Are you unable to work because of a serious medical condition? If so, there’s a good chance you qualify for monthly payments and free health insurance from the U.S. government. We’ll help you figure out whether you qualify and what to do next.
Hundreds of thousands of disabled Americans get benefits from Social Security Disability. For patients and their families, this help can be life-saving. But not everyone with a serious condition is eligible, and government rules can make qualifying a nightmare. At Atticus, we help cut through the red tape and get you the benefits you need. We’ll explain how this program works, then tell you how to qualify.
What is Social Security Disability?
Social Security Disability Insurance (“SSDI”) is a government program that supports Americans that can’t work due to a medical condition. When someone says they’re “on disability,” they usually mean they are getting benefits from Social Security Disability.
The program is huge: About 10 million Americans receive SSDI today, and about 2% of every U.S. paycheck goes to fund the program via taxes.
What do recipients get?
If you qualify for Social Security Disability you will get two big benefits:
- A monthly check (usually for between $1,000 and $3,000).
- Free health insurance through Medicare (sometimes after a waiting period).
You can also get other benefits, including extra money for young kids, forgiveness of student loan debt, an easier time qualifying for other programs, and higher Social Security Retirement payments later in life. There’s no downside to receiving benefits, and it’s free to apply.
What is the downside?
There isn’t one. If you are eligible, you should apply. Applying is free. You can keep your health insurance, or get Medicare for free.
Who is eligible?
In order to qualify for SSDI, six things usually have to be true:
- You’re under 66 years old
- You’re getting treatment for a serious medical condition
- Because of your medical condition, you can’t realistically hold a job
- You’re not currently working (or if you are, it’s part-time and very low-paid)
- You’re not expected to recover (or be able to work) within a year
- Before getting sick, you worked and paid taxes for years*
* If you didn’t work previously, but you and your family have very little money, you can still qualify for a related program called Supplemental Security Income (“SSI”), and the rest of this article will still largely apply to you.
Qualifying is never easy: The government treats claims with suspicion, and rejects most applicants. But if you meet the criteria above, you can likely get benefits with the right help.
Who should apply?
If you have a medical condition that makes it impossible to work, and you are getting treatment from a doctor, you may qualify as disabled. If you are able to work or aren’t getting a lot of treatment, then you probably won’t qualify.
Some quick background: Under government rules, some medical conditions — like needing a kidney transplant or losing both your legs — always qualify a patient for disability benefits. Others — like pregnancy — are never enough. The vast majority of conditions are somewhere in between. You can qualify due to many, but just having one often isn’t enough. Instead, it depends on how long you’ll be sick, the symptoms you are experiencing, and how the condition impacts you.
The formal guidelines are complicated, but it boils down to this: If your condition has a big impact on your life even though you’re getting treatment, and as a result you just can’t hold a job, you’ll probably qualify as disabled with proper help.
Is there a right time to apply?
You should apply as soon as it is clear that your condition is going to last a full year and you have the evidence to prove it. Sometimes that takes a while to figure out: your doctor may need to run tests and try a variety of treatment before they know how long your condition will last. Other times it is clear right away that a disability is long lasting. Once your doctor is pretty sure that your condition is going to keep you out of work for a full year, there is no reason to wait.
How does the application process work?
Atticus exists to help to people navigating this process — so the easiest thing to do is get free advice tailored to your situation via our online tools or caring staff. (People love us, and we don’t charge anything for our help.)
Applying for disability takes preparation. You can win, but this system doesn’t make it easy. So it’s worth taking some time to understand how things work.
The first step is to make a choice: Do you want to (a) Apply on your own, or (b) Get a professional to handle the process for you? Most successful applicants hire a professional. But not everyone needs to, and not everyone who wants to can. We’ll explain both paths and help you decide.
How the process works
The government fears that people will exaggerate their medical problems in order to get free money. So it puts every applicant under a microscope. To win, you have to prove — beyond a doubt — that your medical condition is severe and disabling.
There are two major stages in the process, and most people will need to go through both:
- Initial Application: You submit a lengthy written application, details on past work and treatment, and copies of your medical records. A government staffer reads your file and makes a decision. (Only 20% of people win at this stage; the large majority are denied.)
- Appeals: If you lose, you appeal your denial and eventually get a hearing with a judge. At the hearing, you get to submit additional evidence, speak to the judge directly, and cross-examine government experts. (Among people who make it to this stage, about 50% win. If you lose, there are several more stages of appeal.)
Unfortunately, the process takes time: 3-6 months to get an initial decision, and 1-2 years (or more) to get a hearing. Even a small mistake or omission (like a doctor failing to send in records, or bad answer on a form) can doom an application. The good news is that once you win – even if it takes a long time and several appeals – you get “back pay” (retroactive benefits) for the time you should have been getting benefits.
Who needs a lawyer?
Because the process is so complicated, most successful applicants get a lawyer (or trained non-lawyer representative) to help. Lawyers will pull together your medical records, write your application, advise you on getting proper medical treatment, submit all the paperwork, and (if needed) argue your case before a judge.
There are two big upsides to hiring a lawyer: (1) They do almost all the work for you and hold your hand through the process. (2) They increase your chance of winning. (Government studies show that at the appeal stage, people with a lawyer are three times as likely to qualify.)
The only downside is cost. Lawyers aren’t allowed to charge any up-front fee so it doesn’t matter if you can afford one right now. If they win your case, they get 25% of any back pay (retroactive benefits) that they win for you. This is worth it for almost everyone — you only pay if you win (if you lose, you pay nothing), you only pay once, and the cost pales in comparison to the amount you get.
Should I hire a professional?
Most applicants should hire a lawyer or other professional. (There are exceptions — see, for example, our articles on Huntington’s disease or pancreatic cancer.)
Why? The government treats all but the most serious conditions with a lot of skepticism. Having assistance from an expert can make all the difference.
There are only a handful of situations where we tell people to consider applying on their own:
- If your condition is so severe that no one — not even the most skeptical judge — would believe you could hold a job. (This is the case if you have a terminal condition, or you’re seeing a specialist often, and still have extremely serious limititaitons, and need a lot of help in your daily life, and you haven’t worked in years.) If this is the case you can likely win on your own, as long as you feel comfortable with government paperwork (about the same as filing your taxes) and requesting medical records.
- If you can’t convince a lawyer to take your case. Sadly, this can happen; if your case is quite hard to win, it can be difficult to find a lawyer to represent you. (Though we recommend trying our service before you give up!) In this case, you can apply on your own, and then try again to find a lawyer once you’ve been denied once — at which point it’s often easier.
How Atticus can help
Atticus is a new kind of law firm that helps you navigate the early stages of a disability claim. We help you choose the right approach, hire the right lawyer, and get on with your life. We won’t charge you a dime for our services, so there’s no cost to you.