What is Social Security Disability Insurance (SSDI)?

Facing any interruption in income is stressful but staring at a lengthy or even permanent loss of income can bring life-changing trauma.

Fortunately – or not when you consider how many first-time disability applicants are denied – workers experiencing a significant physical or mental condition that prevents them from doing their jobs may qualify for Social Security Disability Insurance benefits.

SSDI is a payroll tax-funded government program for people who no longer can work because of an injury that is expected to affect them at least one year or is expected to result in death. It’s not an overstatement to say the program is a life-saver for many.

In December 2023, SSDI benefits paid to more than 8.7 million disabled beneficiaries totaled $12.7 billion. The average monthly payout was $1,537.13.

While that might not qualify as a full-blown economic rescue in cities across the United States, let alone in small-town America, the bigger program catch by far is that a large majority of first-time applicants get rejected.

With the approval rate for first-timers standing at 38 percent due in large part to insufficient proof of disability or inaccurate information in filling out the forms, it’s no wonder experts recommend individuals seek help in navigating the sometimes torturous application process.

“Hiring a social security lawyer or advocate can make all the difference when applying for disability benefits,” Colin Ruggiero, Co-Founder of DisabilityGuidance.org said. “They know the ins and outs of the program and will be able to assist you during the initial application process, administrative law judge (ALJ) hearing, and reconsideration if you are denied.

“Also, most social security lawyers and advocates offer no-cost representation, and will only take payment if you are awarded benefits (the fee will be taken out of the recipient’s back pay).”

The SSDI program started in 1956, and 150,000 workers enrolled in the first year, mostly because benefits were restricted to people 50 or older. Over time, the government opened the door for more people to qualify, and as Baby Boomers and women swelled the ranks of the working population the number of people needing disability benefits rose dramatically.

Enrollment in the SSDI program reached 1 million adults in 1966, nearly tripled to 2.8 million by 1977 and tripled again to 9 million by the end of 2011.

In 2023, the 8.7 million receiving benefits included disabled workers, widow(er)s and disabled adult children. Awards to disabled workers accounted for 89 percent of all SSDI payments.

Who Qualifies For Social Security Disability Insurance?

To qualify for SSDI benefits, you must fulfill two criteria: You must have worked a specified amount of time in jobs covered by Social Security, and you must have a medical condition that meets the Social Security Administration’s definition of disabled.

If you have worked jobs covered by Social Security, a table will tell you approximately how long you must have worked to satisfy the first condition. This is known as the “duration of work” test. There also is a “recent work” test required to receive benefits.

Meeting the second half of the qualifying criteria – having a disabling condition so severe you can’t work – is, by far, more difficult.

An old adage perfectly fits the application process: If at first you don’t succeed… you know the rest.

“If your application is denied, you are not the only one,” Jamie E. Wright, Founder/CEO of the Wright Law Firm, said. “Many applications are rejected the first time. The most frequent cause is the lack of sufficient medical documentation… Simple mistakes in the paperwork can also lead to a denial. The good news? Most of the denials can be appealed.”

Medical Conditions for SSDI

The Social Security Administration has a narrow definition of disabled, and the conditions are judged by state agencies known as Disability Determination Services.

The principal conditions that must be met to receive benefits include:

• Unable to do the same work you did before you became disabled.
• Unable to do other jobs.
• Having a disability that is expected to last more than a year or lead to death.

SSDI pays only for total disability. There are no SSDI benefits for partial or short-term disability.

The Social Security Administration reviews your initial application to see if it meets the basic requirements, then sends it to your state’s Disability Determination Services (DDS) office. The office determines whether the medical evidence supports the claim. It considers evidence from doctors, hospitals, clinics or institutions that answer questions about your medical history, tests, treatments and your ability to do work-related activities like walking, sitting, lifting and remembering instructions.

After reviewing the evidence, the state agency decides if you qualify. If your claim is approved, you will be notified by a letter showing the amount of benefits and when the payments will start. If you are denied, the letter will explain why and tell you how to appeal the decision. Again, 62 percent of first-time applicants are denied.

“An applicant’s disability should meet the requirements of a listing in the Social Security Administration’s Blue Book of Disability,” Ruggiero said. “This is a general guideline from the SSA to determine if you are eligible. Prior to applying, view the Blue Book online and locate your disability, or one that closely resembles your symptoms.”

How to Apply for SSDI

Applying for SSDI benefits can be done online, in person at your local Social Security office or over the phone. The application process is tedious and can be painstaking if you – or your advocate – aren’t well-organized.

“You can apply on your own, but you have a better chance of winning benefits with a good lawyer,” Jenni Popp, Managing Attorney at Atticus, said. “A good lawyer will know the best way to present your case to the SSA, make sure you always understand what to expect, help you navigate the paperwork, and make sure all your evidence is in and that you don’t miss any deadlines.”

If you have a medical condition severe enough to keep you from working for a year or longer, start the process as soon as you stop working.

Gather Evidence: The first step is compiling all relevant personal and medical information. To start the application, you need to collect: dates of marriages and divorces; names and birthdates for minor children and spouse; military service discharge information for all periods of active duty (form DD 214); W-2 forms from the last year or your IRS 1040 with Schedule C and SE if you’re self-employed; checking and savings account numbers, including your bank’s 9-digit routing number if you want your benefit checks to be direct deposited.

Document All Information: The next step is a “disability report” that includes: treatment information with names, addresses and phone numbers for doctors, hospitals and clinics you’ve visited; names of medicines you’re taking and who prescribed them; dates for medical tests and who sent you for the tests; a list of jobs you had in the 15 years before you became unable to work; information about insurance or workers’ compensation claims you filed; and the name of someone Social Security can contact about your medical condition.

Complete The Process: When you have compiled all of your personal and “disability report” information, you can go online and fill out the disability benefit application and disability report. You also must complete the form for Authorization to Disclose Information to the Social Security Administration (SSA Form-827) that gives Social Security permission to look at your personal and medical records.

“It is crucial to know the eligibility criteria, with a clear showing of how that condition meets the SSA’s criteria for disability,” Jeffrey Reisman of Jeffrey Reisman Law, said. “Follow up on any requests for additional documentation or information, and then they can follow up with an appeal of denial, within the allowed time frame.”

Other Paperwork That Can Assist in SSDI Approval

Less is not more when applying for SSDI benefits, so if you’re in doubt about whether certain documents or medical records are necessary err on the side of including them. And then some:

• Information on the mental and physical requirements of your job is crucial. Not just your company’s job description but a detailed explanation of your daily/weekly work day.
• Provide an explanation concerning how your condition limits or prevents you from performing the duties your job requires. Again, be specific.
• Include a written report that goes over any details you think will support your case.

You cannot be too thorough in documenting your medical condition and its impact. Include corroborating statements from your doctor if you have them. Also, any personal injury lawsuit settlements should be attached.

Come prepared. The SSA accepts photocopies of W-2 forms, self-employment tax returns and medical documents. But you must submit the original of other documents such as your birth certificate.

Again, this can be an overwhelming process if you are not well-organized or do not have an advocate. Do not be discouraged. Take your time, and be diligent.

What SSDI Benefits Can You Receive?

SSDI benefits are meant to replace a portion of a worker’s annual salary. The more money you earn in qualifying jobs, the higher your benefit up to a certain limit.

If you are approved for SSDI benefits, you receive a monthly check. The Social Security Administration calculates your monthly benefits based on a complicated formula that includes:

• Your age when you became disabled.
• How long you worked.
• Your average amount of earnings during your working years.

In addition to your earnings history and the SSA formula, your benefit amount is influenced by the Substantial Gainful Activity (SGA) threshold.

In 2024, the SGA amount was $1,550 per month, which may increase in 2025. The maximum SSDI benefit in 2024 was $3,822 per month and is expected to increase to $4,018 in 2025.

The amount you receive also is affected by the number of “credits” you earned during your employment. Workers can receive up to four “credits” a year, based on earnings.

In 2025, you receive 1 credit for each $1,810 of earnings, up to the maximum of 4 credits per year.

The amount changes every year, and the credits you earn remain on your Social Security record even if you change jobs or no longer work. Depending on your age, there is a minimum number of credits needed to receive SSDI benefits, but no maximum.

SSDI benefits, like retirement benefits, are adjusted for inflation so that the value of the benefit is maintained over time. Eligible family members can receive benefits based on your work record. A spouse or child could receive as much as 50 percent of your monthly benefit. After you receive SSDI benefits for two years, you become eligible for Medicare.

SSDI Appeals and Legal Advocates

Do not be discouraged if you have to appeal your claim for SSDI benefits. You are in the majority. Only 38 percent of first-time applications are approved, meaning 62 percent are denied. The appeals process requires great attention to detail and deadlines.

The rules and procedures governing SSDI can be very complicated and confusing. Having an advocate, someone who can help you deal with the paperwork and deadlines involved in the process is not required but can be very helpful.

There are four levels in the appeals process: reconsideration; hearing; appeals council; and federal court. It is a step-by-step process, meaning you begin with reconsideration and only move on to the next level (hearing) if your appeal is denied. If you win your appeal at any step along the way, you will begin receiving benefits.

You can handle your own Social Security appeal or choose a lawyer or friend to help. That person is called a representative and can’t collect a fee from you without first getting written approval from Social Security.

“It can be valuable to hire a social security lawyer in these cases,” Ben Michael, Attorney, Michael & Associates, said. “Typically, it doesn’t make much sense to hire one when you are first applying, as there isn’t much they can do. But, if you apply for SSDI and are denied, that is when a lawyer can come in handy.

“When denied, you have 60 days to ask for reconsideration. You can meet with a lawyer at this time so that they can assess your situation and see what might have led to you getting denied. From there, they can help improve your chances of getting approved when your application is reconsidered.”

Continuing Eligibility for Disability Benefits

In most cases, you will collect benefits as long as you are disabled. There are two common circumstances that could result in you losing benefits: Your health improves to the point where you are no longer disabled or you begin to earn too much money to qualify.

The review process for determining whether you are still disabled is divided into three categories:

Expected to improve: If you’re expected to improve, your case will be reviewed six to 18 months after benefits start.

Could improve: The review will happen no sooner than three years after you begin collecting benefits.

Not expected to improve: Your review will happen no sooner than seven years after the start of benefits.

If the SSA is going to review your medical condition, it will notify you through mail.

Can You Work While on Disability?

You can work while on disability, but with a caveat.

When you first start working, you have a nine-month trial period during which you will receive full SSDI benefits, regardless of how much money you make, as long as you report your work activity to Social Security.

“The first nine months of attempting to work are called the Trial Work Period, and during this time you can try working without losing your benefits,”  Wright said. “However, if your earnings are more than the SGA ($1,620 per month or $2,700 for blind individuals in 2025), then your payments may be reduced or even stopped. To avoid any surprises, it is advisable to keep on seeing your doctor and make sure that your medical records are up to date.”

After the nine months – which can be spread over time — you enter the “extended period of eligibility” or EPE, which can protect your SSDI benefits for another 36 consecutive months.

If your income during the EPE exceeds the limit, you enter a “grace period” during which you receive that month’s SSDI check and two more months.

However, because you are earning above the SGA, you will lose your benefits after the grace period. If your disability causes you to stop working or you go back to earning less than the maximum, your benefit checks will start again.

At the end of the EPE, you can continue to work and receive benefits until you work a month at the SGA level or are no longer disabled.

SSDI vs. SSI

If you have not paid social security taxes or worked enough to qualify for Social Security Disability Insurance (SSDI), you may qualify for Supplemental Security Income (SSI), a federal program to assist those who are disabled, blind or aged and who are not working and have not worked for a long time.

The medical requirements for SSI are the same as they are for SSDI, meaning you have to have a significant mental or physical condition that prevents you from working.

But there are more differences than similarities between SSDI and SSI, including some major variances:

• SSI is a need-based program for people with limited income and resources. SSDI is a program based on your work history.
• The monthly benefit for SSI in 2025 is based on need and tops out at $967. SSDI monthly benefits are based on how much you worked and how much money you made.
• You can only apply for SSI over the phone or in person at your local Social Security office. You can apply for SSDI online, over the phone or in person at the local Social Security office.
• In most states, SSI beneficiaries also qualify for Medicaid. SSDI beneficiaries receive Medicare benefits after receiving two years of disability payments.

The approval rates for SSI and SSDI are roughly the same – about 65 percent of first-time applications are denied – which makes the appeals process very important. The appeals process for SSI is identical to SSDI.

Can You Qualify for Both SSDI and SSI?

In certain circumstances, you can qualify for both SSI and SSDI benefits.

“Concurrent” benefits – as the Social Security Administration refers to them – can be claimed if your income and assets are low enough to qualify for SSI and you have worked long enough in a job that paid taxes into Social Security.

It’s important to know that in meeting that criteria, you cannot receive SSI benefits if your SSDI monthly benefit is the maximum amount allowed.

If you are an SSI recipient, you may be automatically eligible for Medicaid. In many states, an SSI application doubles as an application for Medicaid.

In other states, you may have to establish your Medicaid eligibility through a separate agency.

Other Financial Resources for Individuals with Medical Conditions

SSDI and SSI benefits can be a lifeline for people whose earning power is compromised by qualifying disabilities and who meet the eligibility criteria established by the Social Security Administration.

Diligence in collecting all pertinent medical information is of utmost importance in filing an SSDI application for benefits. Even then the process can be too challenging for many first-time applicants.

In seeking legal help, keep in mind that SSDI lawyers work on a contingency basis. If you’re not sure where to turn for help, the National Organization of Social Security Claimants’ Representatives (NOSSCR) has a directory of accredited disability attorneys.

“Many potential clients wonder how they’ll pay for a lawyer without money coming in,” Popp said. “(Contingency) means you don’t pay anything upfront, and you only pay an attorney’s fee if you win. The fee is set by the SSA.

“Contingency work is great because it makes sure you and your lawyer have the same incentive: get your benefits as soon as possible. Lawyers also offer free consultations, where you can ask questions and address concerns before you hire them. We also work with EDPNAs, who are non-attorney representatives certified by the SSA to represent disability applicants. An experienced EDPNA can be just as good an advocate as a lawyer.”

But even if you qualify for disability benefits, you are hardly alone if you still need financial help with medical bills. Approximately 14 million people (6% of the population) in the U.S. have medical debt in excess of $1,000.

Debt in all its forms – medical, credit card, personal loans, etc. – can severely compromise an individual’s earnings let alone the already reduced buying power of disabled person’s insurance benefits.

If you’re just having trouble making ends meet, and especially If you’re struggling to get out of debt as many Americans are, non-profit credit counseling can help with everything from monthly budgeting to tailoring a debt management plan that meets your specific circumstances.