Much of the mystery about Social Security disability stems from a simple misunderstanding of what it is – an insurance program for working Americans who become disabled before their full Social Security (SS) retirement age. Just like any other insurance plan, you pay premiums for your coverage and, if those premiums aren’t current, coverage lapses.

A small part (0.9%) of the Social Security payroll tax paid by working Americans is a Social Security Disability Insurance (SSDI)[1] premium. Hence, while you are working you have Federal insurance to protect you in case you cannot. But the rules for collecting SSDI benefits are strict:

  • You must have worked long enough (and paid SSDI premiums recently enough) to be eligible for benefits. Although the base rule is that you must have worked at least 5 of the last 10 years, an exception is made for younger workers who have not yet worked long enough to fulfill this requirement.
  • You must be totally disabled, unable to work full time[2], and your disability must be expected to last for at least one year. All of this must be supported by medical evidence.

Applying for Disability Benefits

Applying for SSDI is a relatively easy process which can be initiated via a telephone appointment with the Social Security Administration, or by applying online at www.ssa.gov/disability. But although the application process is relatively simple, it will often take Social Security several months to provide a decision on your application (some of this time is due to obtaining confirmation from medical service providers). To facilitate the application process for those with very serious illness, Social Security maintains a “Compassionate Allowance List” (CAL) which contains over 200 serious conditions which can result in a determination within just a couple of weeks. If awarded, SSDI benefits will start in the sixth month following the “disability onset date” set by Social Security when processing your application, and your SSDI benefit amount will be the full SS benefit you earned by working prior to your disability.

Appealing a Denial

Statistically, about 2/3rds of all SSDI applications are denied. However, those who disagree with a denial have the right to appeal Social Security’s decision, and there are several levels of appeal which can be used in the sequence listed:

  1. Request for Reconsideration – Form SSA-561, which can be filed with your local SS office within 60 days of the denial of your disability application.
  2. A Hearing by an independent Administrative Law Judge – which can be requested using Form HA-501 within 60 days of a denial resulting from step 1.
  3. A review by the Appeals Council, which can be requested within 60 days of a denial resulting from step 2 by filing Form HA-520 with your local Social Security office.
  4. Within 60 days of a denial from step 3, filing a civil action in the U.S. District Court in your area, appealing Social Security’s denial of your disability benefits. This usually requires engaging an attorney (although that is not mandatory).

The appeal process can take many months, or even years, to adjudicate, but if your appeal is successful, disability benefits will be paid retroactively.

Engaging An SSDI Attorney

Although it is not required to engage an attorney to appeal a denial of your SSDI application, many choose to do so, especially starting with appeal hearings before an Administrative Law Judge (step 2 above). Attorneys who specialize in SSDI are governed by Federal law and their fees are limited. Normally, there are no out-of-pocket fees to you because attorneys are paid a percentage of back-benefits won[3] on your behalf. You can often assess the viability of your appeal by the willingness of an attorney to accept your case.

Healthcare While on SSDI

Obviously, those unable to work due to disability usually lose their employer healthcare and must seek alternative coverage. Those who have received SSDI benefits for 24 months are eligible to enroll in Medicare starting in the 25th month after their SSDI benefits start, even though they haven’t yet reached the normal Medicare enrollment age of 65.

SSDI Benefits End at Full Retirement Age

Because SSDI is a program meant to provide benefits to disabled workers who have not yet reached their Social Security full retirement age (FRA), once FRA is attained SSDI benefits stop. When full retirement age is reached, SSDI benefits automatically convert to normal Social Security retirement benefits at the same amount as was being received under SSDI, so the conversion is transparent to the beneficiary. Social Security Disability Insurance benefits are not available to those who have reached their FRA.

There are many twists and turns in Social Security’s rules for disability benefits, and the above is just an overview. The AMAC Foundation’s Social Security Advisory staff can assist with understanding how Social Security’s disability rules apply to your unique personal circumstances.  

[1] SSDI should not be confused with Supplemental Security Insurance (SSI), which is a general benefit program provided by the Federal government for disabled children and adults with very low household income and very few assets. There are no such financial asset restrictions with SSDI.

[2] Very limited work is permissible.

[3] SSDI attorney fees are limited to 25% of back-benefits won to a maximum of $6,000.