SSDI Process

Social Security Disability Insurance (SSDI) benefits are determined by how much you have paid into the program through your payroll taxes, or FICA, when you were working. Your eligibility for disability benefits are not based upon or affected by your other income or assets.

The Social Security Administration's (SSA) review and award system for disability benefits has four levels – with an additional level that takes you out of the SSA system to federal court – although only a few applicants reach the fifth level.

1. Application level – level 1. Complete the initial SSDI application and a detailed Activities of Daily Living Questionnaire. You must complete an enormous amount of paperwork at this first level. According to the SSA, a doctor must verify information in your disability application with pertinent medical information and confirm that your disabling condition will last 12 months or longer.



TIP: Your disability claim may be denied if you are vague about your work history and exaggerate –or underestimate – the impact of your disability.


The Disability Determination Services (DDS), usually in your home state, makes the initial disability benefits determination. It obtains medical evidence and schedules one or more consultative exams if there is not enough evidence to make a decision regarding your disability. DDS gathers and evaluates all the information to determine if you qualify for disability benefits. Your wait at this level may be as few as three months, but on average, it takes four to six months. Only about 37 percent of initial disability applications are approved according to the SSA.

2. Reconsideration level* - level 2. If your initial disability application is denied, you have 60 days to ask for a reconsideration, or first appeal. Your medical and vocational information will be reviewed and updated. At this level, another SSA representative will review your disability application and then you will be notified of the decision. Your wait at level two is usually three to five months. According to the SSA, approximately 86 percent of first appeals are denied.

3. Hearing level – level 3. If your disability application or reconsideration* is denied, you must again notify the SSA within 60 days that you will appeal the decision, which takes your disability application to the hearing level, or second appeal. At this level, your disability application is with an administrative law judge (ALJ). The ALJ will make an independent decision based on the evidence, including all testimony at the hearing.
   
   About 20-30 days prior to your disability hearing, you will receive notification of the date, time and place of your hearing, usually within 75 miles of your home. If the ALJ schedules a hearing, you and your disability representative, if you have one, should attend.
   
   You are encouraged to submit any additional evidence you want considered to the ALJ as soon as possible. At your disability hearing, the ALJ will explain the issues in your SSDI case and may question you and any witnesses. The ALJ may ask other witnesses, such as a physician or vocational expert, to provide testimony at your hearing. You and your SSDI representative, if you have one, may question witnesses and submit evidence. After your disability hearing, the ALJ will issue a written decision and provide it to you and your SSDI representative, if you have one. Your SSDI representative may ask for a decision on-the-record. This happens when an ALJ reviews your disability claim and makes a decision without a disability hearing.
   
   According to the SSA, about 63 percent of second appeals are awarded to disability applicants. The average time spent at this level was 491 days in 2009 according to the SSA. If a disability hearing ends in another denial, you may request another appeal.

4. Appeals Council level – level 4. If your SSDI hearing ends in a denial, you have 60 days to request a review by the Appeals Council. At this level, the Appeals Council will review your disability hearing decision to determine if it was rendered properly according to the law. According to the SSA, only two percent of third disability appeals result in a favorable decision for applicants. The average time to receive a decision on this third disability appeal was 261 days in 2009, according to the SSA.

5. Federal Court level – level 5. Less than one percent of disability applicants pursue an additional disability appeal – Federal District Court (FDC). Nearly 70 percent of these are denied, with a few receiving an award at this level. The remaining disability applicants are sent back to the hearing level for an additional disability hearing.
   
   

• Your SSDI Award: If your SSDI claim is awarded, you can expect a monthly benefit payment, and sometimes a retroactive payment if you have been waiting a long time for your SSDI to be approved. Dependents in your household also may qualify for disability benefits when you do. Often, you can receive SSDI in addition to other types of disability-related benefits such as veteran’s disability, private long-term disability insurance and workers’ compensation. However, some of these may create “offsets,” either by Social Security or the other benefit provider. The amount of your SSDI benefits is determined by a complicated formula using your past earnings that were subjected to FICA taxes. The average individual monthly SSDI benefit is $1,064 in 2010, but your amount may vary.
  
  

*Level two doesn't exist in Alabama, Alaska, Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York, Pennsylvania and two offices (LA N 00057 and LA W 00056) in California.

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A recent report by the federal government indicated that people submitting an initial SSDI application might benefit from using a third-party disabilityrepresentative.