Qualifying for Social Security Disability Insurance

disabled-friendly-978536-mIn order to qualify for Social Security disability insurance (SSDI) benefits, it is necessary that one contribute sufficient Social Security payroll tax payments through their employment.  Most individuals do participate in Social Security Disability Insurance (SSDI) program via their Federal Insurance Contributions Act (FICA) contributions as part of their payroll taxes.  However, there are many individuals whose employer may take part in a state disability and retirement program (for example, many teachers that work for the state may contribute to their state retirement and disability program and may not have FICA taxes deducted from their payroll).  Assuming one has paid sufficiently sufficient Social Security taxes to qualify (and have earned sufficient “quarters of coverage”) , then if in fact they become unable to work due to a long-term medical condition, they may be entitled to payments under the SSDI program. Even with a long-term injury or medical condition (which may or may not be related to their job), one can receive SSDI benefits if they cannot perform what is called “substantial gainful activity” (or what is deemed at present to be the ability to earn $1090.00 per month on a regular and continuing basis).  These federal insurance benefits are available to residents of every state, including New Hampshire, Maine and Massachusetts.

The earnings and medical requirements which need to be met are complex.    For example, the Social Security Administration (SSA) has established two tests to  determine whether the applicant has met the earnings requirement, both of which depend on the applicant’s age at the time of the disability’s onset and the applicant’s work history. The “recent work” test verifies that the applicant worked for a certain amount of years before his or her disability. Those who are 31 or older, for example, must have worked five of the 10 years at the time their disability began. It is important to note that the periods are different for younger workers, and certain blind applicants may not be required to meet the “recent work test.” The “duration of work test” is used to confirm that the applicant worked in a job covered by Social Security for a certain amount of time. Generally, the older the age, the more years the applicant must have worked to pass this test. If the applicant has been working long enough to qualify under the earnings requirement, Disability Determination Services (DDS) will then decide whether he or she meets the definition of “disabled.”

An experienced attorney will help navigate you through these rules to ensure you understand the process and can get through it as smoothly as possible.

The test of disability under the Social Security Act requires that the applicant be unable to engage in any substantial gainful activity due to a physical or mental impairment, which is expected to last for at least one continuous year or result in death. In order to qualify for SSDI benefits, the severity of the applicant’s condition must severely hinder their ability to perform even basic work activities, such as walking, sitting, or remembering, among many other fundamental job functions. Further, the disability must be serious enough to prevent the applicant from not only performing his or her previous work, but also from engaging in any other type of substantial gainful activity.  Thus, the  state agency called Disability Determination Services (DDS) will evaluate whether, in light of the applicant’s age, education, skills, experience, and medical conditions, he or she could do other work. Work is considered “substantial” if it involves significant mental and/or physical actions. Generally, it is “gainful” if the work is done for payment or is of a kind typically performed for payment. If the applicant is currently earning money from another activity, it is generally considered substantial gainful activity only if the earnings are over a certain amount. These amounts change each year and are published in a table created by the SSA. In 2015, the amount of earnings demonstrating substantial gainful employment for an applicant with a condition other than blindness was $1,090 per month, and for blind applicants, the amount is $1,820 per month.

Every SSDI applicant has the right to legal representation throughout the application and appeals process. A knowledgeable attorney can help the applicant determine whether he or she is a candidate for SSDI benefits, as well as assist the applicant in gathering the required materials, determining if the relevant requirements are met, and submitting the application materials. The attorney will also assist in reviewing and preparing the supporting documentation that is required as par of the disability determination process (which is addressed by the state agency disability determination service office, aptly called in each state Disability Determination Services).  Likewise, we ensure that supportive medical documentation is obtained from the various treatment providers so as to provide the claimant with the best possible chance in winning their claim at the initial claim filing level.

Assuming one does not win at the initial claim level, we will assist with the preparation and review of all appeals papers to move the case forward to the reconsideration level (which procedure is only available on appeal in Maine and Massachusetts only, New Hampshire residents proceed directly to a hearing before an Administrative Law Judge).  Assuming a denial is once again received at the reconsideration level, we once again assist with the necessary appeals papers and updated medical documentation to move forward with the hearing process and will represent the applicant before the Administrative Law Judge.

It is important to note that if you are denied SSDI benefits, you are entitled to appeal, and you have the right to be represented by an attorney throughout the claim process.

Placing a call to a knowledgeable and experienced lawyer, can make all the difference between winning and losing.  There is no better reason to give a call at this time to the Law Offices of Russell J. Goldsmith at 1-800-773-8622 for a free consultation regarding your circumstances.