The Initial Social Security Disability Claim
Updated: Nov 25, 2019
The initial Social Security Disability claim begins with the filing of an application for Social Security Disability benefits with the Social Security Administration (SSA). The SSA has two programs through which individuals can receive disability benefits: Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). The major differences between the programs are discussed below. Once an application is submitted to a local SSA office, it is assigned to an SSA claims specialist for review. The claim specialist may need to obtain additional information on the applicant prior to submitting the claim to the Social Security Disability Determination Services (DDS) office for review. Once the DDS completes their review process, the SSA will send a decision to the claimant and the claimant’s representative (if one has been appointed).
SSA Disability Basics
The SSA has a very specific definitions of disability. For adults, this definition is as follows: “the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” For a child under age 18, the child “will be considered disabled if he or she has a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months.”
The SSA sets an SGA amount every year based on changes in the national average wage index. The SGA is a monthly amount and varies depending on whether an individual is considered blind or non-blind. SGA will not apply to blind individuals applying for SSI. Further, after an individual becomes eligible for disability benefits, they may attempt to return to the work force. The SSA provides individuals with a trial work period during which an individual may still collect disability benefits while testing his or her ability to work. During this period, an individual is still considered disabled. The SSA will not consider services performed during the trial work period as showing that the disability has “ended” until services have been performed for at least 9 months in a rolling 60-month period. The SSA sets a monthly earnings limit, which if exceeding will count as a month of services for an individual’s trial work period. Like SGA, the monthly earnings for purposes of the trial work period are determined every year by the SSA.
Further, for a physical or mental impairment to be considered medically determinable, the impairment must be one “that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques.” This must be established through medical evidence. It is not enough to provide a statement regarding the individual’s symptoms.
SSA Disability Programs
As mentioned in the introduction, the SSA has two programs through which an individual may receive disability benefits: SSI and SSDI. Although the two programs are similar in that they both require that the individual be unable to engage in SGA due to a medical condition that is expected to result in death, or is expected to last or has lasted for at least 12 months, the major difference between SSI and SSDI is that SSI is a “needs based” program, while SSDI is determined based on an individual’s work history.
For an individual to be eligible for SSI, they must meet the following major requirements:
The individual must be aged (age 65 or older), blind, or disabled;
The individual must have limited income and resources;
The individual must be a U.S. citizen or national, or in one of the SSA categories of aliens;
The individual must be a resident of one of the 50 States, the District of Columbia, or the Northern Mariana Islands;
The individual may not be absent from the country for a full calendar month or for 30 consecutive days or more; and
The individual may not be confined to an institution (such as a hospital or prison) at the government's expense.
For an individual to be eligible for SSDI—also called Retirement, Survivors, and Disability Insurance (RSDI)—they must meet the following requirements:
The individual is unable to work due to a medical condition that is expected to last at least one year or result in death; and
Meet the SSA earnings requirement (“work credits”), which is based on an individual’s work history under the U.S. SSA.
Submitting a Disability Application
An individual has multiple options for submitting a disability benefits application to the SSA. For SSI claims, an individual may either apply in person; by participating in a phone interview; or by completing an online application. For SSDI claims, applicants have all these same options, however the SSA prefers that SSDI applications be completed online. Regardless of which disability program an individual applies for, the SSA generally screens applicants under either program in order to allow for maximum benefits.
Disability Claim Review Process
Once a disability claim is submitted to and received by the SSA, it will be reviewed for accuracy and completion. The SSA will also determine whether the individual has enough work credits for SSDI/RSDI and whether the individual’s current employment status disqualifies them from receiving benefits. If the proper criteria are met, the SSA will be submitted to DDS for a full review of the disability claim. During their review process, the DDS will review the information and any medical evidence an individual provided with their application. DDS will also complete their own independent record gathering by obtaining medical records from the clinics and hospitals the individual lists on their application and reviewing the individual’s employment history. DDS may also mail the applicant a Function report, work History report, and/or other documentation that the applicant must complete as part of the claim review process.
Further, if DDS cannot make a determination on an individual’s claim based on the evidence provided/gathered, the individual may be required to attend one or more consultative exams depending on an individual’s conditions. Consultative exams are performed by independent medical providers who contract with the SSA. Once DDS has received all the necessary information to process an individual’s claim, they will evaluate the information and make a decision regarding whether to approve or deny the claim. Once a decision is made, the SSA will send a letter to the individual notifying them about their decision. If an individual’s claim is approved, their letter will state the amount of monthly benefits they will receive and the date when those benefits will begin. In some cases, an individual may also receive back-pay for their claim, which may go back as far as a year prior to the application date. If an individual’s claim is denied, the letter will state the reason for denial and the steps the individual can take to appeal the decision.
Application Processing Time
Generally, it takes three to six months—from the date the application is received—for DDS to make their decision on a claim and for the SSA to notify the applicant. The major exception to this is those individuals who qualify for benefits under a Compassionate Allowance program. The Compassionate Allowance program is a way for the SSA to quickly identify certain diseases that, by definition, meet the SSA disability standards. These conditions tend to be either very severe or life-threatening/potentially fetal conditions such as certain cancers, adult brain disorders, and rare children’s disorders. Under the Compassionate Allowance program, initial applications are generally processed within 20 days. In Minnesota, a little over 30% of initial applications for disability are approved.
Metropolitan Community Services understands that the initial application process is long and daunting for many individuals. Therefore, MCS employs advocates who can help individuals complete the initial application as well as other portions of the disability process at little or no fee. To get in touch with an advocate, contact us at 952-658-8995 or firstname.lastname@example.org.