Filing and Applying for Social Security Disability Benefits

How the Social Security Administration (SSA) Determines if your are Disabled and Eligible to Receive Social Security Disability Benefits

We work our whole lives to provide for ourselves and our families. We do plan for the unexpected in many ways such as life insurance in the event of an untimely death. We have health insurance to cover ourselves and our loved ones in the event of a medical issue. Many of us even have long and short term disability policies to cover us if we become disabled; if we can afford these policies. If we are fortunate enough, then we might even have enough put away in an emergency fund in the event of a job loss or having to take extended time from our careers to care for a loved one.

Sometimes, however, we just don’t plan for everything and find ourselves in a situation that we did not plan for and we wonder what we are to do. One of these events could be a disability in which we are not covered by insurance or any other means and we need to ask the government for assistance through Social Security Disability.

In fact, the chances that you may become disabled are more likely than you may realize as statistics show that even a person as young as 20 has a 1 in 4 chance of being disabled before reaching Full Retirement Age, and the older that we get the more likely it is that we will become disabled before our Full Retirement Age.

If you have become disabled, then we are truly sorry as we know how frightening this time can be in a person’s life on a number of levels. Not only are you worried about your finances and how you are going to support yourself and your family, you have to concern yourself with how you are going to get well and hopefully back to the life that you once knew before becoming disabled. For some, this never happens and that can cause much grief as well.

This page is meant to be an Overview about how to File and Apply for Social Security Disability Benefits. The pages that follow will discuss in much more detail many of the topics that are covered on this page as well. Of course, you may also see the Frequently Asked Questions about Social Security Disability on our Website for more information as well.

We are experts at representing people faced with having to file and apply for Social Security Disability and we know how daunting a task this is for anyone faced with this situation. Therefore, we encourage you to Contact Us by any or all of the following means for your free legal consultation about Social Security Disability; you may contact us by phone at 770-865-8654 and 813-363-6664, by email at juliericelaw@outlook.com, and/or Contact Us on our website.

How To Apply And File For Social Security Disability Benefits

There are four (4) ways that you can file and apply for disability benefits as follows:

  1. You can apply online at www.socialsecurity.gov;
  2. You can call the Social Security Administration’s (SSA) toll-free number, 1-800-772-1213; or
  3. You can make an appointment to file a disability claim at your local Social Security office which can be found at http://ssa.gov/locator; or
  4. You can set up an appointment for someone to take your claim over the telephone. The over the phone interview process takes about one (1) hour, and if you are deaf or hard of hearing, you may call the toll-free TTY number, 1-800-325-0778, between 7 a.m. and 7 p.m. on any business day.

If you schedule an appointment, then the SSA will send you an Adult Disability Kit if are an Adult applying for disability benefits, and a Child Disability Starter Kit if you are applying for disability benefits for a child, and you may find this Disability Starter Kit is also available online at www.socialsecurity.gov/disability. We will mostly be discussed Filing and Applying for Adult Social Security Disability Benefits on this page, and we will discuss in detail Filing and Applying for a Child’s or Children’s Social Security Disability on our page titled Child or Children’s Social Security Diability

The process to apply for disability can take as long as three (3) to five (5) months so it is important that you apply for disability benefits as soon as you become disabled or are told that you will be disabled for 12 months or longer, or that your disability is terminal.

What Documentation Will I Need To File And Apply For Social Security Disability

In order to process your Disability Application, the SSA will need at least the following information and documentation as the original document or as a certified copy:

  • Your Social Security Number;

  • Your Birth or Baptismal Certificate;

  • Names, Addresses and Phone Numbers of the Doctors, Psychiatrists, Caseworkers, Hospitals, Clinics, and any other facility that took care of you and the exact Dates of your Visits;

  • Names and Dosage of All the Medicine You Take;

  • Medical Records from your Doctors, Therapists, Psychiatrists, Psychologists, Hospitals, Clinics, Caseworkers, and any other persons that have taken care of you that you already have in your possession;

  • Laboratory and Test Results;

  • A Summary of Where you Worked and the Kind of Work you did including the Names, Addresses, and Phone Numbers of your Employers, and the Dates of your Employment; and

  • A Copy of your Most Recent W-2 Form (Wage and Tax Statements) or, if you are self-employed, your Federal Tax Return for the Past Year.

  • In addition to the basic application for disability benefits, there are other forms you will need to fill out such as a form that collects information about your medical condition and how it affects your ability to work, and forms (i.e. medical releases) that give doctors, hospitals and other health care professionals who have treated you permission to send the SSA the information about your medical condition.

What Happens After I File And Apply For Social Security Disability Under The Social Security Disability Insurance Program (SSDI)

After the SSA has reviewed all the necessary documentation along with your application, the SSA will determine if you Meet Some Basic Requirements for Disability such as whether or not you have Worked Enough Years to Qualify and any Current Work Activities. In general, to get disability benefits, you must meet two different earnings tests, if you are applying for disability benefits under the SSDI program:

  1. A “recent work” test based on your age at the time you became disabled as set forth herein below; and
  2. A “duration of work” test to show that you worked long enough under Social Security.

The following table shows the rules for how much work you need for the “recent work” test based on your age when your disability began. The rules in this table are based on the calendar quarter in which you turned or will turn a certain age. The calendar quarters are: First Quarter: January 1 through March 31; Second Quarter: April 1 through June 30; Third Quarter: July 1 through September 30; and Fourth Quarter: October 1 through December 31.

The following is a Rules of Work Needed for the Recent Work Test that is used by the SSA to determine basic eligibility:

Rules for work needed for the “recent work test”
If you become disabled... Then you generally need:
In or before the quarter you turn age 241.5 years of work during the three-year period ending with the quarter your disability began.
In the quarter after you turn age 24 but before the quarter you turn age 31Work during half the time for the period beginning with the quarter after you turned 21 and ending with the quarter you became disabled. Example: If you become disabled in the quarter you turned age 27, then you would need three (3) years of work out of the six (6)-year period ending with the quarter you became disabled.
In the quarter you turn age 31 or laterWork during five (5) years out of the ten (10)- year period ending with the quarter your disability began.

The following table shows examples of how much work you need to meet the Duration of Work Test if you become disabled at various selected ages. For the “duration of work” test, your work does not have to fall within a certain period of time.

NOTE: This table does not cover all situations.

Examples of work needed for the “duration of work” test
If you become disabled... Then you generally need:
Before age 281.5 years of work
Age 302 years
Age 343 years
Age 384 years
Age 425 years
Age 445.5 years
Age 466 years
Age 486.5 years
Age 507 years
Age 527.5 years
Age 548 years
Age 568.5 years
Age 589 years
Age 609.5 years

If you meet these requirements, then the SSA will process your application and forward your case to the Disability Determination Services (DDS) office in your state to complete the disability decision for the SSA.

What Happens After The Ssa Processes My Application And Sends It To The Dds State Agency

Doctors and Disability Specialists in the State Agency will then ask your doctors for information about your condition, and they will consider all the facts in your case using the medical evidence from your doctors and hospitals, clinics or institutions where you have been treated and/or all other information. For example, they will ask your doctors questions such as, but not limited to, the following:

  • What is (are) Your Medical Condition(s)
  • When Did Your Medical Condition(s) Begin
  • How Do Your Medical Condition(s) Limit Your Activities

Your doctors and other medical professionals will also be asked about your Ability to do Work-Related Activities such as Walking, Sitting, Lifting, Carrying Out and Remembering Instructions, and the like. Your doctors, or other medical professionals, will not be asked to decide if you are disabled.

If there is not enough information available from your current medical sources for the State Agency to determine if you are Disabled, then the State Agency will most likely ask you to go for a Special Examination, and Social Security will pay for the examination and for some of the related travel costs.

SSA pays disability benefits through two programs:

  1. The Social Security Disability Insurance Program; and
  2. The Supplemental Security Income (SSI) program.

Social Security pays benefits to people who cannot work because they have a medical condition that is expected to last at least one year or result in death. Federal law requires this very strict definition of disability unlike some programs that give money to people with partial disability or short-term disability, Social Security does not pay benefits for partial or short-term disability.

The decision about whether or not you are Disabled is determined by using a Five (5) Step Process as follows:

  1. Whether or Not you are Working?

    If you are working and your earnings average more than a certain amount each month (and this amount does vary), then the SSA will generally not consider you disabled. If you are not working, or your monthly earnings average the current amount or less, then the state agency will look at your medical condition.

  2. Is your Medical Condition Severe?

    In order for you to be considered Disabled, your medical condition must significantly limit your ability to do basic work activities such as Walking, Sitting, Standing, Remembering, and the like, and this must continue for at least one year. If your medical condition is not that severe, then you will not be considered disabled. If, however, your condition is that severe, then the state agency moves on to step three.

  3. Is your Medical Condition on the List of Impairments?

    There is a List of Impairments that is maintained by the state agency that describes medical conditions that are considered so severe that they automatically mean that you are disabled as defined by law. If your condition (or combination of medical conditions) is not on this list, however, then the state agency will look to see if your condition is as severe as a condition that is on the list. If the severity of your medical condition meets or equals that of a listed impairment, then the state agency will most likely decide that you are disabled. If it does not, however, then the state agency goes on to step four.

  4. Can You Do the Work you Did Before?

    At this step, the state agency decides whether or not your medical condition prevents you from being able to do the work you did before. If your medical condition does not prevent you from doing the work that you did before, then the state agency will decide that you are not disabled. If, however, your medical condition prevents you from doing the work that you did before, then the state agency goes on to step five.

  5. Can You Do Any Other Type of Work?

    If you cannot do the work that you did in the past, then the state agency looks to see if you would be able to do any other type of work. The state agency makes this determination by evaluating your medical condition, your age, education, your past work experience, and any skills you may have that could be used to do other work. If it is determined that you cannot do other work, then the state agency will decide that you are disabled. If, however, it is determined that you can do other work, then the state agency will decide that you are not disabled.

Special rules for blind people or people who have low vision

It is important to note that there are a number of other special rules for people who are blind or have low vision. For more information, ask for the If You Are Blind Or Have Low Vision—How We Can Help (Publication No. 05-10052).

After a Determination has been made, then you will be told the Decision.

When the state agency reaches a decision on your case, then you will be sent a letter. If your application is approved, then the letter will show the amount of your benefit and when your benefit will be paid and for how long.

You may also be Contacted about Your Benefits as Follows:

Normally, the mail or a phone call is the way that you will be contacted about your benefits. Sometimes, however, a Social Security representative may come to your home, and said representative will show you identification before discussing your benefits. Under these circumstances, it is the best practice for you to call the Social Security office to verify that someone was sent to see you.

If you are blind or have low vision, you may choose to receive notices in one of the following ways such as:

  • Standard Print Notice to be sent by First-Class Mail;
  • Standard Print Notice to be sent by Certified Mail;
  • Standard Print Notice to be sent to you By First-Class Mail, and A Follow-up Telephone Call to you;
  • Braille Notice sent to you and Standard Print Notice By First Class mail sent to you;
  • Microsoft Word File on a Data Compact Disc (CD) and A Standard Print Notice by First Class Mail to be sent to you;
  • Audio CD and a Standard Print Notice by First Class Mail to be sent to you; or
  • Large Print (18-point size) Notice and a Standard Print Notice by First Class Mail to be sent to you.

For more information, visit the SSA’s website at www.socialsecurity.gov/notices or call the SSA toll-free at 1-800-772-1213. If you are deaf or hard of hearing, then you may call the SSA’s TTY number at 1-800-325-0778.

As stated herein above, you will be sent a letter stating that your application is approved, the amount of your monthly benefit, and the effective date of your benefits. Please note that your monthly disability benefit is based on your Average Lifetime Earnings, and your first Social Security Disability Benefits will be paid for the sixth (6th) full month after the date your disability began.

You will also receive What You Need To Know When You Get Disability Benefits (Publication No. 05-10153) which gives you important information about your benefits and states what changes you must report to the SSA.

Certain members of your family may qualify for benefits based on your work such as:

  • Your Spouse if she or he is age 62 or older;
  • Your Spouse at Any Age if she or he is caring for a child of yours who is Younger than age 16 or Disabled;
  • Your Unmarried Child including an Adopted Child, or, in some cases, a Stepchild or Grandchild. The child must, however, be younger than age 18, or younger than 19 if in elementary or secondary school full time; and
  • Your Unmarried Child, age 18 or older, if he or she has a Disability that started before age 22. (Please note that the child’s disability also must meet the Definition of Disability for Adults.)

If you are getting other government benefits, then the amount of your Social Security disability benefits may be affected. For example, if you would like more information about how other government benefits may affect your social security benefits, then you may see the following:

You can get these publications from the SSA website (http://www.ssa.gov), or you may contact the SSA to request said publications.

If you have an outstanding warrant for your arrest, then you must tell the SSA if you have an outstanding warrant for your arrest for any of the following felony offenses:

  1. If you in Flight to Get Away From a Prosecution or Any Confinement;
  2. If you are Escaping for any type of Custody; and/or
  3. If you are a Flight and Escape.

If you have an arrest warrant for any of the aforestated offenses, then you can not receive any regular disability payments or underpayments.

If you are convicted of a crime, then you must tell the SSA immediately upon your conviction.

Regular disability benefits or any underpayments that may be due are not paid for the months a person is confined for a crime, however, any family members who are eligible for benefits based on that person’s work may continue to receive benefits.

Monthly benefits or any underpayments that may be due usually are not paid to someone who commits a crime and is confined to an institution by court order and at public expense. This applies if the person has been found:

  1. If you are found Not Guilty by Reason of Insanity or any other similar factors such as mental disease, incompetence, defect or the like; or
  2. If you are found to be Not Competent to Go to Trial.

If you violate a condition of parole or probation, then you must tell the SSA immediately if you have violated a condition of your probation or parole under Federal or State Law.

You cannot receive regular disability benefits or any underpayment that may be due for any month in which you violate a condition of your probation or parole.

MEDICARE AND SOCIAL SECURITY DISABILITY BENEFITS

You will get Medicare coverage automatically after you have received disability benefits for two (2) years. You can find more information about the Medicare program, in Medicare (Publication No. 05-10043).

WORKING AND RECEIVING SOCIAL SECURITY DISABILITY BENEFITS

After you start receiving Social Security disability benefits, then you may want to try working again. Social Security has special rules called Work Incentives that allow you to test your ability to work, and still receive monthly Social Security disability benefits. You also can get assistance with Education, Rehabilitation and Training that you may need in order to work. If you do take a job or become self-employed, then it is important to tell SSA right away.

There is a Ticket to Work Program (Publication No. 05-10061) offered by the SSA, and if you desire to work, then it is important that you look into this valuable opportunity.

What Happens if You Disagree with a Decision Made on Your Claim?

If you disagree with a decision made on your claim, then you can appeal it. The steps you can take are explained in The Appeals Process discussed under Social Security Disability Appeals.

You have the right to be represented by an attorney or other qualified person of your choice when you do business with Social Security. More information is in Your Right To Representation (Publication No. 05-10075), which is also available from Social Security.

As you can tell from this information, filing, applying, and qualifying for Social Security Disability Benefits is a very intense process. If there are any mistakes in your application, medical records, or the like, even if unintentional, then your benefits can be delayed for a very long time.

At Julie A. Rice, Attorney at Law, & Affiliates we are experts at Social Security Disability and we have assisted hundreds, if not thousands, of people in successfully obtaining Social Security Benefits. We offer a free consultation so contact us today by any or all of the following means so that we can answer questions that you may have and so that you don’t delay even one more day in receiving benefits that you may desperately need for yourself and your family: You may contact us by phone at (770) 865-8654 and 813-363-6664, by email at juliericelaw@outlook.com, or Contact Us on our website. We are here to assist you and we look forward to hearing from you soon.

Additional Information

Adult Disability Starter Kit

What You Should Know Before You Apply for Social Security Disability Benefits

Checklist – Adult Disability Interview

Medical and Job Worksheet - Adult

The Red Book - A Guide to Work Incentives

SSI Child Disability Starter Kit

Special Rules for Blind (Publication No. 05-10052)

What Happens if You Don’t Disagree (Publication No. 05-10075)