FAQ

Find the answer to any question about Social Security disability benefits.

Chances of Winning Disability Claim

What are my chances of winning a disability claim?

The response is always, “It depends.” The table linked here shows the average chance of winning a disability claim at each level of the process.

What are my chances of winning a disability claim at the initial level?

The initial level is the first level of the Social Security Disability and/or Supplemental Security Income decision-making process.

Generally speaking, 35% of applicants are awarded at this level. 

Typically, applicants that are awarded at this level meet a disability listing and are so obviously disabled that there is no question as to whether or not they are capable of performing work.

What are my chances of winning a disability claim at the reconsideration level?

The next level in the disability determination process is the reconsideration level.

On average 15% of all applicants win at this level.

In our practice, it seems like the vast majority of claimants who win at this level are those that were not represented by an attorney at the initial level, but hired one for reconsideration. We believe that this difference exists because something was missing from their initial application and an unrepresented claimant did not know about the omission. Usually, represented claimants are denied at this level as well because not much has changed from the time the initial determination and the reconsideration determination. As a result, the DDS examiner usually has the same set of facts at both of these pre-hearing levels and will end up making the same decision twice.

What are my chances of winning a disability hearing?

Claimants that are denied at the pre-hearing level have an opportunity to appeal those decisions and request a hearing in front of an Administrative Law Judge (“ALJ”). After a successful appeal, a claimant’s file will be transitioned from the DDS to the Office of Hearings Operations (“OHO”). This will be a claimant’s first opportunity to present their case in person.

Social Security statistics prove this is the most favorable level of review as nearly 50% of all applicants are awarded at this level. It gets even better for those that are represented at the hearing as those claimants, according to the GAO, have a 3 times greater chance of winning their claim than those that are not represented.

What are my chances of winning a disability appeal?

There are two types of disability appeals: Appeals Council Repeal and Federal Appeal

Appeals Council Repeal
Claimants are awarded approximately 1% of the time at this level.

An additional 9% of claimants have their case remanded (sent back) to the original ALJ who made the hearing level denial. These remands may be for further development on a particular issue or to correct a procedural error made in the hearing level decision. Generally speaking, judges do not like to have another judge tell them that they made a mistake. Hearing level ALJs will often just re-deny appeals council remands. As a result, having your claim remanded is not always the best result. The goal at this level is often to get denied, which allows a claimant to appeal in federal court.

Federal Appeal

At this level, you are suing the Social Security Administration in Federal Court.  The odds of winning at this level are approximately 2%, which is hardly better than at the Appeals Council.  Federal judges; however, remand (send back) approximately half of these claims for a further evaluation of issues that were improperly considered at the prior hearing.

Social Security Disability (SSD) Qualification

Do I qualify for Social Security disability benefits?

In order to qualify for SSD benefits, you must satisfy both a non-medical and a medical test.

In order to satisfy the non-medical test, you need to have worked in a covered job long enough to accumulate enough work credits.

The second test, the medical test, requires you to have a condition(s) that satisfies the Social Security Administration’s (“SSA”) definition of disability and has lasted or is expected to last at least 12 consecutive months.

Generally speaking, this program will provide you with a monthly benefit in the event that you become unable to work.

How Much Will My Disability Benefit Be?

SSD benefits are determined based on your overall contributions to the Social Security fund. The more you contribute through payroll taxes, the larger your benefit. In 2021, the maximum monthly benefit you can receive is $3,148. The average beneficiary; however, receives $1,277 a month.

What is considered a “covered job” by the SSA?

Over 90% of U.S. wage earners are covered by Social Security. To be covered, you must be in a position where payroll or self-employment taxes are being paid on your behalf. These taxes are used to fund the SSA’s programs. The most common types of ‘non-covered’ jobs are city and state employees that are covered by a local pension, railroad employees who are covered by pension or foreign nationals whose income is not subject to payroll tax.

How much do I need to have worked to qualify for SSD?

Prior to a decisionmaker looking into your medical records, you must first satisfy the non-medical test. This test is used to determine whether or not you have worked enough and recently enough to be insured under the SSD program. Again, that work must be performed in a covered job long enough to accumulate enough work credits.

How many “work credits” do I need to qualify for SSD?

The SSA uses a term called “work credits” to determine whether or not you pass the non-medical test. You can earn up to four work credits per year. These are earned based on your yearly wages. The amount needed for a work credit changes from year to year. In 2021, the Administration has set the earnings requirement for each credit at $1,470. As a result, if you earn $5,880 or more during the 2021 calendar year, you will accumulate 4 work credits.

What are “work credits”?

The SSA uses a term called “work credits” to determine whether or not you pass the non-medical test. You can earn up to four work credits per year. These are earned based on your yearly wages. The amount needed for a work credit changes from year to year. In 2021, the Administration has set the earnings requirement for each credit at $1,470. As a result, if you earn $5,880 or more during the 2021 calendar year, you will accumulate 4 work credits.

Do I have a “disability” according to the SSA’s definition?

Unlike other types of disability, there is no partial disability under either SSD or SSI. You are either 100% disabled or not disabled at all.
The SSA uses a three-prong test in its definition of disability. In order to be found disabled, it must be determined that as a result of your conditions;

  • You cannot perform your past work.
  • You cannot adjust to other work.
  • Your disability has lasted or is expected to last for at least 12 consecutive months or to result in death.

In making this the determination as to whether or not someone satisfies this definition, the SSA will conduct a 5-step decision-making process.

What is the process like for determining medical eligibility according the the SSA’s definition of disability?

After a claim passes a non-medical test, the Social Security Administration (“SSA”) sends the claim to the Disability Determination Services (“DDS”). The DDS is the agency that makes disability determinations at the pre-hearing levels.

Here are the steps to make a pre-hearing determination:

  1. DDS will assign an examiner to your file.
  2. The examiner will be tasked with evaluating your claim by looking at your medical evidence. He or she will also take into consideration your age, education and work history.
  3. The examiner may request that you attend a medical examination.
  4. After enough evidence is compiled to adequately evaluate your claim, the examiner will make a decision as to whether or not the facts of your case meet the SSA’s definition of disability.

Social Security Income (SSI) Qualification

How limited must my income and resources be?

Income Limits

In general, the income limit for SSI is the federal benefit rate, which is $794 per month for an individual and $1,191 per month for a couple in 2021. SSI income limits are not quite this simple as not all income is countable. Thus, you can earn more than $794 and still qualify for SSI benefits under certain circumstances.
Countable income includes wages and money you receive from other sources like unemployment, Social Security Disability or gifts of food/shelter/cash
The SSA goes into further discussion about it’s income limits here.

Resource Limits

The limit for countable resources is $2,000 for an individual and $3,000 for a couple.
The SSA has various rules for what is and what is not counted in the ‘resource’ calculation. Some of these rules can be found here.

Do I qualify for Social Security Income?

In order to qualify for SSI benefits you must satisfy both a non-medical and a medical test. The non-medical test requires that you have limited income and resources. The second test, the medical test, is exactly the same as the medical test for Social Security Disability benefits. It requires you to have a condition(s) that satisfies the Social Security Administration’s definition of disability and has lasted or is expected to last at least 12 consecutive months. Generally speaking, this program will provide you with a monthly benefit in the event that you become unable to work.

It should be noted that individuals over age 65 are also eligible for SSI payments if they have the financial need due to having limited income and resources. The original purpose of SSI was actually to lift retirees out of poverty. This article; however, is being written for individuals who are seeking disability benefits so the remainder of this blog will focus on that group.