If you’ve had to stop working because of a disability or a serious medical condition, you might be considering filing a claim for Social Security Disability Insurance (SSDI). What are your chances of being approved for benefits? To help answer that question, we surveyed readers across the U.S. who recently went through the process of applying for SSDI. Here’s what we learned about their experiences.
SSDI is a federal insurance program for people who’ve worked and paid taxes for a certain amount of time before they become disabled. When you apply for SSDI, Social Security will first decide whether you meet the work-history requirements. If you don’t, you’ll receive what’s known as a “technical denial.” Next, a disability examiner will approve or deny your application based on the severity of your medical condition. (Learn more about eligibility for SSDI.)
Seven in ten (70%) of our readers were denied for SSDI benefits at the initial application stage. If that seems discouraging, there are a couple of important points to keep in mind. First of all, the number of denials includes people who were turned down for lack of work-history or recent work (or because they were working at the time they applied). According to government statistics, 45% of SSDI applicants receive technical denials. The approval rate is significantly higher (closer to 40%, according to government statistics), if you only look at initial decisions based on medical reasons.
Second, you can appeal a medical denial by requesting a hearing before an administrative law judge (although most states require applicants to request a reconsideration review first). Our survey shows that the chances of getting benefits improve significantly once a judge reviews your case. More than half (55%) of readers who applied for SSDI were approved at the hearing stage—nearly twice as many as those who got approvals at the initial stage. Yet nearly half (45%) of the readers who were denied at the outset didn’t request a hearing. That’s too bad, because applicants who give up or miss the deadline for filing an appeal lose a good chance to receive benefits. (For details on the factors that improve your chances at a hearing, see our survey results on the odds of getting benefits after a disability hearing.)
Our survey pointed to several factors that affect the likelihood of getting SSDI (beyond the severity of your medical condition and whether you appeal an initial denial), including when you stopped working and whether you’ve recently seen a doctor (see our statistics on who’s likely to get approved for Social Security disability). But one of the most important things you can do to help yourself is to hire a lawyer. More than 70% of SSDI applicants who hired a lawyer were awarded benefits, compared to 41% of those who didn’t have legal representation.
There are several good reasons for these results. Disability attorneys understand what Social Security needs to see to approve someone for disability. They know what medical evidence to gather and can recognize when you need additional exams or tests and when your medical records need updating. They also know when it would help to have a medical expert testify at your hearing, and they know where to find appropriate experts. (Government statistics show that when applicants had a medical expert testify at their hearing, they were 1.6 times more likely to be approved for benefits than other applicants.) And your attorney can prepare you for questioning at the hearing, as well as cross-examine Social Security's vocational expert at the hearing to draw out opinions that support your case. (For more details, see our article with statistics on the difference a disability attorney makes.)
It may help to know that you won’t have to pay your lawyer unless you win your case. If you’re approved for benefits, Social Security will pay your attorney a percentage of your past-due benefits (or backpay), up to 25% of the award or $6,000, whichever is less. Readers who had legal representation for their SSDI applications told us their lawyers received an average of $3,900 in fees.
In addition to helping you increase the chances of getting benefits, a disability attorney is likely to help you get more in backpay by convincing Social Security to grant you an early “onset date” date for your disability. In our survey, 6% of readers who were approved for SSDI benefits reported that they received only a "partially favorable" decision, meaning that the judge decided they became disabled later than their applications alleged.
Some people apply for benefits from both Supplemental Security Income (SSI) and SSDI (known as “concurrent benefits”). Although medical eligibility for these two programs is the same, SSI is a need-based program for people with disabilities and little or no income or assets. SSDI applicants sometimes receive concurrent benefits because their SSDI benefits are so low that they meet the financial eligibility requirements for SSI. If their applications are approved for both programs, the additional SSI benefits will bring their monthly checks up to the SSI maximum. Government data for 2016 showed that 10% of those who received disability benefits got concurrent benefits (while 62% received only SSDI).
Our readers reported that the overall approval rate for concurrent applications was considerably lower than for SSDI-only applications: 15% at the initial application level and 36% at the hearing stage. (For more details—including the reasons behind lower approval rates for concurrent and SSI applications—see our survey results on the likelihood of getting SSI benefits.)