For individuals who are unfamiliar with Social Security Disability Insurance (SSDI), there is a lot of confusion surrounding it. It is difficult to set expectations during the application process in the absence of any information. So, is SSDI hard to get?
SSDI is fairly hard to get. This is because it has a very strict set of requirements that must be satisfied in order to be approved for these benefits. In fact, the vast majority of people who apply for benefits get denied in the initial stage of the review process.
Keep reading below as we discuss more details about these disability benefits.
SSDI Overview
There are two different disability programs managed by the Social Security Administration: (i) Supplemental Security Income (SSI); and (ii) Social Security Disability Insurance (SSDI).
Social Security Disability Insurance is a program that aims to provide financial relief and assistance to disabled individuals. SSDI works like any other insurance policy; you have to pay into it in order to be eligible.
If you are disabled and unable to return to work, you can apply for SSDI benefits. If you are approved for benefits, you will receive monthly payments. The amount of your benefits will be determined by various other factors.
Is SSDI Hard to Get?
There are millions of people in the United States that rely on monthly SSDI payments to sustain themselves. People who are unfamiliar with this program and its complexities may assume that the program is available for anyone who is unable to work due to a mental or physical impairment.
However, it’s not that easy. Obtaining SSDI can be really hard.
According to one survey, approximately 70% of the applicants are rejected at the very initial stage of the review process. Part of the reason why this rejection rate is so high is because of the strict requirements set forth by the Social Security Administration (SSA).
It is also important to remember that the approval rate varies across gender, different medical conditions, and other various factors. So, this overall approval rate is not set in stone or applicable to everyone.
In order to be eligible for SSDI, an applicant needs to meet the following requirements:
Work History
In order to qualify for insurance, applicants must have worked for at least 25% of their adult lives, including at least 5 years within the last decade.
Disability
In order to qualify for disability insurance, applicants must be able to prove to the SSA that they have a medically determinable disability. Furthermore, the disability must be severe, in that it must be expected to last for another 12 months or result in death.
These claims must be backed by hard medical evidence before the SSA can consider your case. If the details of your case are ambiguous, the SSA may order an examination on your behalf.
Substantial Work
In order to be eligible for disability insurance, the applicant must not be able to engage in substantial gainful activity (SGA) or earn over a certain amount of money while performing substantial gainful activities. Substantial gainful activity not only comprises an income threshold but also whether an applicant has the capacity to do any other type of work.
If you earn more than a certain amount and are doing productive work, the SSA generally considers that you are engaging in SGA. For 2023, the income threshold for SGA is $1,090. If the SSA finds that you are able to do any other kind of work that can be considered SGA, irrespective of whether that kind of work exists in your area or if you’ll be fired, it will not consider your application.
Waiting Period
A short-term disability does not qualify for SSDI benefits. To be eligible for disability insurance, a worker’s disability must last for a minimum of five months. Some people may be able to get by during this time on sick leave, private insurance, aid from family, or savings; others may qualify for Supplemental Security Income.
Conditions that Qualify for SSDI
Indeed, many medical conditions qualify an applicant for SSDI. The list of conditions is included in the SSA’s Blue Book. These include:
- Arthritis
- Heart disease
- Degenerative disc disease
- Mental health diseases
Ultimately, any physical or mental health condition that is disabling enough to prevent you from retaining employment and is expected to last for at least 12 months qualifies for SSDI. Some conditions automatically qualify an applicant for SSDI. These include:
- ALS
- Organ transplant
- Certain dangerous cancers
- Esophageal cancer
- Mucosal melanoma
- Anaplastic carcinoma of the thyroid gland
- Small-cell carcinoma
If you have any of these conditions, then you will automatically be approved for disability benefits. For all other medical conditions, the SSA verifies if your condition meets the specific requirements put forth by the Social Security Administration.
The Social Security Administration first eliminates applicants who do not meet the technical requirements and then forwards the remaining candidates to the state’s disability determination service (DDS) for a medical review.
The technical requirements are that the applicants must have accumulated over 40 work credits at a job that pays into Social Security.
In case of rejection, the applicant may file an appeal. The average period to resolve a case is three to four months at the DDS level and well over a year at the appeal (hearing) level. There is evidence that the approval rate decreased from 2009–2011 when it was less than 40%.
Regular “continuing disability reviews” are conducted on those receiving social security disability insurance benefits to ensure they are still impaired.
In summary, most workers must go without a salary for several months while applying for SSDI, with a high risk of rejection. If successful, regular evaluations will occur to guarantee that they remain eligible for a benefit that will replace (on average) about half of their former wages. Furthermore, after a waiting period, those who get SSDI are eligible for Medicare.
Conclusion
Obtaining Social Security Disability Insurance is not only difficult to apply for, but also difficult to get. It’s important to set reasonable expectations when awaiting a response from the SSA. Work with a Social Security Disability lawyer to improve your chances of getting approved for SSDI.
