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The SSDI application process and eligibility determinations

Most social security disability claimants have neither the knowledge nor the understanding of how the SSDI claims process works, hence the need for the assistance of an experienced disability attorney in order to help you with the early stages of the SSDI claims process. There are numerous questions that claimants need answered when they are at this stage of the process, one of which is who actually determines whether your medical condition has disabled you to the extent that you can no longer work and perform everyday tasks.

Ironically, whether or not you are eligible and qualify for SSDI benefits is not determined by the SSA or one of their adjudicators. This responsibility normally falls into the hands of a 3rd party or outside agency in your state, and they will determine if you do qualify for benefits at this stage in the application and claims process. This portion of the process follows your claim for a disability classification.

How does the eligibility determination process work?

One of the most common questions we are asked is “who determines whether or not I am eligible for SSDI benefits?” The agency in your state that normally makes this determination is known as the Disability Determination Service. They are responsible for making the initial decision where your disability benefits are concerned once you have been diagnosed with a disabling medical or mental condition. Interestingly enough, the Federal Government’s laws and regulations which govern eligibility are the same as those of your home state.

Once the decision has been made by the state authority reviewing your claim it is then forwarded to the Social Security Administration who will eventually contact you regarding the decision on your claim. It is up to the state authority to initially determine and confirm whether or not you have been rendered disabled and unable to work based on the medical and/or mental condition you are suffering with.

The next question we are normally asked is “who is responsible for rendering the final decision on my claim?” A DE or Disability Examiner is the person that this responsibility falls on the shoulders of. The DE normally works hand in hand with a Medical Consultant when reviewing your case. Initially, these are the people involved in the determination of eligibility process where you SSDI claim is concerned. Just remember that up to 75% of the initial applications get denied, so don’t let this discourage you.


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Statistics regarding SSDI approvals and denials

The SSA recently divulged statistics attesting to the fact that eventually, 34% of all the SSDI benefit applications get approved and benefits are awarded to the applicant. Conversely, when applications are in their initial stages, approximately 75% of all claims are denied. Additionally, it is difficult to estimate whether an individual will be approved or denied because the aforementioned percentages are not broken down based on what type of medical or mental problem you have. On average, it could take up to 2 years before a decision is rendered.

Why do claims get denied?

Many SSDI claims are justified and worthy ones. Unfortunately, SSDI judges fail to approve many of these claims initially. This is due (in part) to the fact that many of these judges perform limited evaluations of the evidence at hand. Even if you have a good case, the following are the more common reasons that a judge will deny you benefits:

-The applicant has filed previous applications for benefits (when many judges see this, they automatically deny a claim for SSDI benefits)

-The disability application lists numerous impairments, but not a main problem

-Your medical problem may not meet the SSA listing for that specific problem (judges simply reject cases that are deemed as non-listing level ones)

-If you have worked after the onset date of your condition, judges oftentimes deny SSDI benefit claims

-Sadly, the huge workload of disability claims and benefits applications causes some just to randomly deny claims in order to save time

Additional considerations

Knowing the statistics mentioned in the sections above, it becomes important for an individual to realize why their application could be denied. After all, you want to overcome that possibility if you can so that you are awarded the SSDI benefits you deserve and need. Just don’t get discouraged if you are denied initially because it doesn’t mean that your case has to end there.

Herein lays the importance of having an experienced and knowledgeable disability attorney to help you get the benefits you need. Individuals should always consider hiring the services of a trained professional in order to assist them with their SSDI claim. They are skilled at handling these types of cases and know what the SSA judges are looking for when hearing your case. We have always recommended that individuals should consider hiring a disability attorney before starting the application process.


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