As a law firm that assists those in Orlando and throughout Florida who suffer from disabilities due to a work injury or other reasons, the law firm of Frank M. Eidson, P.A., often explains how the Social Security Disability (SSD) benefits process works.
If you are seeking information, we hope the following “by the numbers” approach helps you to get a better idea of the types of benefits available to disabled workers and others, what it takes to qualify for these benefits and what you can expect if your claim is initially denied.
To discuss the specific facts of your case, please feel free to contact us by phone or through our online form. We would be glad to provide a free consultation.
Percent chance that a 20-year-old worker faces of becoming disabled before reaching retirement age, according to the Social Security Administration (SSA).
For an estimate for a person with your age, weight and height, you can go to the “Personal Disability Quotient” calculator. As you can see, whether you use tobacco, work indoors or outdoors, lead a healthy lifestyle and have a history of health issues can all factor into your “PDQ.”
The calculator estimates not only your chances of becoming disabled but also the percent chance of your disability lasting five years or longer and the average length, in months, of a long-term disability for a person with your profile.
How much weight should you give to these estimates? That is actually the subject of debate, as this 2010 New York Times article notes. What can’t be debated is the fact that essentially everyone faces some risk of suffering a disability that may require turning to Social Security Disability Insurance (SSDI) for assistance.
Million people in the U.S. currently receive monthly SSD benefits payments, including disabled workers and their spouses and children, the SSA reports in its most recent “Monthly Statistical Snapshot.” These individuals represent 18.3 percent of the total number of Americans who are receiving Social Security benefits. So, if you are considering applying for benefits, you should realize that you are by no means alone. Many others face the same challenges as you.
Percent of your earnings that you pay in taxes go towards the Social Security Old-Age, Survivors and Disability Insurance (OASDI) program. Your employer pays a matching 6.2 percent in OASDI taxes. So, if you are self-employed, you are basically paying both employer and employee taxes, or 12.4 percent. If you have worked and paid your OASDI taxes, you are not receiving “charity” when you obtain SSD benefits. Instead, you are receiving the benefits of insurance that you have paid for throughout your working life.
Work credits you generally must earn over the course of your career, with 20 earned during the 10 years before your disability arose, in order to qualify for SSD benefits. If you are young worker, however, you can qualify with fewer work credits.
The amount you need to earn to receive a work credit changes each year. In 2015, you receive one credit for every $1,220 you earn. You can receive no more than four work credits in a single year. See the SSA website for a more detailed description of work credits.
Keep in mind: If you are disabled but have not earned enough to qualify for SSD benefits, you may be able to pursue another type of benefit: Supplemental Security Income, or SSI.
Months that a medical condition which prevents you from being able to work must be expected to last, at the least, in order to qualify for SSD benefits. You may also qualify for benefits if the condition is expected to result in death.
Steps in the “sequential evaluation process” that is used to determine whether you are “disabled” and qualify for SSD benefits. Briefly, these five steps are:
- Are you engaged in substantial gainful activity? If you are working and your average monthly earnings are $1,090 or more per month ($1,820 or more per month if you are blind), then you are considered to be engaged in substantial gainful activity. You would not qualify for benefits. However, if you earn below the SGA monthly amount, you would move on to the next step.
- Does your medical condition interfere with your basic work-related activities? If not, then you are not disabled, according to the SSA. If so, you go to the next step.
- Does your medical condition meet or equal a listed impairment? The SSA has a list of medical conditions that are considered to be so severe that a person with a condition that meets or equals one is considered to be disabled. These conditions can be found in the “Blue Book.” If your condition does not meet or equal a listed one, then you move on to the next step for an assessment of your “residual functional capacity,” or RFC.
- Can you do the work you did before? You may still qualify for benefits if your medical condition is severe enough that it prevents you from doing your “past relevant work.” If you can still do the work you did before, you are not considered to be disabled and can’t qualify for benefits. However, if you can’t, you move on to the final step.
- Can you do any other work? Based on your age, education, past work experience and skills, if you could adjust to another line of work, then your claim for disability benefits would be denied. However, if you could not do another type of work, your claim for benefits should be approved as long as you meet all other requirements.
Percent of claims that are denied by the SSA for medical reasons at the initial application stage, based on SSA data from 2006 to 2010. This means that a claim was not denied for technical reasons (such as the failure to earn enough work credits) but because a person’s medical condition did not meet the SSA’s definition of a “disability.” In many instances, a claim may be denied for medical reasons because a person simply failed to provide proper medical evidence.
Days to appeal your denial. The letter you receive from the SSA will have the date when your claim was denied. The 60-day period starts running from this date. Your first level of appeal is to submit a request for reconsideration. If it is denied again, you can request a hearing before an administrative law judge from the Office of Disability Adjudication and Review (ODAR). The next stages in the appeals process would be to seek review by the Social Security Appeals Council and, if needed, to file a complaint in the nearest U.S. District Court.
Percent of claims that are allowed, based on medical decisions, at the hearing level. Again, this is based on SSA data from 2006 to 2010. There are many reasons why a high number of claims are allowed at the hearing level. One reason could be the fact that many people at the hearing stage are represented by an SSD benefits attorney who carefully prepares their case and serves as their advocate at the hearing.
Months, on average, that you must wait until your disability benefits hearing is held. You must then wait, on average, 449 days (15 months) until you learn whether your claim has been approved or denied, according to DisabilityJudges.com (which gets its data from the SSA’s monthly reports).
Those are national averages. In Florida, the wait times can actually be longer. On average, you must wait 18.1 months for a hearing at an ODAR office in Florida (16 months at the Orlando office) and then go 573 days (484 in Orlando) until your disposition date.
You should speak with an attorney about expediting this process. For instance, you may be able to eliminate the need for a hearing if you request an “on-the-record review” of your claim.
Dollars that are paid in monthly SSD benefits, on average, in the U.S., according to the SSA’s most recent “Monthly Statistical Snapshot.” Some applicants may be allowed to receive past due disability benefits, or “back pay.” Any amount received can mean a major difference for those who are suffering from a disability that prevents them from being unable to work.