Applying for Social Security Disability: How It Works, and What to Know About Representatives and Fees

What is Social Security Disability Insurance (SSDI)?

SSDI is a program run by the Social Security Administration (SSA). SSA says that to get these benefits, you must have worked in jobs where you paid Social Security taxes. You must also have a medical condition that meets SSA’s strict definition of disability.

SSA explains that its definition of disability is different from other programs. SSA only pays for total disability. This means you are unable to work for 12 consecutive months or more because of your medical condition. SSA does not pay benefits for partial disability or for short-term disability. Generally, there is a five-month waiting period before benefits can start. SSA pays the first benefit in the sixth full month after the date it finds your disability began.

How to Apply for SSDI

SSA says there are two ways to apply for disability benefits. You can apply online through SSA’s website. Or, you can call SSA’s toll-free number to make an appointment to apply. This appointment can be by telephone or in person. SSA says the appointment usually lasts about one hour. After you schedule an appointment, SSA will send you a Disability Starter Kit to help you get ready.

SSA states that, on average, processing an application for disability benefits takes about six to eight months.

What Information You Need to Apply

SSA says that providing certain information can help it process your application faster. This information includes:

• The names, addresses, and phone numbers of your doctors, therapists, hospitals, clinics, and caseworkers, along with the dates of your visits.
• The names and dosages of all the medicines you take.
• Any medical records you already have.
• Laboratory and test results.
• A summary of where you worked and the kind of work you did.
• A copy of your most recent W-2 form, or, if you are self-employed, your federal tax return from the previous year.

SSA also states that you will need to fill out other forms. One is the SSA-3368, which collects information about your medical condition and how it affects your ability to work. Another is the SSA-827, which gives permission to doctors, hospitals, and other healthcare professionals to send information about your medical condition to SSA.

Working with a Representative

SSA says you have the right to have a representative help you when you do business with Social Security. Your representative can be an attorney or a non-attorney. SSA will work with your representative just as it would with you.

For your protection, your representative usually cannot charge or collect a fee from you without first getting written approval from SSA. This approval is called fee authorization. However, a representative may accept money from you in advance if it is held in a trust or escrow account until SSA authorizes a fee. SSA notes that some organizations can help you find a representative or offer free legal services. Each SSA office has a list of organizations that can help you find a representative.

Once you appoint a representative, SSA says that person can act on your behalf. They can:

• Get information from your Social Security file.
• Help you get medical records or other information to support your claim.
• Come with you, or for you, to any interview, conference, or hearing with SSA. However, a representative cannot testify in your place at a hearing.
• Request a reconsideration, a hearing, or an Appeals Council review if you want to appeal a decision.
• Help you and your witnesses prepare for a hearing and question any witnesses.

After you choose a representative, you must tell SSA in writing as soon as possible. You do this on SSA’s form SSA-1696, called “Claimant’s Appointment of a Representative.” Both you and your representative must sign this form. SSA says you cannot appoint someone the law prohibits from acting as a representative. You also cannot appoint someone SSA has suspended or disqualified from representing others.

How Representatives Are Paid

SSA says that in most cases, your representative must file a fee agreement or a fee petition. This is how they ask SSA to authorize the fee they can charge you. Your representative cannot charge you more than the amount SSA authorizes.

Fee Agreements

SSA generally approves a written fee agreement if certain conditions are met:

• You or your representative file it, signed by you and all your representatives who are charging a fee, before SSA decides your case.
• SSA approved your claim and you will get past-due benefits.
• The fee is not more than 25% of your past-due benefits or the maximum amount set by the Commissioner, whichever is less.

SSA tells you in writing whether it approves the agreement. If you disagree with that decision, or with the fee amount it authorizes, you or your representative must contact SSA within 15 days. SSA states that if a representative charges or collects a fee without its approval, or more than it authorized, SSA may suspend or disqualify them from representing anyone before the agency.

SSA states that the current maximum fee amount allowed in a fee agreement is $9,200 when a favorable decision is issued on or after November 30, 2024. This fee cannot exceed the lesser of 25% of the past-due benefits or this maximum amount. Once SSA approves a fee agreement, that fee is the highest amount the representative may charge and collect for all services related to the claim.

Fee Petitions

If you and your representative do not submit a fee agreement, or if SSA does not approve it, your representative may submit a fee petition. This happens after they complete the work on your claim. The petition must describe in detail the services they provided and the time spent on each. SSA reviews the value of these services and tells you in writing the fee your representative is authorized to charge. If you disagree with the fee SSA authorizes, you must tell SSA in writing within 30 days.

SSA says the fee it decides is the most you owe for your representative’s services, even if you agreed to pay more. However, your representative can charge you for out-of-pocket expenses, such as costs for medical reports or hospital records, without SSA’s approval. If your representative qualifies for direct payment, SSA will withhold up to 25% of your past-due benefits to pay toward the fee.

Appealing an SSDI Decision

The Social Security Administration says you have four chances to appeal its decision, in this order:

1. Ask SSA to reconsider the decision.
2. Request a hearing with an administrative law judge.
3. Request a review by the Appeals Council.
4. File an action in federal district court.

You may not have to go through every level of appeal. You may choose an attorney or other qualified person to help you with the appeal.

Practical Steps for Your SSDI Application

When preparing to apply for Social Security Disability Insurance, consider these general steps:

• Gather Information: Collect the names, addresses, and phone numbers of all your doctors, therapists, hospitals, clinics, and caseworkers, along with the dates of your visits. Make a list of all medicines you take and their dosages. Find any medical records, lab results, or test results you already have.
• Document Work History: Prepare a summary of where you have worked and the kind of work you did. Have a copy of your most recent W-2 or, if self-employed, your federal tax return from the previous year ready.
• Understand Forms: Be aware that you will need to fill out forms like the SSA-3368, which asks about your medical condition and its effect on your work ability, and the SSA-827, which allows medical professionals to share your health information with SSA.
• Consider Representation: If you choose to have a representative, know that they can be an attorney or a non-attorney. Ensure you formally appoint them using SSA’s form SSA-1696 and that both you and your representative sign it.
• Monitor Fees: If you have a representative, understand that SSA must authorize their fee. Be aware of how fee agreements and fee petitions work, including the maximum fee limits SSA sets.

When to get legal help

Understanding Social Security Disability Insurance rules and processes can be complex. The information above is for general understanding. It is not legal advice. Laws and rules can vary, and your situation is unique. If you have questions about your specific situation, consider talking to a licensed attorney in your state. A legal aid office in your area may also be able to help. You can also contact your state bar association for resources or referrals.