The SSDI Process
Social Security Disability Insurance (SSDI) is an employee payroll tax-funded federal insurance program. Its purpose is to provide income to people unable to work because of a disability. You may qualify for SSDI benefits if you have worked and paid into the program for five of the last 10 years. You must also have been disabled before reaching full-retirement age (65-67) and must meet Social Security's definition of disability.
Allsup provides a no cost evaluation to determine likelihood of eligibility, develops an accurate record and guides applicants through the disability decision process. There are four levels in the Social Security Administration's (SSA) review and award system, plus an additional level that takes the applicant out of the SSA system. Few applicants will pass through all five levels:
- Level One - Application. An Allsup team member is assigned to help complete all forms - including the Social Security disability application and Activities of Daily Living questionnaire, develop the case and submit relevant medical and vocational documentation. Because Allsup's process is efficient and its professionals are so familiar with the Social Security process, Allsup's award rate for initial claims is much higher than the SSA standard (59 percent vs. 33 percent).
- Level Two - Reconsideration*. If the initial disability application is denied, Allsup will file an appeal on behalf of the customer. Allsup reviews and updates medical and vocational information and prepares for the next phase of the process. Approximately 89 percent of first appeals are denied.
- Level Three - Hearing. If the reconsideration is denied, an Allsup team member will interview the applicant and file for a hearing before an administrative law judge and assign your case to a senior claims consultant. If a hearing is required, the senior claims consultant briefs the customer on the hearing procedures and appears with the claimant before the judge. Approximately 48 percent of second appeals are awarded to the applicant. The SSA estimates the average time spent at this level was 382 days in 2013. If a disability hearing ends in another denial, the decision can be appealed again.
- Level Four - Appeals Council. If the hearing ends in a denial, Allsup will review the case again and may submit an appeal, along with any additional medical information and a written brief, to the Appeals Council. The Appeals Council reviews the hearing decision to determine if it was rendered properly according to the law. Only 1 percent of third appeals result in a favorable decision for the applicant. The SSA system-wide statistic is that two percent of hearing decisions are overturned.
- Level Five - Federal Court. There is also an additional appeal available which is pursued by less than one percent of claimants -- Federal District Court (FDC). Approximately 70 percent of these are denied with a small amount receiving a decision in FDC that resulted in an award. The remainder of those are remanded (sent back) to the hearing level for an additional hearing.
Allsup does not charge a fee unless it obtains your SSDI benefits. The SSA governs the fee. Typically, under the SSA's fee agreement approval process, we receive 25 percent of the retroactive award, not to exceed $6,000. If you do not receive a retroactive award amount, your fee could be much less. All future monthly benefit payments go directly to you.
Award: If your claim is awarded, the general guidelines regarding when to expect payment, including retroactive payments (if applicable), are two to four weeks for claims awarded at levels one and two, and one to three months for claims awarded at levels three and four. These time frames represent an average or general guideline - specific time frames may be shorter or longer.
How much you receive is determined by a complicated formula using the amount of your past earnings that have been subjected to FICA taxes. The average monthly benefit for an individual is $1,165 in 2015. However, your monthly award is dictated by your lifetime earnings so for many people their award could be much higher. You also may access your Social Security statement online, which will include an estimate of the amount of benefits you may receive.
Continuing Disability Review: Your eligibility for SSDI benefits is subject to review at certain intervals after benefits are first awarded. These intervals are based on if your condition is expected to improve. These reviews are usually at one, three, five or seven years. For example, if medical improvement is expected, a "CDR" (Continuing Disability Review) date of one year is established at the time your benefits are awarded.
Review our SSDI Representation Chart here.