Understanding SSDI Basics

Social Security Disability Insurance (SSDI) is a federal program administered by the Social Security Administration (SSA) that pays monthly benefits to people who cannot work due to a severe disability. Unlike Supplemental Security Income (SSI), which is needs-based, SSDI is an insurance program funded through payroll taxes.

To qualify for SSDI benefits, you must have worked long enough and recently enough to have accumulated sufficient work credits. The exact number of credits needed depends on your age when you become disabled. Generally, you need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled.

The SSA defines disability as the inability to engage in substantial gainful activity (SGA) due to a medically determinable physical or mental impairment that has lasted or is expected to last for at least 12 months or result in death. In 2023, the SGA threshold is $1,470 per month for non-blind individuals and $2,460 for blind individuals.

SSDI benefits are not immediate—there's a five-month waiting period from the onset of disability before payments begin. The average monthly SSDI benefit for disabled workers is approximately $1,358, though the amount varies based on your lifetime earnings.

Qualifying Medical Conditions for SSDI

The Social Security Administration maintains a comprehensive listing of medical conditions, known as the "Blue Book," that qualify for disability benefits. These conditions must be severe enough to prevent you from working and are expected to last at least 12 months or result in death.

Some common physical conditions that may qualify include:

  • Musculoskeletal disorders (back injuries, arthritis)
  • Cardiovascular conditions (heart failure, coronary artery disease)
  • Neurological disorders (multiple sclerosis, cerebral palsy, Parkinson's disease)
  • Respiratory illnesses (COPD, asthma, cystic fibrosis)
  • Cancer
  • Immune system disorders (HIV/AIDS, lupus, rheumatoid arthritis)

SSDI for mental illness is also available. Qualifying mental health conditions include:

  • Major depressive disorder
  • Bipolar disorder
  • Schizophrenia
  • Autism spectrum disorders
  • Intellectual disabilities
  • Anxiety disorders
  • Post-traumatic stress disorder (PTSD)

Even if your condition isn't listed in the Blue Book, you may still qualify for SSDI if your condition is medically equivalent to a listed impairment or prevents you from performing substantial gainful activity.

The SSDI Application Process

Applying for SSDI requires careful preparation and attention to detail. You can complete an SSDI application online through the Social Security Administration's website, by phone, or in person at your local Social Security office.

Before starting your application, gather the following documentation:

  • Social Security number and proof of age
  • Contact information for healthcare providers, hospitals, and clinics that treated you
  • Dates of medical visits
  • Names and dosages of all medications
  • Medical records and test results
  • Work history for the past 15 years
  • Most recent W-2 form or federal tax return

The online SSDI application allows you to save your progress and return later if needed. The process typically takes 1-2 hours to complete. After submission, the SSA forwards your application to a state agency called Disability Determination Services (DDS), which evaluates your medical condition.

Be prepared for a potentially lengthy review process. Initial decisions typically take 3-5 months, though some cases may take longer. During this time, DDS may request additional information or ask you to undergo a consultative examination with an SSA-approved doctor at no cost to you.

Many applications—approximately 65%—are denied at the initial level. However, there is a robust appeals process available if your claim is denied.

Working with a Disability Attorney

Navigating the SSDI system can be challenging, which is why many applicants choose to work with an SSDI lawyer or disability attorney. These professionals specialize in Social Security disability law and can significantly improve your chances of approval.

A disability attorney can help with:

  • Evaluating your case and determining if you meet SSDI eligibility requirements
  • Gathering and organizing medical evidence
  • Completing application paperwork correctly
  • Communicating with SSA on your behalf
  • Preparing you for any interviews or hearings
  • Representing you during appeals

The value of legal representation becomes particularly evident during the appeals process. At disability hearings, attorneys can question vocational and medical experts, address legal issues, and present your case effectively to the administrative law judge.

Most disability attorneys work on a contingency fee basis, meaning they only get paid if you win your case. Federal law caps their fees at 25% of your past-due benefits or $7,200, whichever is less. This fee structure makes legal representation accessible even to those with limited financial resources.

When selecting an SSDI lawyer, look for someone with specific experience in Social Security disability cases, positive client reviews, and clear communication about how they'll handle your case.

The SSDI Appeals Process

If your initial SSDI application is denied, don't lose hope. The appeals process offers multiple opportunities to reverse the decision. There are four levels of appeal available:

1. Reconsideration: Your file is reviewed by a different examiner who wasn't involved in the initial decision. You can submit new evidence at this stage. About 85% of reconsideration requests are denied, but this step is necessary to proceed to the next level.

2. Hearing before an Administrative Law Judge (ALJ): This is often the most successful level of appeal, with approval rates around 50%. You'll present your case in person before an ALJ who will review your evidence and may question you about your condition and limitations. Having an SSDI appeal representative at this stage can significantly improve your chances.

3. Appeals Council Review: If the ALJ denies your claim, you can request a review by the Appeals Council. The council may deny your request, approve your claim, or return it to an ALJ for further review.

4. Federal Court Review: The final level of appeal is filing a lawsuit in federal district court.

Each appeal level has strict deadlines—typically 60 days from receiving a denial notice. Missing these deadlines usually means starting the entire application process over again, resulting in significant delays.

Throughout the appeals process, continue seeing your doctors regularly and following prescribed treatments. Ongoing medical documentation strengthens your case by demonstrating the persistent nature of your disability.