The basics of the federal Social Security Disability Insurance program

An American who becomes disabled from working may have a financial safety net in the federal Social Security Disability Insurance program. Many people do not realize when they pay Social Security through payroll deductions throughout their working lives that not only are they investing in retirement benefits, but also in disability insurance provided by the Social Security program.

Financial eligibility

To be covered by SSDI, a claimant must meet two work requirements. First, he or she has to have worked relatively recently and also fairly regularly over the years to earn coverage. Basically, the worker needs to have earned enough "quarters of coverage" to qualify. The Social Security Administration has detailed parameters for these coverage determinations.

Disability under the Social Security Act

Assuming the work requirements are met, an eligible claimant must meet the specific definition of "disability" under the Social Security Act. Broadly, the person must be disabled from working because of a physical or mental impairment, or combination of impairments, expected either to last a year or cause eventual death.

It is a good idea to apply for SSDI as early as possible after a claimant becomes disabled. The SSA says that it can take "three to five months" to process an application. And if the claimant chooses to appeal an adverse decision, that can extend the time considerably. Currently, times may become even longer as federal sequestration budget cuts for 2013 will negatively impact the agency's staffing and hours.

Contacting an attorney with experience in representing SSDI claimants at this early stage can be a great help in speeding up the process and overseeing the proper development of the case file before the agency.

The SSA contracts with an agency in each state that processes the initial application, gathering existing medical evidence and ordering further medical assessments if necessary. The claimant's lawyer can be pivotal in helping develop the record, although it is the legal responsibility of the agency to do so.

The process

The SSA has a five-step process in analyzing whether an applicant is disabled:

  • Is the claimant working? If yes, not disabled. If no or if the average monthly amount is under the official limit then
  • Is the impairment "severe"? If no, not disabled. If the impairment or combination of impairments "significantly limits" the applicant's "ability to do basic work activities," then the impairment is severe and
  • Does the impairment meet or equal a medical condition on the agency's official List of Impairments? If yes, claimant is disabled. If no, then
  • Can the claimant return to previous work? If yes, not disabled. If no, then
  • Is there other work the claimant can do considering his or her medical condition, age, education, experience and skills? If yes, not disabled. If no, claimant is disabled.

Review and appeal

If the initial claim is denied, the claimant may request up to three levels of review and appeal before the agency, including a hearing before an administrative law judge, and a negative SSA final decision on the case after all appeals are exhausted may be appealed by the claimant to the federal court system.

An attorney can make all the difference

It can't be emphasized enough how helpful it can be to have a knowledgeable lawyer represent a claimant at all phases of the case. A skilled attorney will understand the administrative process, know the legal eligibility requirements and the standards to which the agency is held, have the capability to see that the record is fully developed and be able to represent the claimant on review and appeal, if necessary.