Social Security Disability Insurance (SSDI) is one of the least understood insurance policies available to American workers. Many workers don’t realize that they have the income protection provided by SSDI or that they have contributed to coverage with every paycheck through FICA tax payments. However, based on available statistics, it is important that everyone knows about the program if and when a medical condition or disability prevents them from working.
One in four 20-year-olds will experience a period of disability at some point in their working lives. If it becomes serious and has a long-term impact, SSDI provides financial support in the form of income, health insurance, and even assistance in returning to work. Additionally, as we continue to recognize the effects of “long-COVID” and other debilitating conditions, more and more people are turning to the essential SSDI program.
Sadly, less than 40% of the roughly 2 million people a year who apply for SSDI will receive it after all, according to figures from the Social Security Office of Retirement and Disability Policy. About 67% of initial SSDI applications will be denied by the Social Security Administration (SSA). In the first appeal (re-examination), only 8% of former workers will be approved; and at the audience level, only 2% of those still applying for benefits will be successful.
Many simply give up trying to navigate the confusing SSDI schedule, some manage to recover and get back to work, and others die waiting months or years for a decision.
Three main issues are major contributors to high denial rates and the lengthy appeal process:
1. Candidates who do not meet the employment history requirements
While anyone who pays FICA payroll taxes long enough is generally assured for SSDI it doesn’t mean they are eligible for benefits. Like private long-term disability insurance, there are key technical requirements. To meet the SSA definition of disability, one must have physical or mental impairments that prevent them from being unable to engage in any substantial gainful activity (SGA) for at least 12 months or have a terminal diagnosis. SGA encompasses work done for pay or profit, and for 2022 the monthly benefit one would receive after qualification is set at $1,350 per month, or $2,260 if you are blind.
A candidate must have worked five of the last 10 years, but this varies for younger people. The final requirement to be met is that an applicant must be at least 21 years of age and not have reached full retirement age.
There are two quick ways to find out if you are insured for benefits before you apply. Discuss your situation with an experienced SSDI representative or go to www.ssa.gov and consult your my social security benefit statement.
2. Applicants without complete documentation
The need for detailed medical evidence that documents a disability and its impact on the individual’s ability to perform SGAs is a critical part of the SSDI application. Evidence should include diagnoses, medical tests and results, treatment history, prescription medications, surgeries, ER and doctor visits, and other relevant medical details to demonstrate not only that you have a problem, but also that you have received regular medical treatment for your problem.
Strong medical evidence, combined with details about how a disability influences your activities of daily living, is especially important if you have an invisible disability, such as mental disorders, neurological disorders, or cognitive dysfunctions caused by injury or a sickness. Regular monthly treatments and drug therapies with specialists and mental health professionals are an important part of your claim.
All medical evidence must support the claim that you meet an SSDI “medical list”. These are details that help you prove your disability and are organized around diseases and body systems. Additionally, the SSA follows complex professional guidelines that are enforced based on age and level of education.
3. Candidates not knowing they are entitled to an SSDI representative
The SSA does not inform initial applicants that they have the right to retain a representative to help them early on, and most people try to navigate the complicated program on their own. You need an advocate – someone you can trust will tell the story of your disability and its devastating effects on you and your family.
Less than 3 in 10 applicants have an SSDI representative to help them apply. However, these 3 people are 23% more likely to have their claim approved, which also means getting benefits in six months compared to a year or two. It should be noted that experienced attorneys understand how to document medical lists and usually help confirm your likely eligibility in advance.
If you qualify for long-term disability insurance through your employer, consider yourself lucky. Your plan typically pays your representative’s fees for you if you need to apply for SSDI.
Of course, these are particularly unusual times for people with serious medical conditions that have worsened after a diagnosis of COVID-19. Representatives are caring for more SSDI cases resulting from long COVID symptoms that have exacerbated physical and mental impairments. According to the American Academy of Physical Medicine and Rehabilitation, long COVID can affect up to 30% of COVID patients, or about 25 million people in the United States, especially those with respiratory diseases, diabetes and cognitive problems.
It is hoped that they will never be affected by a serious disability, and it is not uncommon to resist the idea that it has changed your life and your ability to work. However, like other insurance, SSDI is an investment you made while you were working. It’s there if you need it, even if it’s just for a year or two while you recover from a serious injury or serious short-term medical condition.
Vice President, Allup
Steve Perrigo, JD, is Vice President, Sales and Account Management, for Allsup and has over two decades of experience and knowledge of the Social Security Administration (SSA) and its programs. He joined Allsup in August 2010 and helps clients understand their options when coordinating private disability insurance benefits with the Social Security program. Prior to joining Allsup, Steve Perrigo spent 17 years with SSA in various roles of increasing responsibility.