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Most people probably don’t think much about the particulars of filing for Social Security disability benefits — until they need them.
But if a serious medical condition prevents you (or a loved one) from working for an extended period, it’s important to be prepared for a claims process that is complex, cumbersome and taking longer than ever to complete.
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According to Social Security Administration (SSA) data, in 2019 the national average wait time for a decision on an initial application for disability benefits was 120 days. It has nearly doubled since then, to 232 days — more than 7½ months. In some parts of the country, the average wait is nearly 9½ months. If your initial claim is denied, as most are, an appeal can take many more months or even years.
“There’s room for improvement at every stage of the process in the life of a claim, and there’s pitfalls at every step,” says attorney Amy Marinacci, a Social Security specialist with the nonprofit Legal Council for Health Justice in Chicago.
The SSA administers two types of disability benefits. Social Security Disability Insurance (SSDI) is available to most workers, regardless of their financial circumstances, with monthly payments based on past earnings. Supplemental Security Income (SSI) is a safety-net benefit with a federally set payment for people with very limited income and assets who have a disability, are blind or are 65 or older.
While these programs differ in important ways, they use the same criteria to determine if an applicant qualifies under Social Security’s definition of disability — essentially, a condition that is severe enough to prevent you from working for at least a year or will likely cause death. Such standards require extensive documentation of a claimant’s medical circumstances and, often, multiple layers of appeals. These tips may boost your chances for a shorter wait and a successful claim.
1. Don’t wait to file
When a severe illness or injury disrupts your ability to work, get an application into the system, even if you haven’t yet started gathering evidence.
“You want to file right away to get in line,” says Christopher Doherty of Doherty Cella Keane, a Beverly, Massachusetts, law firm specializing in Social Security disability. He says it can take “many, many months” for a new case to even get assigned to a disability examiner, during which applicants can compile medical reports for later submission.
2. Get legal help — from the start
“It’s a complicated process, and people are often surprised when their claim is denied,” says Steve Weiss, former regional managing attorney of the Social Security practice at Bay Area Legal Aid in Oakland, California. “An attorney can really help get you through the process and ensure that Social Security has the information they need to make a proper decision.”
Hiring an attorney or professional disability advocate (a nonlawyer who meets SSA-set criteria to represent applicants) or working with a nonprofit legal aid organization is the surest way to avoid gaps and errors that could delay or doom your claim. A professional representative can monitor every step of the process for you, making sure the paperwork is correct, working with doctors to collect critical records and communicating with the SSA on your behalf.
“Attorneys have access to what they call the electronic record express, and we can upload records electronically, but if you’re filing on your own, you’d have to submit them the old-fashioned way by faxing them or bringing them to the local Social Security office,” Doherty says.
A 2022 study by the nonprofit National Bureau of Economic Research found that having an attorney or professional advocate early in the process increased the probability of getting a positive decision on an initial benefit claim by 23 percent and reduced the total case processing time by nearly a year, in large part because winning at the first stage means avoiding a lengthy appeal.
Private disability lawyers typically offer a free initial consultation and do not charge up-front fees if they take your case. Rather, they get paid if you win, collecting a share of the “back pay” — past-due benefits dating to when the SSA determines you became disabled. Social Security caps the fee at 25 percent of the past-due amount or $9,200, whichever is less.
The National Organization of Social Security Claimants’ Representatives operates a referral service that can help you find an attorney or advocate in your area. State and local bar associations may also be able to connect you with disability specialists.
3. Sweat the details
Of the 1.63 million disability benefit claims filed by workers in 2022, the SSA rejected nearly 45 percent without even assessing the applicant’s health. These “technical denials” might arise from nonmedical eligibility issues — for example, a too-short work history to qualify for SSDI or financial resources above the SSI limit — but they can also be due to inaccurate or incomplete paperwork.
“Social Security makes the applications and the process to file hard enough so that lots of people cannot follow those rules, which allow SSA staff to technically deny even when many of those claimants are [medically] eligible,” says Joshua Eyestone, an attorney with Heard & Smith, a San Antonio firm that specializes in disability cases.
Something as simple as leaving a question unanswered or missing a request for further information can spark a processing delay, he says.
Technical denials have become considerably more common in recent years. According to SSA data, 1 in 7 disability claims filed by workers in 2002 received a technical denial. For 2022 applications, the most recent for which detailed data on outcomes is available, the ratio was about 2.2 to 1.
4. Make sure medical records are complete
“You don’t necessarily get benefits for being disabled — you get benefits for being able to prove it,” Weiss says. That means providing detailed documentation of your condition and how it affects your working life.
“It’s not, ‘I have this diagnosis, so I can’t work,’” he says. “It’s about the condition. ‘I have hypertension or A-fib [atrial fibrillation], which results in fatigue.’ Or, ‘I have more difficulty concentrating and need more frequent breaks.’”
The data you provide needs to be thorough and complete. Just getting a report from an ER or urgent care visit isn’t enough, Weiss says. Make copies of test results, treatment records and doctors’ reports from office visits. Check to make sure Social Security has received any records you submitted rather than waiting for them to tell you things are progressing.
It helps to have a primary care doctor you see regularly — someone who knows your situation and how it limits your ability to work. Your attorney may seek sworn statements from your doctors to present if the case gets to the stage of a hearing before an administrative law judge, where the SSA can call its own medical or vocational experts as witnesses.
“I would love it if a [client’s] treating doctor would appear at every hearing,” Doherty says, “but the reality is they’re too busy, and they might require payment. It’s not practical. It’s down to the medical records plus the claimant’s own testimony [on] how it affects them.”
5. Contact your congressional representative
If a claim is dragging with no word from the SSA, contact your member of Congress, who may be able to help you or your attorney find out why (but who cannot influence the outcome).
“The time to use it is when you hit the wall at Social Security and the case is frozen for no apparent reason,” Eyestone says. “That’s when you go to a congressional office on behalf of the client. They get that file moved a little bit. It will not change whether they win or lose.”
You can use the U.S. House of Representatives directory to find your congressperson’s official website. Look for a menu labeled “Services” or "Constituent Services" and click the link for help with a federal agency to get instructions on submitting a request.
Some members provide information specific to Social Security issues. For example, Rep. Henry Cuellar of Texas invites constituents to contact his office about disability claims, with the caveat that “there are limits to what I can do.”
“At my request, Social Security officials will ‘flag’ a particular case and keep me updated throughout the process. This communication can really help a person understand what is happening with their case, so they can make other decisions regarding their life and family,” Cuellar says on the site, but adds that he cannot act as a ‘representative’ for a disability claimant or overturn an SSA decision.
6. Trim the red tape
If you’re appealing an initial claim denial, you have options to dispense with some of the bureaucracy in hopes of getting a quicker result.
For example, Social Security is required to notify you at least 75 days before a scheduled hearing with an administrative law judge, but you may be able to get an earlier date by waiving the 75-day notice. Just be sure you’re fully prepared to present your case sooner if necessary.
If you believe your case is strong enough, you may be able to skip the hearing altogether by seeking an “on the record” ruling — essentially, asking the judge to review the evidence and render a decision without a formal proceeding. The judge can either grant benefits based on the review or decide to proceed with the hearing.
A claimant who can show “dire need” — an immediate threat to health or safety because the individual doesn’t have money for food, shelter or medical care — can ask to be moved up in the hearing queue.
Some military veterans and people with certain severe or terminal illnesses may qualify for expedited benefit decisions, but in these situations Social Security flags applications for fast-track status — you don’t need to take any action.
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