Applying for Social Security Disability Insurance is not like filing an insurance claim. The process is long, the denial rate on initial applications is high, and the appeals system requires presenting medical evidence and legal arguments before an Administrative Law Judge. Most people who are approved for SSDI benefits are approved on appeal, not on the initial application. Understanding when an attorney makes the difference is the first step in deciding whether you need one.
The SSDI application process and why denials are common
SSDI provides monthly income to people who are unable to work because of a medical condition that is expected to last at least 12 months or result in death. The Social Security Administration evaluates whether the applicant meets the medical criteria for disability based on the severity of the condition, the functional limitations it produces, and whether those limitations prevent the applicant from performing any substantial gainful activity.
The initial application is reviewed by the state’s Disability Determination Services office. Nationally, roughly two-thirds of initial applications are denied. In New York, the denial rate is comparable. The most common reasons for denial are insufficient medical evidence, failure to demonstrate that the condition prevents all substantial gainful activity, and technical errors in the application.
When an attorney is essential
If your initial application is denied, you have 60 days to request reconsideration and then a hearing before an Administrative Law Judge. The hearing is where most successful SSDI claims are won. It is a formal proceeding where you present medical evidence, testimony, and legal arguments. The ALJ questions you about your daily activities, your work history, your symptoms, and your functional limitations. A vocational expert may testify about whether jobs exist that you can perform given your limitations.
This hearing is where an attorney makes the greatest difference. An attorney who handles SSDI cases knows what medical evidence the ALJ needs to see, how to present the treating physician’s opinion in the format the SSA requires, how to cross-examine the vocational expert, and how to frame the testimony to address the specific legal criteria for disability. A claimant who appears at a hearing without representation is at a significant disadvantage.
What an SSDI attorney costs
SSDI attorneys work on a contingency basis. The fee is regulated by federal law: 25% of the back benefits awarded, up to a maximum of $7,200 (as of 2024, adjusted periodically). You do not pay unless you are approved and receive benefits. You do not pay a retainer. You do not pay out of pocket. The fee is deducted directly from the back benefits by the SSA before your payment is issued.
The interaction between SSDI and workers’ compensation
If you are receiving workers’ compensation benefits and also qualify for SSDI, the combined benefits are subject to an offset. Federal law caps the total of workers’ compensation and SSDI at 80% of your pre-disability average current earnings. If the combined amount exceeds that cap, one of the two benefits is reduced. In New York, the workers’ compensation benefit is typically reduced rather than the SSDI payment.
An attorney who handles both workers’ compensation and SSDI can structure the workers’ compensation settlement to minimize the offset and maximize the total recovery across both systems. This coordination is one of the most valuable things an attorney does in cases where both benefits apply.
How Schwartzapfel Holbrook advises clients on SSDI
At Schwartzapfel Holbrook, we evaluate every workers’ compensation case for potential SSDI eligibility. When a client’s injury is severe enough that they may qualify for Social Security disability, we coordinate the two claims to minimize the offset and maximize the total recovery. We work with attorneys who specialize in SSDI hearings to ensure our clients are represented at every stage of the process.
Schwartzapfel Holbrook / Fighting For You