To qualify for Social Security disability benefits, you must have a condition that meets Social Security’s definition of disability and have worked long enough–and recently enough–under Social Security to qualify for disability benefits.  Generally, you need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled. However, younger workers may qualify with fewer credits.

If you meet Social Security’s definition of disability and have very limited income and resources, you may qualify for Supplemental Security Income (SSI), even if you are not insured for SSDI benefits or if you are insured for SSDI but at a lower monthly rate than the SSI rate applicable to you. SSI helps protect people with severe disabilities against the worst effects of poverty.

For both programs you must be determined to be “disabled” under Social Security’s disability regulations. The definition for “disability” and how Social Security determines whether a person is “disabled” is the same for both SSDI and SSI. Social Security Disability Insurance (SSDI) is an insurance program and the amount of benefits a disabled individual receives is based on their work and wage history over their lifetime.SSI is intended to provide basic financial assistance to disabled individuals who have little or no other income or resources for their support.

The difference between the programs is whether you have worked a sufficient length of time and paid sufficient FICA taxes to be “insured” for Social Security Disability Insurance (SSDI). If you have not paid enough money into the Social Security system to be insured for SSDI, then you may still be able to receive SSI. The Social Security Administration will look at your income status and review what resources (for example, bank accounts, value of a second vehicle) are available to you.  This is used to determine if you financially qualify for SSI.

Social Security disability benefits are restricted to individuals with severe disabilities and illnesses. Individuals who are unable to do “substantial gainful activity” (defined as earning $1,090 per month in 2015) because of one or more severe mental and/or physical impairments that have lasted or can be expected to last for a continuous period of not less than 12 months may be eligible for Social Security disability benefits.  Thus, if your impairment is expected to last no more than a few weeks or months, it is unlikely that your condition will satisfy Social Security’s definition of disability.

If you have become disabled and expect to be disabled for more than a year, apply immediately. You can file for SSDI benefits online at ssa.gov.  Alternatively, you can make an appointment with your local Social Security office and file a disability claim in person or via phone by calling Social Security’s toll-free telephone number 1-800-772-1213.

You cannot apply for SSI online. To start an SSI application, schedule an appointment with a local Social Security office. To schedule an appointment, call 1-800-772-1213 (TTY 1-800-325-0778) from 7 a.m. to 7 p.m., Monday through Friday or contact your local Social Security office.

A decision to either award or deny benefits will be made and you will be notified in writing, by mail. It usually takes between 4-6 months to get an initial decision.

If your application is denied, you can appeal, but you must appeal within 60 days of the date on the denial notice.

After you file a claim for benefits, your application is sent to a Social Security disability examiner at a State Agency referred to as DDS. The disability examiner gathers your medical records based on the information you reported in your application, consults with doctors, and evaluates your health problems. The disability examiner is also supposed to consider your age, education, and past work experience in examining your case. Considering the medical evidence and your medical-vocational factors (i.e., your age, education, and past work experience), the examiner evaluates your eligibility for benefits by determining whether you are able to do your previous work or if you are able to do other types of work. When a decision has been made, you will be notified by a letter sent from your local Social Security office.

Some applicants have medical conditions that are so severe that their conditions obviously meet a disability standard referred to as “listing.”  There are 14 categories of “listed impairments” where SSA will consider specific medical tests and limitations to make a disability determination, without the need to consider age, education, or work experience. See http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm.

However, most disability applicants do not meet a Listing, but can still be found disabled given their limitations, age, education, and past work experience. The Social Security regulations are premised on the idea that as people get older, they may have a difficult time switching to different jobs given their impairments.

Social Security has different, often stricter requirements for determining disability than other programs or agencies. Social Security is not bound by disability decisions made by other agencies.

Do not be alarmed or disheartened. Only about one-third of Social Security disability claims are approved at the initial level. Read the denial notice you receive from Social Security carefully — it will tell you what you need to do.

Generally, here are the next steps to take:

 1) File an appeal right away!

If you are denied benefits at the initial level, you should appeal as soon as possible (within 60 days of the date on the denial notice). You do this by filing a special form called a Request for Reconsideration. When a claim for Social Security disability benefits is denied at the initial level, the next step for a claimant is to request “Reconsideration.” The case is then reviewed a second time and a new decision is made. Unfortunately, in nearly 90% of the cases, the reconsideration decision is the same as the initial decision—a denial.

2) If you are denied at Reconsideration, Request a Hearing before an Administrative Law Judge (ALJ)

A hearing is conducted by the Office of Disability Adjudication and Review of the Social Security Administration.   An Administrative Law Judge will preside over your case and a testimony is taken under oath. The hearing is private. The only people present will be the Judge and the Judge’s assistant, you, your attorney, and any witnesses you may want to have present. Often the Judge may ask a vocational and/or medical expert to testify about your ability to work and severity of your medical condition.

 3) If you are denied after an Administrative Law Judge hearing, you may request review by the Appeals Council

If your claim is denied at the ALJ hearing stage, you have the right to appeal to Social Security’s Appeals Council. The Appeals Council reviews hearing decisions, and has the power to “remand” or send cases back to judges when they make mistakes. It also reverses decisions in a small share of cases. It can take year or more to get a decision from the Appeals Council. If your claim is still denied at this level, you can file civil complaint in Federal Court.

The disability determination process can be divided into five basic stages:

• Initial Application;
• Notice of Disapproved Claim (approximately 4-6 months after filing the application);
• Request for Reconsideration;
• Notice of Reconsideration (approximately 2-6 months);
• Request for Hearing;
• Notice of Decision (approximately 12-24 months); and
• Other Appeals, i.e. a Request for Review before the Appeals Council and a civil complaint before the United States District Court (approximately 18 months or more at each subsequent level of review).

Due to the lengthy nature of the process and the very high rate of initial denials, it is important not to become impatient or discouraged. It is also important not to count on receiving SSDI or SSI payments within a matter of weeks, or in many cases even several months, from the time you file you receive your determination.

As a general rule we recommend that a person hire a representative to help them apply for benefits or file an appeal after being denied benefits. The process can be so complicated that many people become frustrated or overwhelmed without the help of a legal representation.  After an initial denial, you should definitely hire a representative who specializes in handling Social Security cases.

Every case and every client is different, so the role that your representative will play is dependent on your specific case. In general, your representative will gather and review your medical evidence, obtain reports from your doctors regarding your health, and advocate on your behalf with Social Security personnel. If you are required to go to a hearing, your attorney may prepare legal briefs to submit to the judge and advise you on how best to prepare yourself to testify at your hearing.  At the hearing, your attorney will elicit testimony from you regarding your disabilities and cross-examine the medical and/or vocational experts called by the Administrative Law Judge to testify at the hearing.

We recognize that about one-third of those people who apply will be found disabled even without a lawyer’s help. We also understand that some people may want to go through the earlier stages by themselves. It is up to you whether to contact us when you first apply or to wait until you are denied; but, the general rule is that it is better to contact us earlier rather than later.

Attorney fees are capped at $6,000 or 25% of a claimant’s past-due benefits, whichever is less. Attorneys are only paid if the claimant wins. All fees are determined by the Social Security Administration.

If you disagree with the decision made by the Appeals Council, you can file a civil action suit in the United States District Court, and then appeal to the Circuit Court.