How Does Social Security Disability Work?

Individuals who suffer from a long-term injury or illness that prevents them from engaging in a substantial gainful activity (SGA) may be eligible to receive Social Security Disability Insurance (SSDI) benefits. On the other hand, Social Security Income benefits – or SSI benefits – are available to low-income individuals who suffer from a qualifying disability and who do not otherwise meet the requirements for SSDI benefits.  

However, recovering these benefits is oftentimes an uphill battle, and it is not unusual to receive a claim denial the first time around. Given the overall complexity of disability matters, it is a good idea to have an experienced attorney by your side to advocate for you every step of the way. A California Social Security Disability lawyer can help you file your initial application and, if necessary, assist you during the appeals process. Your lawyer will do everything they can to help you recover the full amount of benefits you deserve, based on your circumstances. 

Social Security Disability Income

To recover disability benefits, an applicant must meet certain requirements. For example, an individual may be eligible to receive SSDI benefits if they suffer from a long-term injury, illness, or other medical condition that prevents them from partaking in an SGA. SSI benefits, on the other hand, are income-based.

In addition, to receive disability benefits, you must have worked for a sufficient amount of time, depending upon your age at the time you apply for benefits. 

Initial Application

The first step to recovering benefits is to submit an initial application through the Social Security Administration (SSA). Along with your initial application materials, you will need to supply supporting documentation from a medical provider showing that your long-term injury or illness prevents you from working. A benefits applicant might also need to undergo an evaluation by an SSA Consultative Examiner. That individual will make the appropriate determination about whether your injury or illness qualifies as a “disability” under federal law. 

Reconsideration Level

It is not unusual for a first-time benefits applicant to receive a denial of benefits – at least on the first attempt. In most situations, a benefits denial occurs when the applicant fails to attach sufficient medical documentation to support their claim. 

If you receive an initial denial letter, you have to request reconsideration within 60 days. If you do not file your request for reconsideration in a timely manner, it is almost certain that you will receive another denial letter. During the appeals process, you have an opportunity to present additional evidence, including medical documentation. However, if you later appeal your case to the federal court system, you will not have an opportunity to supplement the record at that time. 

Hearing Level

In some instances, a benefits applicant will receive another claim denial post-reconsideration. If that happens in your case, you will have a time period of 60 days in which to request a hearing. The hearing will occur before an administrative law judge. During your hearing, the presiding judge will listen to any witness testimony that you or your lawyer present, review all of the medical evidence in your case (i.e., that is already part of the record), and make a decision.

Appeals Council Level

During this step, an applicant files a written appeal that a special department of the SSA (located in Falls Church, Virginia) will consider. Upon review, the appeals council will make a determination as to whether you received a fair administrative hearing. If you are successful at this level of the appeals process, your case will likely return to the Administrative Law Judge for additional proceedings.  

Federal Court Level

In some instances, an Appeals Council might refuse to review your case, or it may deny your appeal. When that happens, you have a period of 60 days in which to petition the Federal District Court for review. Your case will then go to another hearing over which a District Court judge will preside. Upon reviewing the hearing record, a judge can decide one of the following in your case:

  • To award you benefits
  • To deny you benefits
  • To remand your case back for additional proceedings

What Are the Work Requirements for SSI & SSDI?

To be eligible to receive SSDI or SSI benefits, you must have worked for a certain amount of time. Employed individuals receive various work benefits, depending upon the amount of their earnings. To be eligible for benefits, you must have accumulated a certain number of credits, depending upon the date of your disability, as well as your age. 

To receive SSDI benefits, you will ordinarily need at least 40 work credits. Moreover, you must have earned at least half of those credits during the ten years immediately preceding your disability onset. You can qualify with fewer credits if you are under 24 years old. 

On the other hand, to qualify for SSI benefits, you must ordinarily have at least 40 work credits, and you must have earned 20 of those in the preceding ten years, ending in the year in which your disability started. 

What Are the Qualifying Disabilities for SSI & SSDI?

To receive SSI or SSDI benefits, the SSA must determine that you are, in fact, disabled. In other words, you must be unable to perform work that you did prior to your disability. Moreover, your medical condition must be expected to either result in death or last for a minimum of one year. In making this determination, the SSA will consider various factors, including your:

  • Prior work experience
  • Age 
  • Education
  • Relevant skills

Why Would a Disability Claim Be Denied?

You can receive a disability claim denial for one of several reasons. Common reasons for such a denial include:

  • Failing to satisfy the SSA’s “disability” requirement
  • Alcohol or drug abuse
  • Lack of recent medical treatment
  • Failing to meet the income requirement
  • Lack of sufficient medical evidence
  • Quitting a job or failing to look for work

Contact Our Office for a Free Consultation

If you are currently in the process of pursuing disability benefits or appealing a claim denial, you should have experienced legal representation in your corner every step of the way. A skilled California disability benefits lawyer can help you file your initial application, gather the necessary documents, and represent you at any legal hearings. Your attorney can also help you appeal a disability benefits claim denial and pursue a favorable result on your behalf.