Filing for Social Security Disability (SSD) benefits can be a complex and frustrating process. Whether you're applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), the legal requirements and medical documentation needed to support your claim can be overwhelming. Many applicants are denied on their first attempt, making legal representation crucial for success.
An experienced Social Security Disability attorney can help navigate the claims process, appeal denials, and maximize your chances of obtaining benefits. If you need assistance with your claim, contact us by using our online form or calling us directly at 414-253-8500.
Understanding Social Security Disability Benefits
The Social Security Administration (SSA) provides two primary disability benefit programs:
1. Social Security Disability Insurance (SSDI)
SSDI is available to individuals who have worked and paid into Social Security through payroll taxes. To qualify, you must:
- Have a medical condition that prevents you from working for at least 12 months or is expected to result in death
- Meet the SSA's definition of disability
- Have earned enough work credits based on your employment history
2. Supplemental Security Income (SSI)
SSI is a needs-based program that provides financial assistance to disabled individuals who have limited income and resources. Eligibility is based on financial need rather than work history.
Key Differences Between SSDI and SSI
| Feature | SSDI | SSI |
|---|---|---|
|
Eligibility |
Work history & payroll taxes |
Financial need, no work requirement |
|
Medical Criteria |
Must meet SSA's definition of disability |
Must meet SSA's definition of disability |
|
Payment Amount |
Based on work history & earnings |
Set federal amount, varies by state |
|
Health Coverage |
Eligible for Medicare after 24 months |
Eligible for Medicaid immediately |
Common Reasons Social Security Disability Claims Are Denied
Many SSD applications are denied on the first attempt due to:
- Lack of Sufficient Medical Evidence - The SSA requires extensive medical documentation proving the severity of your condition.
- Failure to Follow Prescribed Treatment - If you are not following your doctor's treatment plan, the SSA may assume your condition is not severe enough.
- Earning Too Much Income - If your earnings exceed the Substantial Gainful Activity (SGA) limit, you may not qualify.
- Failure to Cooperate - Missing deadlines, failing to provide requested documents, or not attending medical evaluations can lead to denial.
- Previous Denial Without Appeal - Filing a new claim instead of appealing a denied application can hurt your chances of approval.
If your claim was denied, do not give up. A Social Security Disability attorney can help you appeal the decision and fight for your benefits.
Common Reasons for Social Security Disability Denials and How to Overcome Them
| Reason for Denial | Explanation | How to Overcome It |
|---|---|---|
|
Lack of medical evidence |
Insufficient documentation proving the severity of your condition |
Provide detailed medical records, physician statements, and test results |
|
Failure to follow prescribed treatment |
SSA may assume your condition is not severe if you do not follow medical advice |
Ensure you comply with your doctor's treatment plan or provide valid reasons for non-compliance |
|
Earning too much income (SGA limit exceeded) |
If your earnings exceed the SSA's Substantial Gainful Activity (SGA) threshold, your claim may be denied |
Ensure that your work activity remains within allowable limits |
|
Not meeting SSA's definition of disability |
SSA may determine that your condition does not prevent you from working |
Provide additional medical documentation and legal arguments supporting your case |
|
Failure to cooperate with SSA requests |
Missing deadlines, ignoring SSA communication, or failing to attend medical evaluations can lead to denial |
Respond promptly to all SSA requests and attend all scheduled exams |
How a Social Security Disability Attorney Can Help
An experienced attorney can make a significant difference in the outcome of your SSD claim. Here's how legal representation can help:
1. Filing Your Initial Claim
An attorney ensures your application is complete, accurate, and supported by strong medical evidence. This reduces the risk of denial due to errors or missing information.
2. Gathering Medical Evidence
Attorneys work with doctors, specialists, and medical professionals to obtain detailed records and expert opinions supporting your claim.
3. Handling Appeals and Hearings
If your claim is denied, a lawyer can:
- Request a reconsideration of your case
- Represent you in front of an Administrative Law Judge (ALJ)
- Cross-examine vocational experts to challenge SSA findings
- Present legal arguments to strengthen your case
4. Maximizing Your Benefits
A lawyer helps to ensure you receive all the benefits you qualify for and helps prevent reductions due to incorrect calculations or overlooked factors.
Steps in the Social Security Disability Appeals Process
If your initial claim is denied, you have the right to appeal the decision through a structured process. The appeals process consists of four levels:
1. Reconsideration
At this stage, a different SSA claims examiner will review your case. You can submit additional medical records, doctor statements, and other evidence to support your claim.
2. Administrative Law Judge (ALJ) Hearing
If reconsideration is denied, you can request a hearing before an Administrative Law Judge (ALJ). This is a critical step, as many cases are approved at this stage. A Social Security Disability attorney can:
- Prepare you for questioning
- Present medical and vocational evidence
- Cross-examine SSA's expert witnesses
- Make legal arguments in your favor
3. Appeals Council Review
If the ALJ denies your claim, you can request a review by the Social Security Appeals Council. This council examines whether the judge followed the law correctly. If errors are found, your case may be sent back for another hearing.
4. Federal Court Lawsuit
If the Appeals Council denies your claim, your last option is to file a lawsuit in federal court. This stage is highly complex, requiring an experienced attorney to navigate the legal system effectively.
What Medical Conditions Qualify for Social Security Disability?
The SSA maintains a Listing of Impairments (also called the "Blue Book") that outlines qualifying medical conditions. Some of the most common include:
Physical Disabilities
- Musculoskeletal disorders (e.g., severe arthritis, back injuries)
- Cardiovascular conditions (e.g., heart failure, coronary artery disease)
- Neurological disorders (e.g., multiple sclerosis, epilepsy, Parkinson's disease)
- Respiratory conditions (e.g., chronic obstructive pulmonary disease (COPD), cystic fibrosis)
Mental Health Disorders
- Depression and anxiety disorders
- Bipolar disorder
- Schizophrenia and psychotic disorders
- Post-traumatic stress disorder (PTSD)
- Autism spectrum disorder
Chronic Illnesses and Other Conditions
- Cancer
- Kidney disease requiring dialysis
- HIV/AIDS
- Autoimmune diseases (e.g., lupus, rheumatoid arthritis)
Even if your condition is not listed, you may still qualify if it prevents you from working and meets SSA's disability criteria. A Social Security Disability lawyer can help you determine your eligibility.
How Long Does It Take to Get Social Security Disability Benefits?
The time it takes to receive benefits depends on multiple factors, including the complexity of your case and whether you need to appeal a denial.
| Stage | Estimated Timeframe |
|---|---|
|
Initial application decision |
3 to 6 months |
|
Reconsideration appeal |
3 to 5 months |
|
ALJ hearing |
9 to 18 months |
|
Appeals Council review |
6 months to 1 year |
|
Federal court review |
1 to 3 years |
The fastest approvals happen when you submit a well-documented claim with strong medical evidence. Some cases, such as terminal illnesses and severe disabilities, may qualify for compassionate allowances, which expedite the approval process.
Can You Receive Social Security Disability Benefits and Still Work?
In some cases, you may be able to work while receiving Social Security Disability benefits, but there are strict income and work limitations that could affect your eligibility. The SSA offers certain programs that allow disability recipients to test their ability to work while maintaining benefits for a limited time. However, earning above the allowed threshold may result in reduced or discontinued benefits.
If you are considering working while receiving disability benefits, it's important to understand how it may impact your case. A Social Security Disability attorney can help you navigate the rules and protect your benefits.
Contact a Social Security Disability Attorney for Help
Navigating the Social Security Disability process can be overwhelming, but you don't have to do it alone. An experienced attorney can handle your claim, gather evidence, and represent you in hearings to increase your chances of success.
If you need assistance with your SSDI or SSI claim, contact us today by filling out our online form or calling 414-253-8500.
Frequently Asked Questions (FAQs)
1. What qualifies as a disability for Social Security benefits?
The Social Security Administration (SSA) defines a disability as a condition that prevents substantial work activity and is expected to last at least 12 months or result in death. The SSA maintains a Listing of Impairments (Blue Book) that outlines medical conditions that typically qualify, including musculoskeletal disorders, neurological conditions, mental illnesses, and chronic diseases. However, even if your condition isn't listed, you may still qualify if it significantly limits your ability to work.
2. What is the difference between SSDI and SSI?
The key difference between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) is how eligibility is determined:
- SSDI is based on your work history and the Social Security taxes you've paid. You must have enough work credits to qualify.
- SSI is a needs-based program for disabled individuals with low income and limited assets, regardless of work history.
3. How long does it take to get approved for Social Security Disability?
The approval process varies depending on the complexity of your case. Initial claims typically take 3 to 6 months, but many applicants are denied and must go through the appeals process, which can take several months to over a year. If you qualify for a compassionate allowance (for severe or terminal conditions), your case may be expedited.
5. Can I receive Social Security Disability benefits while working?
Yes, but there are strict income and work limits that may affect your eligibility. The Social Security Administration (SSA) allows some recipients to work under certain conditions, such as the Trial Work Period (TWP) for SSDI recipients and income limits for SSI. However, earning above the Substantial Gainful Activity (SGA) threshold may result in reduced or discontinued benefits. If you are unsure how working might impact your benefits, a Social Security Disability attorney can provide guidance.