Social Security Disability Insurance (SSDI) is a federally-funded program for people who are disabled and unable to retain employment. You may have heard about how difficult it is to be awarded SSDI. Why is it so difficult to get SSDI?
You must have what the Social Security Administration (SSA) deems to be a debilitating mental or physical condition in order to be eligible for SSDI benefits. This is because the SSA wishes to help only people who really need it.
Keep reading below for more information.
Why Is It So Difficult to Get SSDI?
It’s so difficult to get SSDI benefits because the eligibility requirements for the program are strict. They require:
Job History
For applicants to the SSDI program to become insured, they must have worked for at least five of the previous ten years and, for most people, at least one-fourth of their adult lives. There are some exceptions to this requirement if you become disabled before the age of 31.
Profound Impairment
A serious, medically verifiable physical or mental handicap that is projected to last 12 months or cause death is a requirement for applicants. Data must be supported by reliable clinical facts and findings, not only sentiment, and must come from recognized medical sources.
When necessary, the Social Security Administration (SSA) orders its own inspection.
Unable to Perform Significant Work
The applicant’s impairment must keep them from engaging in “substantial gainful activity,” which is now outlined as work that pays at least $1,470 per month for non-blind individuals or $2,460 for blind individuals in 2023.
According to the law, the applicant’s disability must prevent him from performing any other type of employment, regardless of whether it is available in his area or whether he would be employed, while also taking into account his age, education, and prior work experience.
The Time in Between
The temporarily disabled should not get SSDI. Before a worker is entitled to disability insurance payments, their impairment must have persisted for at least five months. Some may be able to get by during this waiting period thanks to sick days, private insurance, family support, or savings; for some of the poorest, Supplemental Security Income could be a viable option.
The SSA filters out applicants who are clearly ineligible (most commonly because they do not have insured status) and sends the remaining candidates to the Disability Determination Service (DDS) in each state for medical review. The applicant may file an appeal if his or her request is rejected there.
Processing timeframes at the DDS level are usually three to four months for initial and reconsideration decisions, whereas wait times to see an Administrative Law Judge can be over a year at the appeal (hearing) level. Less than 40% of 2009–2011 applicants (including those who failed the initial screening) received benefits in the end, and there is an indication that the percentage has decreased since then.
Periodic “continuing disability reviews” are required of SSDI recipients to confirm that they are still impaired. For every dollar the SSA spends, those reviews save them nearly $10 in benefits. Nevertheless, due to congressional parsimony, the SSA has struggled to complete these inspections on time.
For the most part, applying for SSDI entails going without pay for several months to qualify for a benefit that will, on average, replace about half of their prior earnings. There is a significant chance that they will be rejected, but even if they are approved, they must undergo ongoing reviews to make sure they continue to qualify.
(Furthermore, SSDI beneficiaries can get Medicare but must wait two years before coverage begins.) It is not a characteristic of a lax program.
What are Work Credits?
By working and generating enough income, you can obtain one work credit for each quarter of the year. The amount of money required to qualify for a work credit varies from year to year with cost-of-living adjustments. In 2023, for every quarter that you earn at least $1,640, you will earn one work credit.
The total amount of work credits you can accumulate annually is capped. You can only accrue a maximum of four work credits per calendar year. You can only use the first $6,560 of your annual salary to earn work credits.
If you have accumulated enough work credits, you will meet the technical requirements for SSDI benefits. Depending on your age and when you first became incapacitated, you will need to meet a specific threshold.
As you get older, you will normally require more work credits. For instance, if you were 40 when you first became disabled, you would need 20 work credits to be eligible for SSDI benefits. Yet, you would require 28 work credits to be eligible if you did not become disabled until you were 50 years old.
Why Are SSDI Benefits Refused?
The SSA denies a large number of SSDI claims for a variety of reasons.
As noted above, the SSA will not accept your claim unless you can demonstrate that you fall under the legal criteria of a disabled person. You must provide the SSA with medical records to demonstrate this.
Yet, a lot of people don’t provide adequate medical documentation to support their claim of disability, so the SSA is forced to reject their application.
The SSA will need as much information as you can provide for your claim to be approved, so it is important to send as much as you can.
You will be required to produce medical documentation, for instance:
● Formal diagnoses
● Visit logs for hospital rooms
● Diagnostic procedures and outcomes
● Lab findings
● History of medical therapy
● History of prescribed medications
You can also request that your doctor write a statement outlining the severity of your illness and how it impacts your capacity to work.
Your monthly salary may also be a factor in the decision. If you work for a wage that exceeds the significant gainful activity rate ($1,470 in 2023 for non-blind individuals), the SSA will not approve you for SSDI benefits. If you are employed and earning more per month than this amount, you will not be eligible for assistance.
Additionally, you risk having your application rejected if you refuse to work with the SSA. For instance, if the SSA requests additional proof from you and you don’t supply it within a reasonable amount of time, the SSA will have to reject your claim.
Lastly, failure to adhere to your doctor’s recommendations for your disability treatment could result in the refusal of your claim. If you don’t follow your doctor’s advice, the SSA won’t be able to assess if you qualify for benefits under the law. That shows that you are not entirely devoted to your recovery and that your condition may improve if you were to follow your doctor’s advice.
Conclusion
We can all agree that getting awarded SSDI benefits is challenging. The SSA wants to ensure they only help only people who need it. This is also good news for people who deserve the benefits since the SSA wants to help them.
