SSDI Application Process

Work credits

To qualify for SSDI, you must have earned enough work credits through employment covered by Social Security:

• Generally, you need 40 credits, with 20 earned in the last 10 years before becoming disabled.
• You earn up to 4 credits per year based on your income.
• In 2024, you earn 1 credit for every $1,730 in wages or self-employment income.
• Younger workers may qualify with fewer credits.

Medical condition criteria

Your medical condition must meet the SSA’s definition of disability:

• The condition prevents you from doing substantial gainful activity.
• It has lasted or is expected to last at least 12 months or result in death.
• You must be under the care of a healthcare professional who can confirm the severity of your condition.
• The SSA uses a 5-step process to evaluate your disability claim.

Age considerations

While there’s no age limit for SSDI applications, age can affect eligibility:

• Applicants under 50 are considered “younger individuals” and face stricter criteria.
• Those aged 50-54 are “closely approaching advanced age” and may have an easier time qualifying.
• Applicants 55 and older are considered “advanced age” and have the most lenient criteria.
• The SSA considers age alongside factors like education and work experience when determining if you can adapt to other types of work.

Remember, meeting these eligibility requirements doesn’t guarantee approval.

The SSA thoroughly reviews each application to determine if you qualify for SSDI benefits.

Gathering necessary documents

Before applying for SSDI, collect the following essential documents:

Medical records:

• Detailed medical reports from all treating physicians
• Lab and test results
• List of medications and dosages
• Dates of treatments and hospitalizations

Work history:

• Employment records for the past 15 years
• W-2 forms or tax returns from the previous year
• Pay stubs if you’ve worked after becoming disabled

Personal information:

• Birth certificate or proof of citizenship
• Social Security number
• Marriage and divorce records (if applicable)
• Names and birth dates of minor children

Completing the Adult Disability Report (Form SSA-3368)

The Adult Disability Report (Form SSA-3368) is a crucial part of your SSDI application:

• It’s an 11-part form that provides detailed information about your medical condition and work history
• Complete all sections thoroughly and accurately
• Include information on all physical and mental conditions affecting your ability to work
• List all healthcare providers, treatments, and medications
• Provide a comprehensive 15-year work history
• Use the “Remarks” section to add any additional relevant information

Tips for completing the form:

• Read all directions carefully before starting
• Gather all necessary information beforehand
• Answer all questions completely and honestly
• Consider discussing the form with a Social Security disability lawyer before submission

Remember, the Adult Disability Report is a critical component of your application, and errors or omissions can lead to delays or denials.

Online application

The online application is often the most convenient method:

• Available at www.ssa.gov/benefits/disability/
• Can be completed at your own pace
• Allows you to save progress and return later
• Available 24/7
• Suitable for most applicants aged 18-65

Phone application

Applying by phone is an option for those who prefer verbal communication:

• Call 1-800-772-1213 (TTY 1-800-325-0778)
• Available Monday through Friday, 8:00 AM to 7:00 PM
• A Social Security representative will assist you in completing the application
• Useful for those with difficulty using computers or the internet

In-person application at local Social Security office

For those who prefer face-to-face interactions:

• Find your local office using the SSA’s office locator tool
• Call ahead to schedule an appointment
• Bring all necessary documents to the appointment
• Ideal for complex cases or if you need immediate assistance

Regardless of your chosen method, be prepared with all the necessary information and documents before starting your application.

Each method has advantages, so select the one that best suits your needs and circumstances.

Step 1: Initial Application Submission

1. Submit your application online, by phone, or in person at your local Social Security office.
2. Provide detailed information about your medical condition, work history, and personal information.
3. Include all necessary documents, such as medical records and work history.

Step 2: Review by Disability Determination Services (DDS)

1. Your application is sent to the state DDS office for review.
2. A disability examiner is assigned to your case.
3. The examiner verifies non-medical eligibility requirements and develops medical evidence.

Step 3: Medical Evaluation

1. DDS reviews medical evidence from your healthcare providers.
2. If existing evidence is insufficient, DDS may arrange a consultative examination (CE).
3. The examiner may consult with medical and vocational experts to understand your condition’s impact on your ability to work.

Step 4: Decision Making

1. The DDS examiner evaluates your case using the SSA’s five-step sequential evaluation process.
2. They assess your ability to perform substantial gainful activity, the severity of your impairment, and your capacity to do past work or any other work.
3. A decision is made based on all available evidence and SSA guidelines.
4. The case is returned to the local Social Security office for appropriate action.
5. If approved, SSA will calculate your benefit amount and begin payments.
6. If denied, you have the right to appeal the decision.

This process typically takes several months, and the outcome depends on the strength of your medical evidence and how well your condition meets the SSA’s definition of disability.

Average Processing Time

The SSDI application process can be lengthy, with significant variations in processing times:

• Initial application: Typically takes 3 to 5 months.
• Reconsideration (first appeal level): Averages 7 months.
• Hearing before an administrative law judge (second appeal level): Averages 15 months.

In total, the process from initial application to final decision can take anywhere from several months to over two years, depending on the specific case and appeal levels required.

Factors affecting processing speed

Several factors can influence the processing time of an SSDI application:

1. Completeness of application: Providing all necessary documentation upfront can expedite the process.
2. Complexity of medical condition: Cases involving multiple or rare conditions may require more time for evaluation.
3. Backlog at state agencies: High volume of applications can lead to delays in processing.
4. Need for additional medical evidence: If the SSA requires more information or consultative exams, it can extend the timeline.
5. Applicant’s age: Applications from individuals over 50 may be processed more quickly due to more lenient criteria.
6. Geographic location: Processing times can vary by state due to differences in workload and resources.
7. Appeals process: If initial applications are denied, going through appeals significantly extends the overall timeline.

To potentially speed up the process, ensure your application is complete, provide thorough medical documentation, and respond promptly to any requests for additional information from the SSA.

Outcome #1: Approval

If your SSDI application is approved:

• You’ll receive a notice detailing your benefit amount and payment schedule.
• Benefits typically start the sixth full month after your disability onset date.
• You may be eligible for back pay if there was a significant delay in your application process.
• Medicare coverage will begin 24 months after you start receiving SSDI benefits.

Outcome #2: Denial

Approximately 65% of initial SSDI applications are denied.

Common reasons for denial include:

1. Insufficient medical evidence
2. Ability to perform substantial gainful activity
3. Failure to follow prescribed treatment
4. Disability is not expected to last 12 months or result in death
5. Incomplete or incorrectly filled application

Appeal Process Overview

If your application is denied, you have the right to appeal.

The appeal process consists of four (4) levels:

1. Reconsideration: A complete review of your claim by someone who didn’t take part in the initial decision. You have 60 days from the date of denial to request reconsideration.
2. Hearing by an Administrative Law Judge (ALJ): If reconsideration is denied, you can request a hearing before an ALJ. This must be done within 60 days of the reconsideration denial.
3. Appeals Council Review: If the ALJ denies your claim, you can request a review by the Appeals Council. They may deny the request, approve your claim, or return it to an ALJ for further review.
4. Federal Court Review: The final level of appeal is filing a lawsuit in federal district court.

It’s important to note that each level of appeal has strict deadlines, and missing these can result in losing your right to appeal.

Many applicants find it beneficial to seek legal representation during the appeals process to improve their chances of approval.

Waiting period

After approval, there’s typically a mandatory waiting period before benefits begin:

• The waiting period is five full calendar months from the established onset date of disability.
• Benefits start on the sixth full month after the disability onset date.
• There’s no waiting period for applicants with Amyotrophic Lateral Sclerosis (ALS).

Benefit calculation

Your monthly SSDI benefit is based on your lifetime average earnings:

• The Social Security Administration (SSA) uses a complex formula to calculate your Average Indexed Monthly Earnings (AIME).
• Your Primary Insurance Amount (PIA) is then determined using your AIME.
• In 2024, the average monthly SSDI payment is $1,489, with a maximum of $3,011.
• Your specific amount depends on your work history and earnings record.

Ongoing requirements

To maintain your SSDI benefits, you must:

• Participate in periodic Continuing Disability Reviews (CDRs) to verify your ongoing eligibility.
• CDRs typically occur every 3 years, or every 7 years for conditions unlikely to improve.
• Report any changes in your medical condition or work status to the SSA.
• Follow prescribed treatments and cooperate with SSA requests for information.
• Be aware that working above Substantial Gainful Activity (SGA) levels may affect your benefits.

Remember, SSDI is not necessarily permanent.

The SSA will periodically review your case to ensure you still meet the disability criteria and program requirements.

Incomplete applications

One of the most frequent errors is submitting an incomplete application:

• Failing to provide all required information
• Leaving sections blank or marking them as “N/A” inappropriately
• Not including a comprehensive list of medical conditions and treatments
• Omitting details about work history or daily activities

To avoid this, carefully review your application before submission and ensure all sections are filled out accurately and completely.

Missing deadlines

Failing to meet crucial deadlines can severely impact your claim:

• Not submitting the initial application within the specified timeframe
• Missing the 60-day window to appeal a denied claim
• Failing to respond to SSA requests for additional information within the given time (often as short as 10 days)

Stay organized, keep track of all deadlines, and respond promptly to any SSA communications.

Lack of medical evidence

Insufficient medical evidence is a common reason for SSDI claim denials:

• Not providing up-to-date medical records
• Failing to include detailed reports from healthcare providers
• Omitting test results, imaging studies, or treatment plans
• Neglecting to obtain statements from doctors about your limitations

Ensure your medical records are comprehensive, current, and clearly demonstrate how your condition affects your ability to work.

By avoiding these common mistakes, you can significantly improve your chances of a successful SSDI application.

Remember to be thorough, timely, and provide as much relevant information as possible to support your claim.

Thorough documentation

Comprehensive documentation is crucial for a strong SSDI claim:

• Gather all medical records, including test results, imaging studies, and treatment plans.
• Obtain detailed statements from your treating physicians about your condition and limitations.
• Keep a journal documenting how your disability affects your daily life and ability to work.
• Include records of any accommodations made at previous jobs due to your condition.
• Provide a complete work history, including job duties and reasons for leaving each position.

Timely responses to requests for information

Prompt communication with the SSA can expedite your application:

• Respond to all SSA requests within the specified timeframe, typically within 10-30 days.
• If you need more time, contact the SSA immediately to request an extension.
• Keep copies of all correspondence and note the dates of any phone conversations.
• Follow up if you haven’t received a response or decision within the expected timeframe.

Considering professional assistance

Seeking professional help can improve your chances of approval:

• Consult with a Social Security disability attorney or advocate who specializes in SSDI claims.
• Professional representatives can help navigate the complex application process and increase your odds of success.
• They can ensure your application is complete, deadlines are met, and your case is presented effectively.
• Many representatives work on a contingency basis, meaning they only get paid if you win your case.

Remember, a successful SSDI application requires attention to detail, persistence, and a thorough understanding of the process.

By following these tips and considering professional assistance, you can significantly improve your chances of approval.

Navigating the SSDI application process can be challenging, but understanding the key steps can significantly improve your chances of success:

• Ensure you meet the eligibility requirements, including work credits and medical criteria.
• Gather comprehensive documentation, including medical records and work history.
• Choose the application method that works best for you: online, phone, or in-person.
• Be prepared for a potentially lengthy process, which can take several months to over a year.
• If denied, remember you have the right to appeal the decision.

If you believe you’re eligible for SSDI benefits, don’t hesitate to start the application process.

The sooner you begin, the sooner you may receive the financial support you need.

At TruLaw, we understand the complexities of SSDI applications and appeals.

If your application for disability benefits has been denied, we’re here to help.

Our experienced team can guide you through the appeals process, ensuring your case is presented effectively and increasing your chances of approval.

Don’t let a denial discourage you from pursuing the benefits you deserve.

Reach out to TruLaw today for a free consultation.

We’re committed to advocating for your rights and helping you secure the SSDI benefits you need to support yourself and your family.

Remember, with the right approach and support, you can navigate the SSDI application process successfully.

Let TruLaw be your trusted partner in this important journey.