Applying for Social Security Disability or SSI benefits

Who can apply for Social Security Disability Insurance benefits (aka SSDI or DIB or Title II benefits)?

Social Security disability insurance benefits are for anyone who has worked but has become so disabled he or she can no longer work. Sometimes a spouse, dependent children, parents, or even a divorced spouse, can also receive SSDI benefits based on the earnings record of a person who has become too disabled to work. has retired or died.  

You can apply for SSDI benefits if you have been disabled for at least twelve (12) months, or your doctor is sure you will be disabled for at least twelve (12) months, but that you will eventually recover and be able to return to work or you actually have returned to work. You do not need to be permanently disabled to apply for SSDI benefits.

Who can apply for SSI (Supplemental Security Income or Title XVI) benefits?

SSI benefits are mostly for anyone who is blind, disabled or 65 years of age or older and who meets certain income and resources requirements.  You do not need to have paid FICA (Social Security taxes).  Sometimes people will be eligible for both SSDI and SSI benefits. That can happen if you were not able to earn much money before you became disabled or elderly or blind, you have little to no other income and don’t own much or have few resources. However, when figuring out the value of what you own (your “countable resources”) Social Security does not count the value of your home, if you own it, a motor vehicle if needed to get to medical appointments and/or buy food, ordinary belongings and some life insurance policies and tribal payments.

For Social Security to decide that you are blind, you must give evidence that you have corrected vision of 20/200 or worse in your better eye. Corrected means how well you see when you are wearing glasses or contact lenses.

How can I get benefits for a disability?

To get SSDI and/or SSI benefits for a disability, you must show that you have one or more severe mental and/or physical impairments that keep you from working at a paying job for at least 12 months or your illness or impairment is expected to result in death in 12 months or less.

Usually, it is not enough to show that your mental and/or physical impairments stop you from doing your old job. You must show that you cannot do any kind of full-time work, although your age, education and work experience are taken into consideration in determining what other kinds of work you might be able to do. Different rules apply if you are over 50 years old. You cannot get benefits if you are able to work or will be able to return to work in less than 12 months, even if no one will hire you.

When should I apply for SSDI and SSI benefits?

You should apply as soon as possible after you become disabled or blind. You do not need to wait 12 months to apply.  If a disabled worker dies, you (a widow/widower/parent/dependent) can still file an application for SSDI benefits but you must apply within 3 months of the worker’s death.  If the claim is approved, benefit payments may be paid for some months before the worker died.  There is also a small “death” benefit that can be applied for.

SSI‘s rules are different: if someone has applied for SSI disability benefits and dies before a favorable decision is made, only a spouse can receive any retroactive benefits.

How do I apply for SSDI and/or SSI benefits?

You can apply online at www.ssa.gov or you can call 1-800-772-1213; if you are hard of hearing or deaf, you can use Social Security’s TTY line, 1-800-325-0778, to start the application process. You can also go to your local Social Security office.  If you do not know where your closest Social Security office is, you can find it by calling one of the 800 numbers listed above or using Social Security’s online office locator https://secure.ssa.gov/apps6z/FOLO/fo001.jsp. You can also ask at your local welfare office.

What evidence should I include with my application?

To get SSI or SSDI disability benefits, you must provide medical evidence that shows that you have physical or mental impairments that stop you from working.  Medical evidence can be: doctor or hospital reports or records, test results, letters, records or reports from any mental health provider or center.  If you are a veteran and you are receiving benefits for a service-connected disability, make sure you tell Social Security about those records or send in a copy of those records with your application. The more medical evidence you have, the more likely you are to get disability benefits.  Part of your Social Security application is a form that asks you to list all treatment you’ve received, make sure you list all of the medical treatment you have had.

Social Security may not request any medical records that date from more then twelve (12) months before the date you became disabled.   If you believe older records may support your claim for Social Security disability benefits, it may be up to you to get copies of those records and submit them to Social Security. 

Can I apply for SSDI and/or SSI disability benefits if I use and/or am addicted to alcohol or other drugs?

Starting in April 1996, people who are disabled only because of current use/abuse of alcohol or another drug(s) are not eligible to receive SSDI or SSI disability benefits. BUT, if you have another condition(s) that would make you unable to work for 12 months or longer even if you stopped using alcohol and/or other drug(s), you may be eligible for benefits.

What happens after I apply?

SSA will contact your health care providers and request your treatment records.  If you have been hospitalized, they will contact the hospital(s) to get copies of your records.  SSA/DDS (Disability Determination Services) will send you forms that ask questions about what you do or try to do all day, what kinds of jobs you have had in the past ten years, and possibly about your level of pain.

It’s very important to take your time and fill out the forms completely. For example, if one of the forms has a question that asks: do you prepare your own meals? If you just write in yes, then SSA thinks you can prepare a cooked meal 3 times/day every day.  If what you are really doing is microwaving a frozen meal because you can no longer stand long enough to cut up vegetables and/or meat and cook it, or there is some other disability related reason you eat only prepared foods, SSA needs to know that you are not able to prepare a home cooked meal for yourself or anyone else in your household.   It's important that you take the time to write about any and all difficulties you have in preparing a meal, shopping for groceries, etc.  Another example: you still have a driver’s license and can drive short distances, but someone else drives you if it’s more than a five (5) mile drive because you can’t sit any longer or your back/knees, or neck hurt too much and you can’t drive safely or you have to stop & walk around for 5 minutes or stretch out on the back seat for ten minutes before you can drive any further.    If a form asks if you can drive, then your answer would be "yes, but . . and then you would describe all the ways your ability drive yourself is limited. 

If you need help filling out the forms, you can ask someone to help you, but you and the person who helps you must be sure to write on the form that that he/she helped you and how you were helped.

SSA may send you to a doctor for an evaluation. Usually the doctor is not a doctor you know. If you can, it’s wise to take a copy of your medical records with you to this evaluation, because the doctor usually will not have a copy. The doctor can understand your disability better if he/she can review your records in addition to examining or testing and talking to you.  

It is a good idea to make a copy of the completed forms before you return them to Social Security. 

What happens if Social Security approves my disability claim?

If you are found to be disabled and entitled to SSDI benefits, you can get benefits for up to a year before the date you applied.  How many months depends on the date Social Security decides you became disabled. There is a 5 month “waiting period.”  This is a time period that starts the date you became disabled. You will not receive monthly cash SSDI benefits during the 5 month waiting period.

If you are found eligible for SSI benefits, the earliest date you can get benefits back to is the first day of the month after the month in which you applied for benefits. Your benefits may begin at a later date if Social Security decides you became disabled at a date later than the date you applied for SSI benefits.

What do I do if Social Security denies my claim for benefits?

If you are denied benefits because Social Security does not think you are disabled, you can appeal Social Security’s decision.  Many people are denied benefits at first, so don’t be discouraged if your claim is denied the first time.  If you think Social Security was wrong in denying you benefits, you can request reconsideration of SSA’s decision. If your claim is denied again (or upon reconsideration), you can appeal again, this time by requesting a hearing before an administrative law judge.

How do I request reconsideration?

You can request reconsideration in several ways, but each way requires you to ask for reconsideration in writing. You cannot request reconsideration or a hearing by calling SSA’s 800 number or your local office and saying, “I want to appeal,” or “I want to request reconsideration.” You must do it in writing. You can request reconsideration through Social Security's website.  You can write a letter to your local SSA office and say that you want to request reconsideration. You would need to list your Social Security number, your address, your name and sign the letter. To make sure that SSA receives your letter within the 60 day time limit, you should mail the letter by certified mail, return receipt requested, and keep a copy of your letter. After SSA gets your letter, it will mail a “Request for Reconsideration” form and some other forms to you. You will need to fill out those forms and return them to SSA.

You can go to SSA’s website, www.ssa.gov click on Apply for Disability benefits and then click on Internet Appeal and follow the instructions on that page to file an online appeal. You can also call 1-800-772-1213 and ask that the forms used to requesting reconsideration be mailed to you.

It is important to be sure that you appeal or request reconsideration before the 60 day time limit has expired. You have 60 days from the date your claim was denied (the decision date is listed on the denial notice) to request reconsideration. Sometimes, if you can show that you were very ill, did not receive the notice for some reason (moved, etc.), or could not read the notice yourself, you can still ask for reconsideration after the 60 days is up, but it’s better to find a way to ask, in writing, for reconsideration before the 60 day period is over.

Some people find a lawyer to help them with their Social Security case if they need to file a request for reconsideration because their claim was denied because they want a lawyer to help them gather records and help them with their claim in other ways.

If Social Security denies my claim on reconsideration, what can I do?

If Social Security denies your claim on reconsideration, you can appeal that decision by requesting a hearing before an administrative law judge (ALJ). The hearing is your first opportunity to talk about your disability face-to-face with someone who makes a decision on your Social Security disability claim.  You can have a lawyer represent you at your hearing.  If you think you would like to have a lawyer represent you, it is wise to contact a lawyer as soon as you receive your reconsideration denial. The sooner you find an attorney, the longer the attorney has to work on your case and prepare for your hearing.

It is worth requesting a hearing because many people are found disabled (get benefits) after a hearing.

How long will I have to wait for a hearing? Where will it be?

After you request a hearing, it can be approximately 18 to 24 months before a date for your hearing is scheduled. You will get a notice at least 20 days before the hearing telling you the date, time and location of the hearing. If the hearing is held at a location more than 75 miles from where you live you may get reimbursement of some of your travel expenses.

You will be asked in writing by the hearing office (ODAR) if you will agree to a video hearing.   You will still travel to a hearing site, but the Administrative Law Judge (ALJ) won't be in the same room.   You will see and talk to the ALJ by video, and he/she may be anywhere in the US.  You do not have to agree to a video hearing.

What happens at a hearing?

An ALJ (administrative law judge) runs the hearing. The hearing is held in a small room and it is private, members of the public cannot come in and watch. Generally, the only people at the hearing are: the ALJ, his/her assistant, you, your representative if you have one, and any witnesses. Usually, the ALJ will have one witness, called a vocational expert, and sometimes there will another witness as well, a medical advisor.   Sometimes these expert witnesses will testify by telephone.  You can also have witnesses, your doctor, or people who know you well and can testify about what you can and can no longer do.  A hearing can be as short as ten (10) minutes or as long as an hour and a half, although usually it lasts from half an hour to an hour. The hearing is recorded.

It is the ALJ’s job to take a “de novo” look at all the evidence in your Social Security disability case in order to decide if you are disabled. De novo means that the ALJ looks at your case as if he/she is the first decision-maker to look at it, or makes a decision that is independent of the two earlier denials of your claim.

To help the judge make his/her decision, the ALJ will question you about your disability. The ALJ may also ask the vocational expert for information about jobs that you have held or/and ask a medical advisor questions about what your medical records indicate about how severe your disability is.

If you are represented by a lawyer at your hearing, the lawyer can also ask you, the vocational expert and/or the medical advisor questions.

How can a lawyer help me at my hearing?

An attorney who represents you can help you before, during and after your hearing. Before the hearing, an attorney can help you:

Make sure that all of your medical records, test results, hospitalization records are in your case file and request and submit any medical records that are not already in your file;
Ask that a prior application(s) for disability benefits be reopened;
Obtain a report(s) or written statements from your doctor(s) that strengthen your case;
Analyze your case under Social Security’s regulations, rules, and caselaw and review Social Security’s actions taken on your case;
Request that Social Security or DDS send you to a doctor for a consultative examination; and if SSA/DDS does so, help you prepare for that examination;
Prepare for your hearing.

During your hearing, an attorney can:
Submit written argument;
Make opening or closing statements;
Cross-examine witnesses such as vocational experts and medical advisors;
Help you tell the ALJ how your disability affects you by asking you questions;
Protect your right to a full and fair hearing by objecting to improper procedures or evidence.

After your hearing, if the ALJ approves your claim, an attorney can help make sure all necessary information has been submitted for Social Security to process your claim(s), and check to make sure that Social Security has calculated the correct amount of back benefits.

If the ALJ denies your claim, an attorney can help you request review of the ALJ’s decision by the Appeals Council, and, if that appeal is denied, represent you on further appeals before the federal courts.

Money is tight because I haven’t been able to work for awhile, how will I pay a lawyer? Will an attorney represent me without being paid a retainer?

Usually an attorney will charge a fee for representing you. Most attorneys represent people on Social Security disability cases using a contingency fee agreement. A contingency fee agreement is when an attorney is paid only if he/she helps the client win his/her case, so you do not have to pay the attorney a retainer at the start of his/her work for you.

The fee charged by an attorney representing you on a Social Security disability case is usually 25% of your retroactive benefits. The fee must be approved by the Social Security Administration. You should make sure you understand any fee agreement with an attorney before you sign it.

In addition to a fee, attorneys expect their clients to be responsible for the costs of their cases. The costs are usually charges by health care providers for copying records or for providing statements or reports. Sometimes costs will include what a health care provider charges for a one time examination and to write a report. Total costs can range from $50 to $650, occasionally more.

How should I prepare for the hearing?

If you don’t have an attorney representing you, you will need to make sure that all of your medical records and any other medical evidence you want the ALJ to see have been submitted to the hearing office.  You will need to think about the testimony you’ll give and if there are other people you think could give useful information to the ALJ (testify) about your disability.  If you want any of those people to testify at your hearing, you will have to ask them if they will go to the hearing and tell the hearing office that you will have witnesses.

What will an ALJ ask me about at the hearing?

The ALJ will ask you questions about:

  • What are the physical or mental problems you have and how have they prevented you from working?
  • Any pain you may feel that stops you from working or doing your normal daily activities, or interrupts or stops you from sleeping. The ALJ will ask you if the pain is always there, if it is less at times, or worse sometimes, if you take pain medications and if you do, how well they work on decreasing your pain.
  • If you have any side effects from pain or any other kind of medication, the ALJ will want to know about them.
  • If you feel fatigue or are often tired. If you are tired sometimes or often and if you take naps during the day.
  • What you are able to do around the house; if you are able to shop for food or do other kinds of shopping.
  • If you have children, how your disability has affected your ability to care for them; if you drive a motor vehicle and if you have any hobbies.
  • If what you can do has changed since you became disabled, you will be asked to describe what those changes are.
  • What jobs you have held in the ten years before you became disabled.  You will be asked about what you did in each job and how long you worked at each job.

The hearing notice I got says that there will be a medical advisor and vocational expert at the hearing.  Who are they and what do they do?

An ALJ will call a medical advisor if the judge needs some questions answered about your medical condition(s) that make you disabled.  A medical advisor is a doctor or psychologist who looks at your file, maybe asks you a few questions, and then uses his/her professional training and experience to tell the ALJ something about your medical condition(s).

An ALJ will have a vocational expert come to your hearing if the ALJ thinks he/she will need some expert advice or information about jobs you have had or jobs you might be able to do even though you have limitations because of your medical condition(s).

If you have an attorney, the attorney can ask questions or cross-examine the medical advisor and/or vocational expert for you to make sure that the ALJ hears how your disability can affect your ability to work and do daily activities of living.

Judges usually do not tell you their decision at the hearing.

What happens after the hearing?

You will receive a written decision from the ALJ a few weeks to, usually, several months after the hearing.  If the ALJ decided you were disabled, then you will get disability benefits. How far back you will get benefits will depend on:

  1. What type of benefit, SSDI or SSI, you applied for
  2. The date you became disabled
  3. The date you applied for benefits
  4. The date the ALJ decided you became disabled (if it’s different than the date you said you became disabled)

If the ALJ thinks you have trouble handling money, the judge may decide you need a "representative payee" to help you manage your monthly cash benefit.  It is sometimes possible for the attorney representing you to talk to Social Security and offer evidence that you don’t really need a representative payee if you don’t want one. Otherwise, you need to think about who would be willing to help you by being your representative payee because SSA will ask you for suggestions.

If the ALJ decided you are not disabled, you can ask that the ALJ’s decision be reviewed by the Appeals Council. You will have sixty (60) days from the date of the judge’s decision to ask, in writing, that the AC review the judge’s decision. You can file another application for disability benefits while you are waiting for the Appeals Council to make a decision on your case.

If the Appeals Council refuses to review your case or denies your claim again, you can appeal to the US District Court in your area. You have sixty (60) days from the date of the AC’s decision to file an appeal. Usually, you have to pay money to file an appeal in the US District court, but if you have very little or no money, you can ask the court to waive (not charge) the filing fees because you do not have enough money to pay them.  While you can represent yourself before the US District Court, it is probably wise to find an attorney to represent you.

What can happen once I am receiving SSDI or SSI benefits?

Social Security can review your case periodically to see if you are still disabled.  If Social Security decides to review your case, you can give Social Security medical records from your health care provider that show that your disabling conditions have stayed the same or gotten worse.  If Social Security decides that your medical conditions have improved enough that you are no longer disabled and your benefits should be terminated, you can appeal that decision. You should appeal immediately, as usually, if you appeal the decision within ten (10) days, your cash benefits will continue unless or until an ALJ holds a hearing and decides you are not disabled anymore. If the judge decides you are not disabled anymore, you will have been overpaid benefits from the date of Social Security’s first decision that you were not disabled anymore.

Sometimes, people go to school or try to work while they are getting disability benefits.  SSA has some programs and rules that may help you go to school or return to work without losing your disability benefits right away.  If you think that’s something you want to try, you should ask Social Security for all the information it has before you go back to school or try working.  Make sure that you understand all the rules and requirements of these programs before you sign up for one, return to school or try working.

What can I do if SSA says I was overpaid disability benefits?

If SSA decides that you were paid too much in disability benefits, you can appeal the decision if you think there really isn’t an overpayment or the amount is wrong.   You can also file a request for waiver of the overpayment if it wasn’t your fault that the overpayment happened and you won’t be able to pay your ordinary living expenses if you have to pay the money back.

If you want to stop SSA from starting to collect the overpayment from your disability benefits, you must file a request for waiver within thirty (30 days or less, or the time period stated on the Social Security notice of overpayment you get).

If Social Security does not grant your request for waiver of the overpayment or agree that there was no overpayment, SSA will start to collect the overpayment from your monthly disability benefit.  If you are not receiving disability benefits, it is unlikely that Social Security will try to collect the overpaid amount unless it is a very large amount or Social Security believes it can prove there was fraud. Otherwise, Social Security will wait until you are receiving a Social Security benefit (disability or retirement benefits) again. At this time, Social Security does not charge interest on overpayments.

What happens to my disability benefits if/when I reach retirement age?

When you reach retirement age, your SSDI benefits will become retirement benefits. Sometimes people who are almost 62 and disabled, will file for early retirement benefits because their claim for disability benefits has been denied and they need money while they are appealing. Your application for early retirement benefits can be approved and you can start getting monthly retirement benefits while you are appealing your denial of disability benefits. If your claim for Social Security disability benefits is approved, you may get some retroactive benefits for the same period of time you got early retirement benefits.  That may happen because your monthly disability benefit is usually higher than your early retirement benefit.  In addition, after you have received (or been entitled to receive) SSDI benefits for twenty four (24) months, you will be eligible for Medicare benefits.  If you are receiving Social Security early retirement benefits, you aren’t eligible for Medicare benefits until 65 or full retirement age.