work than what you had previously. If you can adjust to other work, you will not qualify for benefits.
If you are considered unable to do other work, your application for benefits will most likely be approved.
Expedited SSDI application process
To expedite new disability claims, the following initiatives have been created:
Social Security makes allowances for people to receive benefits quickly if they suffer from medical conditions that are so obvious that they easily meet disability standards.
Compassionate Allowances quickly identify diseases and medical conditions that fall under the Blue Book of Impairments with minimal medical information. This allows Social Security to speed up the process of helping people obtain benefits in the shortest amount of time possible.
The list of Compassionate Allowances has been developed based on public hearing held by Social Security, along with input from medical and scientific experts and the National Institutes of Health. Currently allowances include disabilities such as Alzheimer’s disease, cardiovascular disease, organ transplants, schizophrenia, and others.
A full list of Compassionate Allowances can be found here.
Quick Disability Determinations:
Sophisticated computer screening is used here to identify cases that have a high probability of allowance.
It’s common for applicants to be denied. In fact, only about 1 in 3 applicants are initially approved for SSDI benefits. The two main reasons for denial are usually a lack of work credits, or that applicants do not meet the criteria for disability.
If you have been turned down, you do have the right to go through a Social Security Disability appeal process. Either you or your designated representative can file a “Request for Reconsideration.” Your initial appeal will then be turned over to Disability Determination Services, who will thoroughly review your file.
If you are denied again, you can proceed to the next level of appeal which is to appear in front of an Administrative Law Judge. An Administrative Law Judge will conduct a hearing in which all of your medical records and testimony will be heard before the judge renders a decision in the form of a written notice.
If you are still denied benefits, then you have a final appeal step you can take: filing a lawsuit in U.S. district court. You will need an attorney for this step if you haven’t already retained one. This can be an expensive and time consuming option, and as a result, less than 1% of disability claimants take their cases to this level.
Certain family members may be eligible to receive disability benefits on your record including a spouse, a divorced spouse, children, a disabled child and/or an adult child who was disabled before the age of 22. Each beneficiary’s rate depends on the number of family members receiving benefits on your record as well as the amount you receive.
The maximum amount each family member is eligible to receive is 50 percent of the disability rate. The total payment to an entire family, however, is capped and is not based on other personal financial situation factors.
Disabled children under the age of 18 are eligible for benefits as beneficiaries of a parent who has earned enough work credits under Social Security.
If a child is disabled before the age of 22, he or she is also eligible for disability benefits under a parent’s record if the parent is deceased, collecting retirement, or collecting disability themselves. The following stipulations apply:
- The person must be unmarried, age 18 or older, and have a disability that started before age 22
- The person cannot have ‘substantial’ earnings as determined by Social Security
- The person must meet the definition of disability for adults
People who are blind or have low vision
If you are blind or have low vision, Social Security offers several adjustments to disability benefits to accommodate the additional difficulties associated with loss of sight.
These accommodations include being able to work toward Social Security credits after you become blind, delayed benefits that will increase if you continue to work without receiving disability benefits and a higher monthly salary cap.
Special rules make it possible for those receiving SSDI benefits to go back to work while continuing to be paid the monthly benefits. This is for those workers whose disability is not life threatening and have some capacity to work.
Three incentives are offered by SSDI for people attempting to go back to work: trial work period, extended period of eligibility, and expedited reinstatement.
Trial work period
A trial work period allows you to test your ability to work. You are able to receive your full disability as long as your work activity is reported to the Social Security Administration and you continue to be disabled.
You must report your work to the Social Security Administration in order to qualify.
During the trial period you can accumulate a maximum of 9 months of work with any pay grade over a 60-month period and still receive full benefits. A month is considered part of your trial work period if you earn more than $750 (as of 2015) or work more than 80 hours if you are self-employed.
Extended period of eligibility
Following your trial work period, you will enter a 36-month extended period of eligibility. It is in this period that you can work and still receive benefits only as long as your earnings are less than what Social Security considers ‘substantial’. Social Security deducts what they consider ‘work expenses’ that are a direct result of your disability from your total monthly earnings. These ‘work expenses’ can range from prescription drug copays, transportation to and from work, and specialized work equipment.
If you exceed the level of substantial earnings at a point beyond the trial work period, your benefits will be stopped. However, you can receive expedited reinstatement that allows you to restart your benefits any time within the five years following your withdrawal if you are unable to keep working because of your condition. You will not need to reapply.
Can I get SSDI back pay?
Yes. Lump sum SSDI back pay is available to claimants who are paid retroactively for those months from the time they became disabled, also known as a disability onset date, and when they applied for SSDI benefits. In addition to SSDI back pay, people who apply for SSI may also receive retroactive benefits as well.
When will I receive my first SSDI payment?
If the Social Security Disability application is approved, the first benefit will be paid to you for the sixth full month after the date that the disability began.
Monthly disability benefits are wholly based on your lifetime average earnings covered by Social Security. You can receive an estimate here.
Are there SSDI income limits that might affect my benefits?
Yes. A disabled person applying for SSDI may not earn more than $1,170 per month by working. However, there are no SSDI income limits on unearned income, such as those from investments, interest or a spouse’s income. Blind applicants are exempt from this SSDI requirement.
I’ve heard that my SSDI payments may be reduced if I receive other benefits. How does this happen?
If you receive other disability benefits such as Workers’ Compensation, your benefits may be recalculated or reduced. This may take place based on the SSDI index which is also the same index used to compute all Social Security benefits. The SSDI index looks at average wage indexes and applies them to a beneficiary’s average current earnings.
How can I find out if I have a disability that will qualify me to collect SSDI benefits?
Social Security bases many of their decisions about what qualifies as a disability based on information published in the Blue Book of Impairments. This Social Security Disability list of impairments details all qualifying medical conditions that meet the test for disability. While it is a comprehensive list, if you have a medical condition not listed in the Blue Book, you can still possibly qualify for SSDI benefits. As part of your disability application, you will need to submit copious information about your condition, including medical records, doctors’ statements and other related materials that will help to convince Social Security you meet Social Security Disability Insurance requirements.
My condition is not listed in the Blue Book. Can I still receive SSDI benefits?
While the Blue Book is a fairly comprehensive guide, by no means does it contain every ailment or disability that could keep a person from working. If you have a condition not listed in the Blue Book (i.e. Lyme disease, thyroid problems, narcolepsy, and many others), you can still apply for SSDI. The main thing to remember is that you will need to provide substantial proof that your condition has rendered you unable to work.
Which states offer supplementary disability payment programs?
The majority of all disability payment programs are administered on the federal level, but there are five states that offer state-funded disability programs in addition to SSDI and SSI. Currently, those five states are California, Hawaii, New Jersey, New York and Rhode Island. They are intended to supplement, but not replace, federal disability payment programs.
Is there a phone number I can call to check on my SSDI application status or if I need more information regarding the program in general?
For more information on any aspect of SSDI, contact the Social Security Administration at (800) 772-1213.
There are also several online SSDI forums that provide support and information for people who are looking for answers on a variety of subjects.