HOW DISABILITY CLAIMS WORK

US citizens who work are usually covered by Social Security Disability Insurance, called SSDI.  This insurance is paid for by taxes withheld from the worker's paychecks and matched by their employer.  You must work for a certain length of time to be covered by SSDI.  When you stop working before retirement age, you will loose SSDI eligibility, usually after about 4 years from the date you stop working.

The state in which you live has an agency that will look at your application and decide whether you meet the rules to receive a disability benefit from Social Security.  This decision is based primarily on your medical evidence--records obtained from your doctors or other treating/examining providers.  There are some basic rules to be met by everyone who applies for Social Security disability:
  1. You must have an impairment which is expected to last for at least 12 consecutive months OR to end in death. Conditions for which recovery is expected within 12 months are not covered.
  2. The medical impairment must be severe enough to impose significant restrictions on your ability to perform full-time work; the impairment may be physical or mental.
  3. You must not currently be working at Substantial Gainful Activity (defined in 2015 as gross wages of at least $1,090 per month).
  4. As mentioned earlier, you must have accumulated enough "quarters of coverage"  from work to have insured status. The number of quarters of work needed will vary by age. A very young individual may only need to have worked about 1 year to be insured by Social Security (SSDI).
After you file an application with Social Security, it takes 90 to 120 days to get a decision.  Approximately 27 percent of applications are approved while the other 73 percent will be denied.  This is based on national averages.  Of course, your individual odds are not "average," since each case is different from all others.

If you are denied, you have 60 days to file an appeal.  In Alabama, an appeal amounts to requesting a hearing before an administrative law judge, a special judge who hears Social Security appeals.  If you do not file a written appeal within the 60 day time period, you will probably lose all rights to appeal and have to file a new claim and "start over."

About 80 percent of individuals who file an appeal choose to be represented.  You are not required to have a representative but having someone on your side who knows the regulations and requirements of Social Security may prove very helpful and increase your odds of winning benefits. You may also appoint a representative before you are denied and he or she may help you with the initial application process.

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