Applying for and being approved for disability benefits (SSDI) from the Social Security Administration (SSA) can be a time-consuming and challenging process. In this Part 1 of our 3 part series, we will talk about what social security disability benefits are, the qualifying components and key steps in the application process.
What are Social Security Disability Programs?
The branch of government in the United States that oversees the programs that provide disability benefits to individuals is The Social Security Administration. While the Social Security Administration oversees multiple programs, we are just going to focus on the programs that are for disability benefits: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both SSDI and SSI are programs that pay benefits to individuals who are unable to work due to a medical condition that is expected to last (at least) one year or is expected to result in death.
What is the difference between SSI and SSDI
For both SSDI and SSI you must meet the Social Security Administration’s disability criteria. The biggest difference between the two programs is the minimum initial qualification requirements. To qualify for SSDI benefits, you must have earned enough work credits during your recent work history. For SSI the requirements are that you must have limited income and resources.1
Social Security Disability Insurance earnings requirements
There are two specific requirements that an individual must meet in order to qualify for disability benefits: recent work test and duration of work test.
A recent work test requires that you have actually worked for a certain number of years during the period prior to you becoming “disabled.” For example, someone under the age of 24 must have worked for at least 1.5 years after turning 21 in order to meet this requirement. Another example is for someone who is 31 and over, they must have worked for at least 5 out of the 10 years prior to becoming disabled.1
The second test is the duration of work test. This test measures the amount of work that has been performed over the course of the applicant’s life. An example of this is a 46-year-old applicant must have worked for 6 years since they turned 21 in order to pass the duration of work test, a 60-year-old applicant must have worked 9.5 years.1
If you do not have enough work credits to qualify for SSDI benefits, you may still be able to qualify for SSI. SSI is a needs-based program for low-income families. In addition to meeting the disability criteria, you must also meet certain income and asset restrictions.
Ways to apply for SSDI
There are two ways that you can apply for disability benefits. The Social Security Administration website: www.socialsecurity.gov
The Social Security Administration also has a toll free number (1-800-772-1213) that you can call to make an appointment at a local social security office or to schedule an appointment with someone to take your disability claim over the phone. Note: there are some restrictions for applying online, in some cases you may not be allowed to apply online.
The interviews typically last about one hour, but if you are going to the office for an in person interview, it is probably best to leave yourself additional time in case the office is running behind on the day of your interview.
The Social Security Administration has a disability starter kit that is available online or they can mail it to you. This has the step by step instructions of what you will need to apply, including forms that need to be completed by a doctor, and what other documentation pieces you will need to submit with your claim.
Qualifying for SSDI with psoriasis
The Social Security Administration has a publication that lists all of the medical conditions that may qualify an individual for disability benefits, along with the criteria that must be met.
While there is not a specific section for “Psoriasis,” there is a disability category for “Skin Disorders” (Section: 8.0). Under “Skin Disorders,” there is a subsection called “Dermatitis,” of which psoriasis falls under. If you are diagnosed with psoriasis and it causes you not to be able to work, you may be able to obtain disability benefits if you meet the eligibility requirements that the SSA describes in the “Dermatitis” category. The category description states that the condition must present itself with “extensive skin lesions that persist for at least 3 months despite continuing treatment as prescribed.1”
To note: If you have psoriatic arthritis you may qualify under the “Autoimmune Condition” category (Section 14.09) which lists “Psoriatic Arthritis” under the category of “Inflammatory Arthritis.”
What do you need to apply
One of the things to note is that if you don’t have all of the items that are needed for the application, your claim can be held up for review. Before applying it can be helpful to gather all of the information that is needed for the application to be processed. Below are the items that the SSA will need to process your claim for disability benefits.
1. Your social security number
2. Your birth certificate
1. Medical records from providers you are seeing for the condition in which you are applying for disability for, or other related conditions. (Tip: Hospitals typically have a department or office that handles requests for medical records, they typically don’t have a quick turnaround for these requests, so allow yourself enough time to request a copy of your medical record. A smaller doctor’s office typically an office or practice manager can help facilitate getting a copy of your record. Even smaller offices may require a couple days to process a medical record request. Typically, you will have to sign a HIPPA Form, which is a medical release form. This will allow the medical office or hospital to release your information.
2. Medical records may include occupational, physical or other therapists you may have worked with. You can and should include records from caseworkers as well. As long as the records pertain to the claim you are making than they are beneficial to include.
3. Contact information for your “care team.” Having one document that includes the contact information for the doctors or other medical professionals and caseworkers you have seen (AKA Your care team). Contact information should include the professional’s name, address of office and a contact phone number. You can also include email if you have that as well. If you had an inpatient hospital stay you can include the hospital name, address, and phone number where the stay occurred. If you know the doctor’s name who attended to you during your stay you can include his/her name in the document, however having the doctor who is currently providing care, or provided care to you after the inpatient hospital stay will be more important than the attending physician’s name who provided care during the inpatient hospital stay.
4. If lab results are not already included in your medical records you will need to get copies of laboratory and test results. These often times can be included in your medical records, but sometimes records need to be obtained from the lab that conducted the test(s) if they were not done at a clinic or hospital setting.
5. A list of the current medications that you are taking and what the dosage for each medication is. Your medical record should provide the clinical documentation to support the medications you are taking.
Documentation of work history is a key component of applying for SSDI.
1. If you have held employment you will need a copy of your most recent W-2 form. The W-2 form is a “Wage and Tax Statement” and each person who works in the United States will get one of these. For people who own their own business or are self-employed, instead of submitting a W-2, you can include your most recent tax return.
2. You will also need a work summary, which includes the places you have worked in the past and the kind of work you have done.
Additional notes about the application process
It can take a long time for your application to be processed! The Social Security Administration says anywhere from 3-6 months, but often it can be longer. Try and apply as soon as your condition impacts your ability to work, as this will help get the wheels in motion. If you granted SSDI you will receive a letter in the mail that will describe when your benefits will begin.
If the Social Security Administration denies your original application, you may want to pursue a disability appeal. To do so you must file your appeal within 60 days of the date of your denial letter.
There is a video series that provides additional step by step instructions to guide you through the application process and can be a helpful tool to use. (Click to go to SSDI tutorial)
You can have a “representative” (family member, trusted loved one) assist you with the process. If you choose to use a representative to help complete the application, you will indicate who that person is at the beginning of the application.