Navigating Social Security Disability Benefits

There are two different social security benefit programs

The Social Security Administration manages two programs for people living with disabilities: Social Security Disability Insurance and Supplemental Security Income. You might be eligible for one or both, depending on your work history and financial situation after a brain injury.

Social Security Disability Insurance (SSDI):

• Eligibility: To qualify for SSDI, you must have worked long enough and recently enough to be “insured” for disability. This means you’ve accumulated enough work credits.
• Benefits: A person identified by SSDI as living with disabilities may become eligible for Medicare after approximately 29 months (a 5-month waiting period for benefits typically applies after the start of a disability).

Supplemental Security Income (SSI):

• Eligibility: SSI may be possible for people who haven’t worked long enough to qualify for SSDI, or whose SSDI benefits would be minimal. To be eligible for SSI, you must meet strict financial eligibility criteria, including income and resource limits.
• Benefits: People identified as living with disabilities are immediately eligible for Medicaid.

Get started by gathering your paperwork and filling out an application

Gathering all necessary information and documents upfront can save you time and stress. We put together the following information to help you understand the process, from initial application to potential appeals, making it less confusing and frustrating.

1. Start by checking your earnings and eligibility by creating or accessing your My Social Security account. Your account will allow you to view your earnings history, see your eligibility for SSDI, and get an estimate of your potential payment amount.
2. If you have general questions, need to check your application status, or prefer to speak with someone directly, you can call the Social Security Administration at 800-772-1213. To schedule an appointment for assistance with your application, it’s often best to call or visit your local office.
3. Submit Your Application: You can submit an online application (the quickest and often easiest way to apply), or a paper application (you can download, print, and mail a paper copy).
4. We highly recommend you print and review the Checklist for Online Social Security Disability Application. This helps you gather all the necessary information and documents before you begin, streamlining the process.

Your application will be reviewed as part of a multi-step process

Step 1: Initial Review by SSA to confirm you’ve worked enough years to qualify and evaluate any current work activities.

Step 2: Your case is forwarded to Disability Determination Services (DDS) in your state. DDS is a state agency that makes the initial disability determination for the SSA.

Step 3: DDS will often schedule an appointment to review your application and request any necessary documentation, including medical records from the doctors, hospitals, and clinics you list on your application. They might also schedule you for a consultative examination with a medical professional they choose if more information is needed. It’s crucial to provide a complete and accurate list of all your medical providers. Also, be prepared to describe how your condition affects your daily activities of living, as this helps SSA understand the impact of your disability.

Step 4: The state agency makes the initial disability determination decision. This decision typically takes 90 to 240 days.

Be prepared to appeal, as many initial applications are denied

If your initial application is denied, you have 60 days to file an appeal. Don’t be discouraged. You have four opportunities to appeal the decision.

Request for Reconsideration. This is the first level of appeal. Your case will be reviewed by a new examiner at DDS who was not involved in the initial decision. Filing online is the quickest and easiest. To appeal, visit the Appeal a Decision page on the Social Security Administration’s website. Select “Start disability request” or “Start non-medical request” as applicable. Follow the instructions to complete and submit the appeal electronically. Next, download, complete, and print Form SSA-561-U2 (Request for Reconsideration). Send the completed form to your local Social Security office. You can find your local office’s fax number and address using the Social Security Office Locator by entering your ZIP code.

Hearing with an administrative law judge. If you disagree with the reconsideration decision, you can request a hearing with an administrative law judge. This is a formal hearing where you and/or your representative can present your case, including testimony, to an impartial judge.

Appeals council review. If you don’t agree with the decision made by the administrative law judge at your hearing, you can request a review by the Appeals Council. The Appeals Council can affirm, reverse, or remand (send back for another hearing) the administrative law judge’s decision.

Federal district court action. The final level of appeal is to file a lawsuit in federal district court. This is a legal proceeding outside of the SSA.

Considering legal representation. While not required, it’s often recommended to contact a Social Security disability lawyer to assist in the appeal process, especially at the hearing level or beyond. Contingency Basis: All Social Security attorneys must take cases on a contingency basis. This means no attorney fee is owed unless the claimant wins benefits. Fee Caps: Attorneys are allowed to charge 25 percent of past-due benefits or $7,200 (as of 2024), whichever is less. These fees are regulated by the SSA.

Compassionate answers. Real support. Every step of the way.

Contact the National Brain Injury Information Center at 1-800-444-6443 to speak to a specialist about:

• Help with care needs
• Legal and financial resources
• Services in your community
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