Social Security Disability Insurance
Social Security Disability Insurance (SSDI) is a payroll tax-funded, federal health insurance program of the United States government. SSDI, managed by the Social Security Administration (SSA), is designed to provide income to people who are unable to work because of a disability.

SSDI is intended to be provided until their condition improves, and is intended to guarantee income if the individual's condition doesn't improve. SSDI is a social insurance program, and benefits are only granted after a lengthy determination process, whereby the applicant must prove that they are disabled.

The National Multiple Sclerosis Society has an abundance of information that is of great assistance if the time to apply for SSDI arises. They have put together the following guidebook to assist you in deciding whether applying for disability benefits is right for you and in navigating the complex application process. You can go directly to their site's SSDI section at here or pull up the guildbook directly in the box as a (.pdf) file.

National Multiple Sclerosis Society
SSDI Guidebook for People Living with MS

SSDI Guidebook for People Living with MS (.pdf)

Now when you reach retirement age, SSDI ends and you transition to Social Security retirement benefits. Social Security disability entitlement "freezes" Social Security earnings records during your period of disability. Because the years in which you collect SSDI benefits are not counted when computing future benefits, your Social Security retirement benefits may be higher than if your earnings were averaged over a greater number of years.

● Social Security provides a regular monthly payment that supplements any current disability benefits already received. It also provides annual cost of living increases. A portion of these benefits may be tax free.
● Regardless of a person's age, after receiving SSDI benefits for 24 months, they are eligible for Medicare, including Part A (hospital benefits), Part B (medical benefits), and Part D (drug benefits).
● Once a person is entitled to Medicare, they are also eligible for Medicare Part D, the new prescription drug plan.
● If a person receives Social Security disability benefits, any COBRA benefits may also be extended from 18 to 29 months.
● Social Security disability entitlement "freezes" Social Security earnings records during a person's period of disability. Because those years will not be counted when computing future benefits, their Social Security retirement benefits may be higher.
● If a person receives Social Security disability benefits and they have a dependent under age 18, he or she may also be eligible for benefits.
● Social Security will provide a person opportunities to return to work while still paying them disability benefits.

As of the 2007, there were 10.7 million people receiving some type of Social Security benefit for their disability.
Qualification
According to the SSA, a person qualifies for SSDI if they:

● have a physical or mental condition that prevents them from engaging in any "substantial gainful activity", and
● the condition is expected to last at least 12 months or result in death, and
● they are under the age of 65, and
● generally, have worked 5 out of the last 10 years as of the determined date of onset of disability.

The work requirement is waived for applicants who can prove that they became disabled at or before the age of 22, as these individuals may be allowed to collect on their parent or parents' work credits. The parent(s) experience no loss of benefits.

Medical evidence must be provided that demonstrates the applicant's inability to work. The applicant must meet a SSA medical listing for their condition. If their condition doesn't meet the requirements of a listing, their residual functional capacity is considered, along with their age, past relevant work, and education, in determining their ability to perform either their past work, or other work generally available in the national economy.

Determination of a residual functional capacity often constitutes the bulk of the SSDI application and appeal process. A residual functional capacity is assessed in accordance with Title 20 of the Code of Federal Regulations, part 404, section 1545 by a Disability Determination Service (DDS) or, on appeal, by an administrative law judge (ALJ), and is generally based upon the opinions of treating and examining physicians, if available. The DDS or ALJ may also require the applicant to visit a third-party physician for a medical opinion.

Residual functional capacity is classified according to the five exertional levels of work defined in the Dictionary of Occupational Titles, which are: Sedentary, Light, Medium, Heavy, and Very Heavy. A person is generally not considered disabled if they are found to retain the capacity for work at or above the sedentary level.

In an attempt to speed up the application process, beginning in August 2006, the SSA implemented changes to the application process in the six-state New England region, on a trial basis. On December 1, 2007, the SSA implemented the program nationwide.
Application Wait Time
The amount of time it takes for applications to be approved or denied varies, depending on the level of the process at which the award is made. In 2006, there were 2,532,264 applications for SSDI. As of March 31, 2007, the number of pending applications or backlog was 1,463,153. It's been asserted that this backlog is being caused by the increase in applicants, the increase in retiring SSA workers, the inability of the SSA to replace the retiring workers and budget limitations. The Social Security Administration estimates that the initial benefits application will take 90-120 days, but in practice filings can take up to eight months to complete.

Social Security estimates that nationwide, as of July 2008, there was a backlog of more than 760,000 disability cases pending at the Office of Disability Adjudication and Review or the level 3 hearing. When combined with the more than 519,000 disability applications waiting an initial decision (level 1) and 102,990 pending reconsiderations (level 2), the extent of the problem is apparent. At the second appeal, the 2008 wait time is estimated by the SSA to be 535 days. Appealing a third time adds an additional 242 days to the application process. In October 2007, the SSA acknowledged that more than 140,000 of these have been waiting between 900 and 1,000 days for an appeal decision.

A September 9, 2008 report by the Senate Ways and Means Committee - Subcommittee on Social Security released by Chairman Michael R. McNulty says that nationwide, there is a backlog of more than 765,000 disability cases pending before the Social Security Administration. There are currently more than 1.3 million people awaiting a decision on their claim at all levels of the SSDI process, which expressly allows people the opportunity for a face-to-face evidentiary hearing at the reconsideration level of appeal.
Likelihood of receiving benefits
There are four levels in the SSA's review and award system for disability. There is an additional level that takes the individual out of the SSA system, although only a small percentage of applicants will pass through all four levels. The figures are provided by the SSA.

SSA levels of review:

Level One

The initial SSDI application. There is an extensive amount of paperwork to fill out at this initial level. It's necessary for a doctor to verify information in the application with pertinent medical information and a confirmation that the disabling condition will last 12 months or longer, or is terminal. In 2007, approximately 65% of initial applications were denied.

Level Two

The reconsideration, or first appeal. At this level, a different individual within the Social Security Administration (SSA) reviews the application. Approximately 87% of first appeals are denied.
 

Level Three

The hearing level, or second appeal. This level takes an applicant away from the SSA claims processors and places them in the hands of an administrative law judge. Approximately 62% of second appeals are awarded to the applicant. The SSA estimates the average time spent at this level is 535 days in 2008. If a disability hearing ends in another denial, the decision can be appealed.

Level Four

The appeals council, or third appeal. At this level the Appeals Council will review the disability hearing decision to determine if it was rendered properly according to the law. Only 3% of cases that reach third appeals (Appeals Council) result in a favorable decision for the applicant. The SSA estimates the average time to receive a decision on this third appeal in 2008 is 242 days. SSA has said that for 2009 its target time frame is 506 days for the second appeal, and 242 days for the third appeal.

Level Five

An additional appeal which takes an individual out of the SSA system and into Federal District Court (FDC). In 2007, 5 % of decisions in FDC resulted in an award, 46% were remanded back to the hearing level for an additional hearing and the remaining cases were either dismissed or denied.

Be aware that when you file for SSDI, it's basically passed on to the state that you reside in for the first determination. Each state handles this rather differently. Some states are "easier" to obtain an approval and others are more "difficult" with more initial denials. There is also a significant difference in how fast the process moves with some states giving determinations in 6 months and others dragging their feet for 2 years. Don't expect speed to be on your side, so it's very important to plan ahead and be patient with the process.

It's important to be aware that when the time arrives and you are applying for SSDI, it will present itself with a few challenges for you. With the urgency of any federal government agency, submitting a claim does take some time. Most SSDI claims are denied on the first round and you need to be ready for this.
Assistance in applying for benefits
This shows that it can be a battle just to get the government to believe you and it's either a black or white issue with no shades of gray. This all can be an undertaking that can take some time to accomplish. While legal representation is not required by law, the percentages above may tend to favor those with representation, especially when medical evidence is less compelling, and especially at the more advanced stages. As a result, specialized law firms focused on representing SSDI and SSI claimants have formed a substantial private industry around the Social Security Administration.

There are two major types of paid SSDI representatives. First, there are specialized organizations that only work on disability claims, which has multiple representatives and specialists experienced in handling SSDI claims in local communities across the country. There also are law firms that may or may not have attorneys solely dedicated to SSDI claims, typically a law firm handles more than just disability claims.

The myth that you can't have a representative help you file your initial SSDI application may stem from the fact that many attorneys only accept SSDI clients after their disability applications are denied. However, it can be to your advantage to use a representative in the earliest stages. This is especially true when completing the Activities of Daily Living questionnaire, which requires a level of detail that can easily derail you because you are unfamiliar with the process.

A specialty company will make sure that you "should" qualify under the Social Security definition of each disability prior to filing any claim. If they feel that you do qualify, then they will obtain all the necessary information from you and fill out all the paperwork in the manner that the SSA requires. These companies typically will only get paid if you are awarded your claim and Social Security sets a limit on the amount that can be paid for this type of service.

With the average time to be awarded Social Security benefits just under 500 days or 1 year and 4 months, it's important that you apply for these benefits with no delay. All specific information as to a companies performance in obtaining benefits must be obtained from the individual companies themselves.

For clarification, we are not saying that this is the route you should take, but rather you should look into the process, do your research, and be prepared. These companies are successful due to the fact that they typically deal with this and only this and they know how to do it well.

Below are two links to Social Security websites that could assist you as well. It would be a good idea to look at these as well as other websites prior to taking any action. You can do all of this by yourself if you wish, but if your plate is full, one of the disability service companies can take a bit of stress away and save you some time. You also have the right to contact an attorney that specializes in Social Security claims at any time.

The SSA determines the fee that any organization, company, or attorney can charge for SSDI representation. Currently, under the SSA's fee agreement approval process it is 25% of the retroactive dollar amount awarded, not to exceed $5,300. Those who are approved quickly at the Social Security disability application level and receive no retroactive award typically pay much less.
Example 1: If you are awarded a $1,000 monthly benefit and the award is retroactive 12 months ($12,000), your fee would be $3,000 (.25 x $12,000);
Example 2: If your claim is caught in the SSA backlog and it takes 42 months to get your $1,000 monthly benefit, your representation fee would be capped at $5,300 on the $42,000 retroactive award rather than $10,500 (.25 x $42,000).
Multiple Sclerosis and SSDI
The following is provided by Social Security and explains the five-step process to determine if a multiple sclerosis (MS) patient qualifies for SSDI:

1. Determine if an individual is "working (engaging in substantial gainful activity)" according to the SSA definition. Earning more than $980 a month as an employee is enough to be disqualified from receiving Social Security disability benefits.

2. Conclude that the MS disability must be severe enough to significantly limit one’s ability to perform basic work activities needed to do most jobs. For example:
● Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling.
● Seeing, hearing and speaking.
● Understanding/carrying out and remembering simple instructions.
● Responding appropriately to supervision, co-workers and usual work situations.
● Dealing with changes in a routine work setting.

3. MS is listed under the category of impairments known as neurological. There are several ways to satisfy the listing criteria for MS:
● Significant and persistent disorganization of motor function in two extremities, resulting in sustained disturbance of gross and dexterous movements or gait and station.
● Visual impairments with either best corrected vision in the better eye of 20/200 or less, marked contraction of peripheral visual fields to 10° or less from the point of fixation or visual efficiency in the better eye of 20% or less.
● Organic mental disorder with marked restrictions.
● Significant, reproducible fatigue of motor function with substantial motor weakness on repetitive activity, demonstrated on physical examination, resulting from neurological dysfunction in areas of the central nervous system (CNS) known to be pathologically involved by the MS process. For example, an individual requiring assistive devices to ambulate secondary to MS would be a listing level impairment.

4. Explore the ability of an individual to perform work they have done in the past despite their MS. If the SSA finds that a person can do his past work, benefits are denied. If the person can't, then the process proceeds to the fifth and final step.

5. Review age, education, work experience and physical/mental condition to determine what other work, if any, the person can perform. To determine MS disability, the SSA enlists medical-vocational rules, which vary according to age.

For example, if a person is:
● Under age 50 and, as a result of the symptoms of an MS disability, unable to perform what the SSA calls sedentary work, then the SSA will reach a determination of disabled. Sedentary work requires the ability to lift a maximum of 10 pounds at a time, sit six hours and occasionally walk and stand two hours per eight-hour day.
● Age 50 or older and, due to the MS disability, limited to performing sedentary work, but has no work-related skills that allow him to do so, the SSA will reach a determination of disabled.
● Age 55 or older and, due to the disability, limited to performing light work, but has no work-related skills that allow him to do so, the SSA will reach a determination of disabled.
● Over age 60 and, due to the MS disability, unable to perform any of the jobs he performed in the last 15 years, the SSA will likely reach a determination of disabled.
● Any age and, because of MS, has a psychological impairment that prevents even simple, unskilled work, the SSA will reach a determination of disabled.


Disability Evaluation Under Social Security (The Blue Book)
http://www.ssa.gov/disability/professionals/bluebook

Social Security Planner
http://www.ssa.gov/dibplan