A short course on claiming disability benefits.

Social Security Disability Insurance (SSDI) benefits are available to workers who have "medically determinable" impairments that prevent them from staying on the job - or from performing any "substantial gainful activity". SSDI is the safety net for workers who cannot be helped by adjustments and adaptations called "reasonable accommodations" in the Americans with Disabilities Act ADA).

To be entitled to the benefits, a person must have worked at least five of the ten years immediately before the disability and paid FICA taxes. (Exceptions and the way work time is counted are explained in the application instructions.) The disability or impairments must be expected to last for at least 12 months.

How to begin

A claim for SSDI benefits begins with the written application. Benefit payments may be retroactive for as much as one year before the application date, but no benefits are due until the 6th month following the month when medical conditions caused the person to stop working. Early applications can be seen as evidence of poor motivation to work by Social Security. Thus, the initial claim form should be filed only after an individual's physician determines that the impairment is expected to last at least 12 months.

Expect to wait

The key to a successful claim is perseverance! Most initial claims are denied. For example, in 1994, only 35% of initial claims filed in New York State were approved. Most applicants who went on to file a written appeal called the "reconsideration" were also turned down. Only 11 % of these second-level claims were approved in New York in 1994.

The third level provides a face-to-face hearing before an administrative law judge - called the ALJ hearing. This level represents the best chance of receiving a favorable decision. (Over 50% of the hearing decisions in New York State in 1994 were approvals.) However, no applicant is entitled to an ALJ hearing until levels one and two have been completed.

A fourth and final level is also available: the Appeals Council of the Social Security Administration. This rarely results in an award of benefits. Beyond this point, a person may file a complaint in the U.S. District Court.

File a winnable claim

To win a claim at any level, the applicant must provide medical evidence of a disabling condition. The best source of this evidence is the applicant's doctor, not the applicant her or himself.

The law assumes that the treating physician knows the applicant's condition - and the Social Security Administration gives the greatest weight to the professional findings and opinions. Fatigue, numbness, dizziness and other hidden impairments can be considered by the doctor, so applicants should be sure that their doctor is aware of how their symptoms affect them.

Help is available

To a person who is already having difficulty with daily living, the long application process can look discouraging. Do not give up!

The law permits SSDI applicants to retain a representative on a contingency basis. (The fee is based on the outcome of the claim.) The representative may or may not be a lawyer but is a professional with expertise in Social Security rules and regulations. And now, a change in Social Security law allows an applicant to pay a representative out of the Social Security benefit check, when the claim is approved. The fee will be 25% of the retroactive benefit, but cannot exceed $4,000.

This means that SSDI applicants can hire a professional who will file the initial application, secure medical statements from the appropriate sources, and represent an applicant before the administrative law judge. A worker who has been forced to retire because of disability should not fear pursuing Social Security benefits to which she or he is entitled.

For more information and referral to a representative, call one of these organizations: ALLSUP, Inc., 1-800-854-1418; Government Entitlement Services, 313-350-8250; or the National Organization of Social Security Claimants' Representatives, 1-800-431-2804.

Michael G. Wagner, Esq., is the past president of the New York Social Security Bar Association. He is available for free consultation in the New York/New Jersey area. (Call 1-800-540-4320.)