If you are unable to work due to a disabling physical or mental condition, you may qualify for Social Security Disability Benefits. In order to receive these benefits, you must meet several requirements set by the SSA. There are many aspects that may make your case more likely or more unlikely to be approved. There are also aspects that may make your case more likely or more unlikely to attract professional representation. Some of these aspects are addressed below.
You must be under full retirement age to be eligible for Disability Benefits. Usually, this will be the age of 65, but recent changes are gradually increasing the age for full retirement to 67. Many people who are near retirement age opt to take early Social Security, which negates eligibility for Disability Benefits.
You must be 18 years or older to be eligible for SSDI or SSI. For those under 18 years of age, there is a Children’s SSI program.
For persons aged 18-49, the ability to get approved for SSDI and SSI is reduced. This is related to how the SSA evaluates disability requirements for that age group.
Persons aged 50-63 tend to have the best likelihood of getting approved for SSDI and SSI.
Although SSDI and SSI are federal programs, they are predominantly administered by state agencies. The approval rates and processes can vary significantly depending on the state in which you reside. Simply put, some states are just more likely to result in a winning case.
For example, published win rates for Initial Applications have shown 25-30% for states such as Arizona, Tennessee, Kentucky, Mississippi, North Carolina, Georgia and Florida, but over 40% for states such as Massachusetts, North Dakota, Vermont, New Jersey and New Hampshire.
Reconsideration (appeal) win rates have varied from 5.5% in Indiana to 22% in Massachusetts. Ten states don’t offer reconsideration appeals and direct you straight to hearings for your first appeal.
Hearing win rates vary as well, from Alaska at 16% to eight states over 50%.
In addition, processing differences in each state can make it problematic for firms to assist individuals and still remain a viable business entity. Most law firms and advocacy groups need to restrict the number of cases that are taken in certain states due to the financial constraints. This does not mean the cases might not be good cases that get approved.
If there is a restriction from Premier in taking a case for state reasons alone, we promote Applying on Your Own.
There are many qualifications for SSDI and SSI. The most pertinent tend to be:
• Your disability must have lasted, or be expected to last, a minimum of 12 months.
• You generally must have medical evidence to substantiate your disability. You can get this evidence after you apply.
• You should not be involved in “Substantial Gainful Activity,” which generally means work.
• For SSDI, you need to have paid into the SSDI system via FICA tax. For most workers, if you have worked for 5 of the last 10 years you will meet this qualification.
• Once you are receiving Social Security benefits, you are no longer eligible for Disability Benefits.
For firms to represent you, you need to sign an authorization allowing them to represent you. Only one representative can be used at any given time. If you have already authorized someone to represent you, there are factors involved in order to change to another representative. If this is your desire, you can call us to find out more about that.
Applying on Your Own
There are ultimately two ways to apply for disability benefits owed to you; you can apply with professional help or you can apply on your own.
In some cases, you may have a good case but professional representation is not forthcoming. In such situations you can apply on your own. SSA representatives will often advise people to file their SSA applications on their own. This will involve filling out forms, filing the paperwork, communicating with the SSA, and in later stages potentially obtaining medical documentation and attending court hearings independently.
For those who may be interested in this process, there are helpful links below.
File a new application for Social Security Disability
File an appeal
Locate SSA Office/Make an appointment
Directory of all online services provided by SSA
NOSSCR referral – Get representation
Apply for Medicaid