Applying for Social Security Disability benefits (SSDI)

What is SSDI?

SSDI stands for Social Security Disability Insurance. SSDI is an insurance program for disabled people who have worked “on the books” and paid FICA taxes for a certain number of calendar quarters. SSDI pays a variable monthly benefit amount, which depends on your work history. Payments begin after a 5-month waiting period from the time of disability. SSDI is administered by the Social Security Administration (SSA).

How long does it take to start?

It is to your advantage to file for benefits as soon as you become disabled. However, you must be disabled for five full months before you become entitled to SSDI. You will receive your first benefit payment for the sixth month of your disability. You do not receive SSDI benefits for the waiting period.

These are terms you need to know:

Date of Onset

Your “date of onset” is considered the first day you are unable to work because of your disability. The date of onset may or may not be the same as the date you were diagnosed. Applicants usually use the day they last worked as the date of onset.

Note: If you had periodic absences from work caused by your disabling condition be sure to mention that on your application because that can affect your date of onset.  For example, if you stopped work in January 2013, returned to work in March 2013, and then stopped work again in July 2013, your “date of onset” would be January 2013 because the time you spent on the job from March through June 2013 would be considered “an unsuccessful work attempt.”

Month of Entitlement

Your “month of entitlement” to SSDI will be that month which is five full months following your last day of work (your sixth month of disability). For example: If you last worked on January 5, 2005, your month of entitlement to SSDI will be July 2005.

Past Due Benefits

If your disability began (and you were unable to work) more than six months before you applied for SSDI, you may be eligible for “past due benefits.” Applications for SSDI can be retroactive up to 12 months from the date of application.

What happens if I don’t apply right away?

Sometimes people apply for benefits many months after they stop working. This does not change the eligibility date, but it may effect when your first benefit payment will arrive. For example, if you become disabled and unable to work on January 1, your date of onset is January 1. If you apply for SSDI benefits in January, your month of entitlement to SSDI and your first benefit payment will be for June. The check for June will arrive in July.

A person who is disabled on January 1, but waits to apply until June or July (or even later) is already eligible to receive SSDI benefits (because he/she has been disabled for 5 full months). However, since the application has to be evaluated, processed and approved (which normally takes at least 90 days), the first check may not be received until September or later. This person, though, will be able to receive a separate check covering the time from the month of entitlement (June) to the date of the first check (September). That is called the “past due benefit.”

Remember: The month of entitlement is the month following 5 full months after your date of onset (last day you worked).

How are SSDI benefits calculated?

SSDI benefits amounts are determined by a formula which takes into account your age and earnings record. This formula allows for yearly increases in the level of individual benefits in order to reflect adjustments in the cost of living. The amount of your benefits will be based upon your average earnings for all of the years you’ve been working, not just your most recent salary.

There is no minimum SSDI benefit amount. Your monthly benefit will be based on your earnings record. If you receive only a small SSDI benefit, however, and you don’t have a large amount of savings or other assets/resources, you may be eligible for some Supplemental Security Income (SSI) benefits in addition to your SSDI benefit.

SSDI beneficiaries may receive additional unearned income and have unlimited assets/resources. Unearned income you may receive includes private disability payments from an insurance policy or short-term and long-term disability coverage from your employer.

How do I file an application?

You can call your local Social Security Office for an appointment to file a claim. WARNING: do not walk into a local office and expect to file a claim. You may wait an hour or more to speak with an SSA Representative, who will tell you that you must make an appointment.

Social Security also has a toll-free telephone number — 1-800-772-1213 — that you can call to begin your claim.

Tell the SSA (Tele-Claim) representative that would like to apply for Social Security Disability Benefits.

The Tele-Claim representative will ask you some basic questions (name, address, date of birth) as well as some questions about your disability.

What happens next?

The Tele-Claim representative will refer your claim for SSDI benefits to your local Social Security District Office. A Claims Representative will call you back at a later date (usually within two weeks) to complete the applications over the telephone. Be sure to get the name and telephone number of the Claims Representative with whom you speak and the date and time of any calls. You should also ask for the address of your local Social Security District Office for your records.

Note: When you are contacted by your local Social Security Office ask them to provide you with a “Benefit Estimate,” that’s the amount of money you will be paid per month if your claim is approved.

What will I be asked?

In addition to basic demographic information, the Social Security Claims Representative will ask you questions about your disability. The most important question is about the date you last worked because of your disability. It is best to use the earliest date possible. SSA can often establish an earlier date of disability onset if you were in and out of work because of illness.

Required application documents.

Social Security will tell you which documents you will need to submit with your claim.

* birth certificate, passport, baptismal certificate or school records, etc.
* social security card
* W-2 for last year or income tax return (1040) or Schedule SE, if you are self-employed
* your last pay stub for all jobs for the current year.

WARNING! SSA has a policy of taking unnecessary claims for Supplemental Security Income (SSI), which is Federal Welfare. When a Federal Welfare claim is taken in conjuction with an SSDI claim, it can delay the payment of your past due benefits for six months or more…Read More

DO NOT answer any questions about your income, savings, etc. until you ask the Claims Representative  the purpose of the questions. If you’re told it’s for a Supplemental Security Income (SSI) claim, do not answer any questions until the Claims Representative (aka CR) gives you a clear explanation of how income and resources affect the payment of Supplemental Security Income.

If the CR tells you that you must file a claim to find out — ask to speak to a supervisor.

What happens next?

Social Security will mail the completed application to you for review, corrections and signing. Be sure you check the forms for accuracy before signing. You should initial next to any changes you may make on the applications they send you.

Included with the applications is a Disability Report The Disability Report will ask for the names, addresses and telephone numbers of all doctors, hospitals and clinics that have medical information on your disability.

 

Where do I send my applications?

Once you have gathered the requested documentation and you have completed and reviewed your applications, make photocopies of everything to keep for your records.

A return envelope with the address of our local Social Security District Office will be included with the applications sent to you. Enclose the original application and the original documenting proof that is requested.

When Social Security receives the application, they will photocopy the original documents and mail them back to you. If more information is needed, they will write you.

What is the medical determination?

SSDI claims are reviewed for a medical determination of disability by the New York State office of Disability Determination Services (DDS). The determination is based on medical information from your doctors, hospitals or clinics which you have been to for treatment.

The Office of Disability Determination Services (DDS) will request the medical records from your doctors, hospitals or clinics.

WARNING! They will also send you a questionnaire regarding your daily activities, how you spend your day, do you cook, do you drive, etc. Answers to these questions can  and will be used against you, so be sure your answers focus on the effects your disabling condition have on your ability to engage in your day to day daily activities.

Note: You can also choose to ignore the questionnaire. DDS determinations are based upon your medical reports.

How long does the processing of my claim take?

It may take three to six months for a decision to be made on your SSDI claim. Once the medical determination of your disability has been made, Social Security will notify you in writing as to whether or not your claim has been approved. SSDI will also inform you of your month of entitlement to SSDI benefits, the amount of your monthly benefit, and when you will receive your first benefit payment.

Remember: Given the time it takes to process a claim, it is best to apply for SSDI as soon as you have stopped working because of a disability.

How will I be paid?

SSDI benefit payments are based on your date of birth. If you were born during the first week of the month, you will be paid on the first Wednesday of each month and so on.

What if my claim is denied?

Don’t panic! It’s just the nature of the system. The majority of initial claims for Social Security Disability Benefits are denied. Fight back! Send a letter to your local Social Security Office stating that you disagree with their decision and want to file an appeal — and be sure to request a copy (CDR) of your disability claim, so you can review it.

How long does an appeal take?

Here, in the Capital region of upstate New York, it can take an average of 15-months for a hearing before an Administrative Law Judge to be scheduled — and 6 to 8-weeks to receive a decision. However, it is often possible to expedite a disability claim by requesting a decision based upon the written evidence in file — commonly know as an OTR (on the record).  In order to obtain a successful OTR decision, there must be enough medical evidence in file to prove that the claimant is disabled without the need for further information.

See How to appeal a denied disability claim for more information.

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