People asked me all the time if and when they should hire an attorney. In my experience, on the initial and reconsideration level attorneys are not really necessary. Unless a person is illiterate and has no family member who can apply for them, all an attorney can do is exactly the same thing that the claimant does, all of which is self-explanatory. The government limits the amount of money an attorney can make from representing an SSDI or SSI applicant. If your case is never approved, the lawyer can bill you for her miscellaneous expenses such as postage, copying files, phone calls, etc., but not for her time. However, if your case is approved, you likely will have an amount of back benefits, payable at the time of approval, and your attorney is permitted to collect 25% of this before you get your first check. If you have no back benefits due (unlikely), then you would owe the attorney a fee as spelled out in your contract with him.

It may be to your advantage to retain a lawyer once you have been denied on the initial level, however. I say this because most attorneys who handle these claims are very familiar with the processes and can often speed things up to get you on to the ALJ level. They can also use this time to become familiar with your claim and you as a person, which would help in arguing your case before the ALJ. I would not recommend that anyone attempt an ALJ hearing alone, unless they are thoroughly familiar with the system and have a very well-documented file. Once again, do NOT retain an attorney without seeing him or her in person.

Most people who have had any contact with these programs probably know this already, but I would just like to add this in case someone is wondering. Children who are disabled can receive benefits, including money and medical treatment under special programs, usually SSI. This was the intent of Congress when they passed legislation in 1974 setting up the program. SSI medical rules for disability are the same as for Title 2, but a family must prove that they have limited income and resources first. So if you have a disabled child and you are in the American middle or upper income levels, your child probably would not qualify, no matter the nature of their limitations. Once your child has reached a certain age, however (this varies according to the benefit involved), then it is possible that they would qualify based on a working parent's record, especially once they themselves reach adulthood and are too disabled to work. This particular area can be confusing, and you should ask questions, either online, or directly in person with an SSA Field Office representative.

If you are thinking of applying for Social Security Disability -- are in the process of applying -- or have already applied and been denied -- there are a few things you should know. If you are still working (at SGA), you cannot apply for SSDI. If you are no longer working, it helps to have a good set of medical records which are available to the examiner handling your claim. You can apply at your local SSA office, or online at the SSA website. During the process of application, you will be asked to sign release forms so that the DDS can obtain your medical records. Most important are the records from the year leading up to the day on which you stopped work, known as your "alleged onset date". Sit down and list all of the doctors and hospitals which have treated you in the year prior to your last day of work (as well as any since), and let your examiner know the names, addresses, and phone numbers. If you have had no treatment, the DDS will send you for medical evaluations based upon your alleged impairment(s), and this can significantly delay your claim.

Be aware that there are backlogs at all levels of appeal. There are simply too many claimants and not enough trained evaluators. Many times Congress will enact new legislation and requirements concerning issues -- most recently related to Homeland Security, for example -- but does not always allocate the appropriate monies to hire additional staff at the local SSA Field Offices and DDS's.

If you have been diagnosed with a terminal illness, your case may be approved within 90 days from the time that you apply. There is a built-in 5 month waiting period for Title 2 benefits (none for SSI), so this eliminates anyone killed by accident or anyone who dies within five months of ceasing work activity. Everyone else may have to wait from three to six months on the initial level and another three to six months for a reconsideration. Beyond the reconsideration level is a hearing before an ALJ. Current wait-times for ALJ hearings in certain regions are as long as 1,000 days -- or three years.

If you are age 55 or older, you have a better chance of being approved no matter what your impairment. This is because younger workers tend (in general) to be less chronically ill and may be able to switch to a less demanding job or lighter work, as well as re-trained for other work. You might think that an older surgeon with arthritis might have less of a chance of being approved than a younger, unskilled worker with a more severe impairment, but this is not necessarily the case. From the government's point of view, a surgeon is highly skilled in her/his field, and if she can no longer perform surgery due to arthritis, unless the examiner can establish that there are closely matching medical administrative jobs for this claimant, her claim will likely be approved. By the same token, a 53 year old commercial airline pilot who has suffered a heart attack, undergone by-pass surgery, and then recovered will almost certainly lose his/her license to fly commercial aircraft, but his claim may be denied as he could perform other work. Each case is determined, then, on the basis of that person's unique profile.

The federal government added the Social Security Disability regulations to the regular retirement system in 1958. This added a layer of protection to workers who are under age 65 and who -- due to a disabling impairment -- are no longer able to work. Most American workers pay for this insurance through automatic payroll deduction at work, as well as the hospital portion of Medicare (Part A). This insurance is known as Title 2, or sometimes DIB or SSDI. It is intended to benefit disabled adult workers and their dependants. Later, in 1974, the government added a needs-based program to benefit disabled children and adults who had not worked enough to obtain coverage under Title 2. This is known as Title 16, or SSI (Supplemental Security Income), according to the legislation which initiated it. The medical qualifications for both programs are the same. The only difference between them is the needs-based rules for SSI, which require the claimant to fall below a certain level of income and resources. If an individual qualifies for Title 2 based on their disability, they may also receive a supplemental benefit from SSI based upon their low income and resources as well. SSI also provides for additional medical benefits and help paying for treatment, as administered through each state.

To qualify for Title 2 benefits, a worker must perform substantial gainful activity (SGA) for at least 20 out of 40 quarters. The government's definition of SGA is adjusted yearly based on the national average wage index, and also to the worker's age, so that people in their mid-twenties, for example, would not have to work a full 40 quarters. SGA will be set at $940.00 per month for the upcoming year (2008).

SGA is an important figure, not only because it adds to your quarters of coverage going forward, but it is used both before and after you become disabled to "prove" whether you can or can not work, and it is also the basis for your ultimate monthly retirement check. In addition, the government uses somewhat higher figures which pertain to individuals who are blind, both for receiving an income, and for work activity once placed on disability.

The process used to determine disability under Social Security is complex, and each of the 50 states uses separate offices to process this caseload. SSA's local offices are not staffed to handle medical issues, and so disability examiners and doctors are hired and trained to do this work exclusively, accurately, and in a timely manner. In many states the DDS's are a division of that state's Vocational Rehabilitation department. The rationale here is simple: if you are going to deny a person's disability claim, you should have counselors readily available and trained to assist that person in finding a suitable replacement job.

Many factors go into the decision, not the least of which is the severity of the person's illness(es). Age, educational background and training, and work history also play important roles. By nature of the system, it is weighted in favor of older workers. This is true whether you are an engineer, plumber, teacher, or mechanic. However, some impairments are so severe that all that is needed is a diagnosis and the claim will be allowed. This is because there is a process called "sequential evaluation", and, believe it or not, it is intended to speed up each claim.

Many claimants would state to me that the VA, or Worker's Comp., for instance, had already declared them to be "60% disabled", or "80% disabled". SSDI does not work this way. It is an "all or nothing" thing -- you are either "disabled", or you are "not disabled". In making this decision, the examiner and doctor at the DDS will consider (in this order): your impairment(s), your age, your educational level, and your work history. Without getting too technical here, the DDS uses a Listings book which describes each body system and impairment, and uses your medical records to see if you meet the severity of any of these listed impairments. SSDI is intended only for severe impairments which will last more than one year and/or result in death, so about 60 - 70 % of all first-time claimants (initial level) are denied. People apply for SSDI for all kinds of reasons, ranging in severity from terminal cancer to depression to colds and the flu.

Welcome! The Basics

As a recently retired Social Security Disability Claims Examiner, my guess is that one of two things brought you here. You are seeking information about the program and its processes. Or -- you are very, very frustrated about the delays.

Before I go any further, I need to explain that I am neither a medical doctor nor an attorney. Absolutely nothing that I might say on this website should be used to direct anyone's decisions, choices, or activities. You may feel that I have "hit" your particular "nail" on the head, but I claim no legal or medical expertise beyond that which I obtained during the particular course of my own career. If you feel that you do need legal or medical assistance, I strongly suggest that you seek out a competent physician, and that you speak in person to a lawyer who deals exclusively with SSDI (Social Security Disability Insurance) and Worker's Compensation claims. In dealing with any illness or disability, you want a good doctor, and when dealing with the government, you may need a special attorney. All of the facts that I shall post here are free and readily available on multiple other websites, including SSA's own. In addition, some attorneys have built similar websites, though, again, I suggest you not retain an attorney without seeing one in person.

I shall include on this site a place for feedback, comments, and questions. I may get no response to this site, or, I could become overwhelmed. If it turns out to be the latter rather than the former, please bear with me, as I also have other interests, and it may take time to respond to you. I will monitor this site often, but cannot promise to address individual situations or solve specific problems. Again -- I herein create no contract with anyone, and am not responsible for anyone else's situation, decisions, or choices. It is also not my intention to ignore or rebuff anyone, but you may find that I can offer nothing in the way of advice for your particular problem or situation. My opinions are simply that. All I can do is offer information, suggestions, and ideas for cutting through the red tape.

Having said all of this, let me tell you that during my 30 years of work for a state DDS (Disability Determination Service), I saw just about any scenario that you can imagine. I personally and directly adjudicated more than 50,000 disability claims on children and adults on every level below the Administrative Law Judge (ALJ) hearings, covering all physical and mental impairments. I am bringing my unique perspective as friends, colleagues, and associates have urged me to do so. I am doing this because I enjoy writing, I have the free time, and this is what I know.