Approved Disability Insurance Form Stock PhotoAre you suffering from an injury or medical condition that prevents you from living a healthy, productive life? You are not alone. Millions of people are incapable of making a living due to a disabling physical or mental impairment. If you’re in this situation, Social Security Disability Insurance (SSDI) may be the right option for you. If you’re considering applying for disability benefits under SSDI, it’s in your best interest to speak with a Social Security disability lawyer. The rules and regulations surrounding the Social Security system are complex, and people often underestimate the overwhelming amount of paperwork involved.

The Law Offices of Dr. Bill LaTour is here to help you navigate the tricky road to obtaining disability benefits. Applying for SSDI benefits alone can feel like a huge burden. Our attorneys exclusively handle Social Security disability claims and can take the burden off of your shoulders. If you have questions, we’re here to answer them.

What Is SSDI?

Before you get started, it’s important to have a basic understanding of SSDI and its purpose.

The Social Security Administration (SSA) manages two disability programs that provide monthly benefits for disabled individuals who are no longer able to work: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).

While the two sound similar and share some eligibility requirements, they are actually separate programs with distinct differences. SSDI is specifically intended for individuals who have worked for a certain number of years but suffered a physical or mental disability that prevents them from continuing any kind of job.

How Many Years of Work Do You Need?

To be eligible for SSDI, you must have first worked jobs that pay into Social Security. In other words, you must have contributed a certain amount of money in taxes to the SSA through jobs that are covered by Social Security.

These contributions are measured in “work credits.” You can receive up to four work credits per year. The amount needed to gain a work credit changes from year to year but, essentially, once you earn the specified amount for that year in wages or self-employment income, you earn one work credit.

Depending on your age, you need a certain number of credits to qualify for SSDI. What’s more, the SSA requires that some of those credits be earned in the 10-year period before you became disabled. Typically, you need 40 credits, of which 20 were earned over the last 10 years prior to the year you became disabled. However, younger disabled workers may still qualify with fewer credits.

How Do You Qualify for Disability Benefits?

In addition to the work requirements, you must also meet the federal government’s strict definition of ‘disability’ in order to qualify for SSDI. The SSA will only consider you to be ‘disabled’ and possibly entitled to benefits if:

  • You cannot do the work that you did before.
  • It is determined that you cannot adjust to other types of work for which you are qualified because of your medical condition.
  • Your disability has lasted or is expected to last for at least one year or result in death.

Many people assume that qualifying for SSDI is solely based on their particular condition, however, eligibility is largely work based. In other words, a large portion of the SSA’s decision to approve or deny your application is based on your ability to work.

If you’re suffering from severe back pain, for instance, but are still capable of performing your job and earning a living, the SSA will not consider you to be disabled.

The SSA’s Process for Determining if You Are Disabled

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The SSA’s method for determining if you are disabled involves five questions. After seeing that you have enough work credits to qualify for SSDI, the claims examiner will review your application using the following criteria. If you’re unsure if you’re eligible for disability benefits, ask yourself these five questions:

1)Are You Working?

The SSA asks this question to determine how much income you’re capable of earning through a job. Specifically, if you can engage in what is known as “substantial gainful activity” (SGA), you won’t be considered disabled.

The SSA makes this determination by evaluating if your monthly earnings from work exceed their maximum income limit. If it does, you are considered to be engaging in SGA and will not be eligible to receive benefits.

Federal regulations use the ‘national average wage index’ to establish the earnings limit each year. You can use the SSA’s benefits planner to determine the amount of money you’re able to earn from work and still qualify for SSDI benefits.

While the SSDI program does put a limit on how much you can make from working, there is no limit for your assets or unearned income. Furthermore, any income your spouse earns will not affect your eligibility.

2) Is Your Condition Severe?

In order to be entitled to SSDI benefits, your condition must significantly limit your ability to perform basic activities required in most job fields. This can include lifting, walking, standing, and remembering instructions.

If your condition prevents you from carrying out these types of work-related activities for at least 12 months, the claims examiner will move to the third question. If not, they will determine that you are not disabled.

3) Is Your Condition Found on the List of Disabling Conditions?

In most cases, the SSA will scrutinize your ability to work regardless of the specific condition you claim. However, they do maintain a list of medical conditions that they have established to be so severe that it would prevent a person from working.

If the condition you claim is on this list, the SSA is likely to determine that you are disabled automatically. If your condition is not on the ‘pre-established’ list, the examiner will decide if it is comparable to any of the conditions that are on the list. If so, you will be considered disabled but if not, the SSA will move to question four.

4) Can You Do the Work You Did Previously?

This question evaluates whether your condition allows you to perform any of your past jobs. Despite your condition, if you are able to continue any past work, the SSA will determine that you don’t have a qualifying disability for SSDI benefits.

5) Can You Do Any Other Type of Work?

If the SSA finds that you aren’t capable of continuing any of your past jobs, they will then evaluate whether you are able to perform other types of work.

When making this determination, the claims examiner will consider the nature of your condition, your age, education, and any transferable work experience and skills. If they determine you can make a living in a less strenuous field for which you are qualified, you will likely not be approved for SSDI.

What Happens if Your Claim is Denied?

Even if you meet all of the above requirements, the application process for disability benefits is tedious and claims are often denied at the initial stages. Many people, understandably, become frustrated after receiving a denial. However, it doesn’t mean that you will never be able to receive benefits.

Out of the overwhelming number of Americans who apply for disability benefits every year, it is common to come across claims that are misleading or fraudulent. In an attempt to identify fraud attempts, the SSA denies any claim that gives them reason to believe it is false.

The Disability Determination Services (DDS) – a state-run agency in coordination with the SSA – is strict in their review process of SSDI claims. If your application is missing paperwork, improperly filled out, or lacking the appropriate medical evidence, it will almost certainly be denied.

However, keep in mind that denials are common, and you may still have options.

Appealing a Denied Claim: What to Expect

If you applied for SSDI and your claim was denied, your next step can be to appeal the SSA’s decision. Many disability applicants who were initially denied are able to obtain benefits through the appeals process.

Oftentimes, individuals who appeal their claims are approved after demonstrating in more detail how their disability affects their everyday life and ability to hold a job. For example, if your claim was denied for a lack of medical evidence, you may just need to submit the correct documentation from your doctor during your appeal to start receiving benefits. However, it’s not always as simple as that.

After receiving a denial, it is in your best interest to speak with a Social Security disability lawyer. There are many possible reasons behind an SSDI denial. A legal professional who is familiar with the system can review your claim and pinpoint exactly why it was denied.

By appealing a denied claim, you’re basically asking the SSA to reconsider their decision. If you’re considering the appeals process, here’s what you can expect:

Request for Reconsideration: After receiving a denial, an attorney can file a request for reconsideration with the SSA. A new claims examiner will review your application, taking into consideration any new documents or evidence you or your attorney submit.

Hearing: In the event that your request for reconsideration is denied, you may be able to request a hearing in front of an administrative law judge (ALJ). During this stage of the appeals process, it is especially beneficial to have an experienced attorney present. They can prepare you for the hearing, question expert witnesses to support your claim, and argue a strong case on your behalf.

An Attorney Will Be Your Best Resource

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Whether you are applying for SSDI for the first time or you would like to start the appeals process, an attorney will be a valuable resource.

From preparing your claim for success to coordinating with the SSA on your behalf, hiring an attorney will give you the best chance of receiving the benefits you deserve.

The Law Offices of Dr. Bill LaTour focus exclusively on assisting clients throughout Southern California with their SSDI and/or SSI applications and appeals. Tapping into our extensive experience and knowledge, we can act as a trusted guide and resource during the difficult process of obtaining SSDI benefits.

Attorney Bill LaTour has been a licensed psychologist since 1989. He understands the mental and physical impairments that result in disability as well as the mental and emotional stress that can be associated with pursuing SSDI benefits. We’re passionate about helping disabled California residents get the benefits they need to account for everyday essentials. Our attorneys will help you deal with the Social Security Administration every step of the way.

Schedule a Free Case Review

Dr. Bill LaTour is an experienced disability lawyer in Southern California, representing clients in Los Angeles, Orange County, Riverside, Palm Desert, Lancaster, and Colton.

To have your case reviewed by Dr. LaTour, please give us a call at (800) 803-5090 or fill out our contact form to schedule a free consultation. If your disability makes it difficult for you to leave the house, we’ll come to you.

Contact an experienced attorney who knows both sides of the issue.

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