Funded by payroll taxes, Social Security Disability Insurance (SSDI) is a federal insurance program, similar to health and property insurance. Contrary to what you may have heard from Congress or the media, it is not an “entitlement program.”
The sizable deduction on your paycheck marked “FICA” is the regular premium you pay for this insurance – and if you become disabled and unable to work, you have the right to file a claim, just as you would if you had an auto accident.
SSDI is also known as Disability Insurance Benefits and Title II Benefits. This is true whether your case is in Pensacola, Florida, or any other city or state.
Who Can File a SSDI Claim
Anyone who experiences and can prove disability because of an injury or medical condition and is unable to engage in regular employment as a result may file a claim. Typically, this is due to a physical disability; however, in some cases, claimants with a psychological disability or mental illness may qualify under certain circumstances.
How Does One Qualify to Collect SSDI
The basic requirement is that the claimant is able to prove a disability that prevents him or her from engaging in productive employment. Additionally:
- the medical condition must be expected to continue for twelve months or longer
- the claimant must be under 65 years of age
- the claimant must have a minimum of twenty “Social Security Credits” for the previous ten years if younger than age 42, plus one credit for every additional year beyond that (claimants age 22 or younger who have not accumulated the required credits can collect on those of their parents).
What Is The Application Process
Claimants (whether in Pensacola or nationwide) can apply online, by telephone or at a local Social Security Office in their community. You will be required to provide:
- your Social Security number
- proof of citizenship or legal residence
- a recent W-2 form or tax return
- military discharge papers (if applicable)
- documented work history
In addition, you will need to have complete medical records, including medications, dates and locations of treatments, name and contact information for attending physicians and lab test results.
What Specific Conditions Qualify for SSDI
The Social Security Administration offers a manual listing specific medical issues that are covered. A number of these automatically qualify an applicant; other conditions are evaluated on a case-by-case basis (known as “equaling a disability listing”).
The list of qualifying injuries and disorders include:
- back injuries and limb disorders
- heart disease
- respiratory diseases (i.e., asthma or COPD)
- neurological disorders (multiple sclerosis, epilepsy, Parkinson's, etc.)
- auto-immune disease (HIV or AIDS, lupus, rheumatoid arthritis)
- skin disease
- gastro-intestinal disorders
In addition, certain mental illnesses are listed, including depression, anxiety disorder, schizophrenia, Asperger's Syndrome and autism.
How Long Does It Take to Process a Claim
According to the Social Security Administration, an initial application can take 3-4 months to process, whether in Pensacola, Florida, or another state. However, due to heavy caseloads, large number of backlogged pending applications and budget cutbacks, it can take as long as eight months for an application to be approved or denied. An appeal can take up to a year, depending on the length of time required to obtain medical evidence from attending physicians.
An exception is made for military personnel who are disabled as the result of a service-related injury or other condition. The Social Security Administration offers an “expedited” application process for disabled veterans.
What if a Claim is Denied
Only about 36% of initial claims are approved – but most of those whose claims are denied fail to file an appeal. This must be done in person within 60 days of the denial notice, or the claimant will have to file an entirely new claim.
It is important to read the denial notice carefully in order to determine why the claim was denied. The most common reason for denying a claim is insufficient medical evidence of a disability; the SSA may also determine that a claimant may be capable of employment in a field other than his or her previous job.
The bottom line: if you have applied for SSDI and received a denial notice, it is important to file an appeal at the earliest opportunity.
How Can a Lawyer Help
In many cases, the information in a case file can be very technical and difficult for most people to fully understand. It is not uncommon for a case file to contain inaccurate information as well as errors on the part of the claims examiner or the medical consultant (for example, the severity of a claimant's condition and its effect on his/her ability to work may have been minimized, or all possible impairments were not considered). In some cases, important information may be missing altogether.
A lawyer is trained to note the smallest details of complex files, and understands the often complicated legal issues of Social Security law. A lawyer also understands how to effectively communicate with case examiners and others involved in the appeals process. In some cases, it may require going before a judge in a U.S. District Court in order to successfully appeal a decision. A lawyer can also advise you as to whether or not you are even eligible for SSDI.
What Will It Cost
Attorneys at Levin Papantonio provide case evaluations free of charge – and if it is determined that you are not eligible to collect SSDI benefits, there is no fee. If we are successful on your behalf, federal law caps the lawyer's fee at 25% of the past amount recovered, not to exceed $6,000, in addition to any expenses incurred (such as copying and printing). This is true whether your case is national or limited to Pensacola.
To contact us for a free confidential consult, you can call us at (850) 435-7000 (Pensacola) or (800) 277-1193 (toll free). You also can request a free private and confidential evaluation by clicking Free & Confidential Consult, and your inquiry will be immediately reviewed by one of our attorneys who handles your specific type case.