What Is a Disability Claim?

If you develop a medical condition that makes it difficult or impossible to work, you may qualify for disability benefits from the Social Security Administration (SSA).

The Social Security Administration manages two programs providing monthly disability benefits to those qualifying as disabled under strict SSA guidelines.

What Is Social Security Disability?

The SSA pays out disability benefits to individuals possessing some documented work history—at least five of the last ten years—with a qualifying disability lasting at least twelve months.

You may receive retroactive payment of benefits up to twelve months, less a five-month waiting period. Although it may take several months to obtain approval of your disability benefits, you receive back pay of any benefits during that waiting period.

Qualifying for disability claims from the SSA is a complicated process. In most situations, those needing benefits receive a denial of their request for disability benefits.

To obtain benefits, you must satisfy specific criteria. However, even possessing the qualifying criteria does guarantee benefits. Despite receiving millions of disability claims every year, between 2001 and 2010, the SSA averaged a 53% approval rate for disability claims.

How Do I Qualify for Social Security Disability?

To qualify for disability benefits, you must suffer from a disability meeting SSA disability guidelines. The SSA will deem you disabled if you satisfy the following conditions:

You are unable to work a job you previously were able to work because of your medical condition;

You cannot do other work due to your medical condition; and

Your disability has lasted or is expected to last for at least one year or result in death.

Additionally, some types of disability benefits depend on work credits. Individuals earn up to four work credits per year when working and paying Social Security taxes. In 2021, individuals earn one credit for each $1,470 made in wages or self-employment income.

The number of work credits you need to qualify for benefits depends on the age you were when the disability occurred. But generally, individuals must have earned at least 40 work credits. Half of these credits must have been earned in the last ten years and ending in the year your disability occurred.

The SSA provides five questions an individual should ask to determine whether they may qualify for disability benefits.

Are you currently working?

Is your disability considered "severe?"

Is your condition listed on the SSA list of qualifying medical conditions?

Are you able to do the work you were able to do previously?

Can you do any other type of work?

However, meeting these criteria does not automatically qualify you for disability benefits. Therefore, individuals who choose to hire a Social Security disability lawyer to assist them in applying for disability benefits often experience greater success than those choosing to go it alone.

What Are the Types of Social Security Benefits

According to Gerling Law Disability Lawyers, the SSA manages two programs providing benefits to qualified individuals with disabilities and blindness.

Social Security Disability Insurance Program (SSDI)

SSDI provides disability benefits to qualifying individuals who contributed to Social Security through contributions from their income. Your earnings determine the number of contributions made to the SSA. The Federal Insurance Contributions Act (FICA) defines the amount of contributions deducted from your income. Additionally, any dependents may receive benefits from your contributions.

Supplemental Social Security Income Program (SSI)

SSI provides cash payments to disabled, blind, or aged persons with limited income. SSI receives funds from taxes and does not determine benefits based on contributions made from past earnings. To earn SSI benefits, you must possess less than $2,000 in assets—or $3,000 for a couple—and earn a minimal income.

What Happens If I Receive a Denial of My Claim?

In the event you receive a denial of your disability claim, you may appeal. If you plan to appeal, you must do so within sixty days of the denial. Many denials of SSA disability claims stem from the following reasons:

Lack of medical evidence to support the medical condition claimed;

You earn too much money to qualify for disability benefits;

You have not followed a doctor-prescribed treatment plan for your disability;

You did not respond when the SSA contacted you for additional information; or

You refiled your claim rather than appealing the denial.

Carefully review the information provided in the denial, so you understand what to address on appeal. Oddly enough, your chances for approval of your disability benefits may be stronger on appeal. Many find greater success when they don't give up on their disability claim. However, it's advisable to seek a Social Security disability attorney's guidance to help you through the complex appeals process.

There are four stages of the appeal process.

Reconsideration

Reconsideration occurs upon the first appeal of the original claim. In this stage, the SSA reviews your original disability claim and any additional evidence you submit for review. Reconsideration does not require you to be present at a hearing.

Hearing by Administrative Law Judge

If your reconsideration does not result in an approval of your claim, you may request a hearing by an administrative law judge (ALJ). The ALJ reviews your case file and may request additional information from you for review.

At the hearing, the ALJ may question you and any other witnesses you bring to support your claim. You may choose to get experts to appear at the hearing. At the hearing, the judge decides whether to approve your disability claim or uphold your disability claim's denial based on the evidence provided.

Review by Appeals Council

An appeals council receives all requests for review. However, they may deny a request if they believe the ALJ made the correct determination. If it grants your request for review, the appeals council reviews your claim and either makes a decision or returns the case to the ALJ.

Federal Court Review

The last resort lies in filing a lawsuit in federal court based upon denial at all prior stages of your disability claim. A federal review of your claim takes some time. Upon reviewing your claim, the federal court either reverses the decision and approves your request for disability benefits, rules in favor of denying your disability claim, or sends the case back to the SSA to obtain more information regarding your claim.

At all stages of filing your disability claim and possible appeal, it's advisable to seek a Social Security disability lawyer's legal guidance through the complex process.