Attorney Danielle Beaver joins producer/host Coralie Chun Matayoshi to discuss who qualifies for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), how do you apply, how long it takes, why most people are initially denied, common reasons for denial, the appeals process, and changes being made by the new administration.
Danielle Beaver is an attorney with over a decade of experience in Social Security Disability and Supplemental Security Income cases. Prior to private practice, she worked for the Legal Aid Society Law Center in San Francisco where she advocated for clients in unemployment and wage and hour hearings and clerked for a Federal District Court judge in California.
Q. Everyone has heard of Social Security and most of us look forward to receiving benefits when we retire. But Social Security also provides disability insurance and supplemental security income under certain circumstances.
First, what is Social Security Disability Insurance (SSDI)?
SSDI is a federal program that provides financial assistance to individuals who are unable to work due to a disability. To qualify, applicants must have worked and paid Social Security taxes for a certain period. Typically, this means that in order to qualify you must have worked at least five years cumulatively out of the past ten years.
Q. Who qualifies for Social Security Disability Insurance?
Individuals qualify for SSDI if they have a medical condition that meets the Social Security Administration’s (SSA) definition of disability (e.g. a medical condition that is expected to last at least 12 months or result in death and prevents the individual from engaging in substantial gainful activity) and have earned enough work credits recently enough through their employment history. The definition of what it means to be disabled under Social Security laws is very specific and depends on your age and work experience. Some conditions automatically qualify you for SSDI, like if you are on dialysis or have a terminal illness.
Social Security has specific rules called “The Grids”: The “grids” refer to a system of guidelines that determine disability benefits based on a claimant’s age, education, work experience, and ability to work, specifically in cases where their work history and functional limitations may align with a lack of viable work options. The Grids are particularly relevant for individuals 50-65, as they recognize the potential challenges older workers with limited education and skills may face in finding suitable employment. For instance, if you are 58 years old, and have worked construction for many years, and you injure your back so you can no longer lift over ten pounds without pain, you would likely qualify under the grids as disabled because you do not have the skills to work a desk job.
Q. What are the key differences between Social Security Disability and Social Security Retirement?
- Focus: SSDI focuses on disability, while Social Security retirement focuses on age and work history.
- Work History: SSDI requires a sufficient work history, while Social Security retirement requires a certain number of quarters of coverage.
- Disability Criteria: SSDI has strict criteria for determining disability.
- Benefit Amount: SSDI benefits are based on the individual’s earnings record, while Social Security retirement benefits are based on the individual’s earnings and age.
- Medicare eligibility: SSDI recipients are eligible for Medicare after receiving disability benefits for 24 months regardless of age, and are automatically enrolled in both Medicare Part A and Part B.
Q. Both Social Security Disability and Social Security retirement benefits are funded by payroll taxes and require some kind of minimum work history. Supplemental Security Income is also part of the Social Security program. What is SSI and how is it different?
SSI is a needs-based program that provides financial assistance to individuals with limited income and resources who are disabled, blind, or aged 65 and older, regardless of their work history and is funded by general tax revenues instead of payroll taxes. SSI recipients are eligible for Medicaid.
Q. What types of disabilities are covered under SSDI and SSI?
Both programs cover a wide range of physical and mental disabilities, including but not limited to chronic illnesses, mental health disorders, and injuries that severely limit a person’s ability to work. The Social Security Administration looks at the whole picture, not just one individual injury or illness.
Q. How do you apply for Social Security Disability Insurance and Supplemental Security Income?
Applicants can apply for SSDI and SSI online, by phone, or by calling and making an appointment to go to a Social Security office in person. The process includes filling out forms, providing medical documentation, and sometimes attending a disability hearing.
Q. How long does the process take?
It varies depending on where you live and what’s going on in the Social Security Administration, but in Hawaii I would say that the entire process on average takes about 2-1/2 to 3 years. It can take up to one year for an initial decision. The first appeal can take up nine months. If you get denied again, you request a hearing, and it can take anywhere from 9-18 months before you see the judge. After that you have to wait a couple of months for the decision.
Q. Is it true that most people get denied initially and why does that happen?
Yes, most people get denied initially because Social Security does not think that your medical records show that you have a disabling condition. These denials are often incorrect and it’s important to appeal them. You have the best chance of winning at a hearing with an administrative law judge.
Q. What should applicants know about appealing a denied claim?
If a claim is denied, applicants can appeal the decision within 60 days. The appeals process involves several steps, including reconsideration, a hearing, and potentially further appeals to higher authorities.
Q. What are some common reasons why people get denied?
- There are a lot of reasons, but in my experience, there is often no valid reasoning or extremely flimsy reasoning.
- Lack of Medical Evidence: Claims may be denied if there isn’t sufficient medical documentation to support the existence and severity of the disability.
- Failure to Follow Treatment Plans: If the applicant does not follow prescribed treatments or therapies, the Social Security Administration may view this as a sign that the condition is not severe enough to warrant disability benefits.
- Insufficient Work Credits (for SSDI): Applicants may not have enough work credits from their employment history to qualify for SSDI.
- Income Exceeds Limits (for SSI): For SSI, claims can be denied if the applicant’s income or resources exceed the program’s eligibility limits.
- Inability to Demonstrate Functional Limitations: The Social Security Administration requires applicants to show how their disability significantly limits their ability to perform basic work activities. If this is not adequately demonstrated, the claim may be denied.
- Failure to Attend Appointments: Missing medical examinations or consultations requested by the Social Security Administration can lead to denial.
- Non-compliance with Social Security Administration Requests: Failure to provide requested information or documentation during the claims process can result in a denial.
- Age and Work Capability: If the Social Security Administration believes that the applicant can still perform their previous work or adjust to other types of work despite their disability, the claim may be denied.
- How are Social Security Disability Insurance and Supplemental Security Income benefits calculated?
SSDI benefits are based on the applicant’s average lifetime earnings, while SSI provides a standard monthly payment based on federal and state guidelines, taking into account other income and resources.
Q. Once these benefits are fixed, are they forever? Or are there circumstances under which they can be decreased or discontinued?
Social Security can review your medical condition at any time, but they usually do it within one to three years of the initial receipt of benefits. The closer you are to age 65, the less likely they will review your condition. They will look to see if your condition has improved enough to go back to work. If they think you have improved enough to go back to work, they will discontinue your benefits. You can appeal that decision.
SSI benefits can be decreased if Social Security learns that you have received any kind of income, either earned (for going to work) or unearned (i.e. inheritance). If you receive money that puts you over the threshold ($2,000 for unmarried individuals and $3,000 for married people) then they will discontinue your benefits until you spend down your money.
Q. The new administration has brought about staff cuts to the federal workforce and policy changes. What should we know about recent changes at the Social Security Administration?
- Staffing cuts will lead to longer waiting times for everything.
- As of early April 2025, all claim types can still be completed over the telephone, including retirement, survivor and spousal or children’s benefits.Previously, the Social Security Administration said those applicants would need to visit an agency office in person for identity proofing. Individuals making other benefit claims, including for Social Security disability insurance, Medicare and Supplemental Security Income, can also complete their claims entirely over the telephone. Anti-fraud checks on all phone applications could require in-person identify verification.
- Changes to direct deposit information will still need to be made either online or in person.
- So far, all benefits remain intact, but it’s hard to predict with this administration. The White House mischaracterizes the data leading to a lot of fear and confusion. For instance, they talk about “improper payments”, but an improper payment does not necessarily mean outright fraud. For example, the Government Accountability Office report that is cited by the White House website, indicates that improper payments include $10 billion dollars in underpayments, which means that SSA actually owes this money to individuals. They also discuss billions in overpayments. Overpayments are not generally due to outright fraud. https://www.gao.gov/blog/federal-government-made-estimated-162-billion-improper-payments-last-fiscal-year. Beware of misinformation about fraud. Deceased people are not necessarily still receiving benefits. https://www.ssa.gov/news/press/releases/2025/#2025-02-19.
A press release from Lee Dudek, Acting Social Security Commissioner stated:
(https://www.ssa.gov/news/press/releases/2025/#2025-02-19):
Our continuing priority is paying beneficiaries the right amount at the right time, and providing other critical services people rely on from us.
DOGE personnel CANNOT make changes to agency systems, benefit payments, or other information. They only have READ access.
DOGE personnel do not have access to data related to a court ordered temporary restraining order, current or future.
DOGE personnel must follow the law and if they violate the law they will be referred to the Department of Justice for possible prosecution.
Disclaimer: this material is intended for informational purposes only and does not constitute legal advice. The law varies by jurisdiction and is constantly changing. For legal advice, you should consult a lawyer that can apply the appropriate law to the facts in your case.