Understand SSA’s Decision

The Social Security Administration (SSA) may take six months or more to decide if you have a disability and should get Social Security Disability Insurance (SSDI) benefits. Once they've decided, they will send you a disability determination notice, which is a letter that says whether they approved or denied your application.

This letter can be confusing. If you have questions, call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY) or contact Disability Rights New Jersey (DRNJ).

If you disagree with Social Security’s decision, you can file an appeal.

If You Are Approved for SSDI

If you are approved for SSDI:

  • SSDI benefits start at least five full months after your disability began. This is called the waiting period.
    • Note: If you are approved for SSDI more than five months after your disability began, you may get a retroactive payment for the months since the five-month waiting period ended. Example: You are approved for SSDI eight months after your disability began, so you get a one-time payment that covers your SSDI benefits for the last three months (since the fifth month after your disability began).
    • Note: There is no waiting period for Childhood Disability Benefits (CDB).
  • The amount you get depends on your Social Security earnings record. Generally, the more you worked and paid in Social Security taxes, the more you get in SSDI benefits. For CDB, the amount is based on a parent's work record and for Disabled Widow(er) benefits, it's based on the spouse's work record.
  • Your SSDI benefits go into your bank account automatically each month. If you don’t have a bank account, you can get your SSDI benefits put onto a Direct Express debit card that you can use to buy things.
  • Your children under age 19 may also qualify to get benefits based on your work record in any month you get SSDI benefits. Your spouse may also get benefits if age 62 or older or if caring for a child under 16. It doesn't matter whether they have disabilities. Learn more about these benefits.
  • Medicare health coverage automatically starts after you get SSDI, CDB, or Disabled Widow(er) benefits for two years (24 months). Learn more in DB101's How Health Benefits Work article.
Example

Silvio’s disability begins on April 22, 2018, but he has to wait five months (May, June, July, August, and September) for his SSDI benefits to begin. His first SSDI payment is for October 2018, but SSDI sends payments one month after they are due, so he doesn’t get his first payment until November 2018.

Silvio has to wait another two years, until October 2020, for Medicare coverage. While he’s waiting for Medicare, Silvio applies for Medicaid.

Medicare and Medicaid if you get SSDI

When you have Medicare coverage, there are a couple of ways you may also qualify for Medicaid.

If you qualify for Medicare and Medicaid (or NJ WorkAbility) at the same time, you have lower overall medical expenses, because Medicaid covers some medical expenses that Medicare doesn’t cover; you may also pay less for Medicare premiums and deductibles.

If You Are Denied SSDI Benefits

You may be denied benefits if Social Security says you are not insured or you do not have a disability. If you are not insured, you may still qualify for another Social Security benefit for people with disabilities called Supplemental Security Income (SSI). Learn more in DB101’s SSI article.

Filing an Appeal

If you feel that Social Security's decision is incorrect, you can file an appeal:

  • File your appeal quickly. After you get a denial letter, you have 60 days to file an appeal. If you don’t appeal within 60 days, you may not be able to appeal.
    • If you were already getting SSDI and are appealing an overpayment notice, appeal within 30 days to avoid having your benefits withheld while your appeal is reviewed.
    • Note: Social Security figures that you get a letter within five days after they sent it.
  • If you are denied SSDI benefits for medical reasons, you can file your appeal online or call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY) and ask them to send you an appeal form. If you file online, you need to mail or deliver any new information to Social Security about your medical condition, including updates on any treatment, tests, or doctor visits.
  • If you are denied SSDI benefits for nonmedical reasons, you can request a review from your local Social Security office or by calling Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY).

File an appeal as quickly as possible. Once you file your appeal, it may take months to resolve.

Note: If your application for SSDI benefits is denied and you disagree with the decision, file an appeal. Do not just fill out the application forms again — that would be refiling.

The appeal process

There are four levels to the appeal process. If you don't like the result at one level, you can appeal to the next. The four levels are:

  1. Reconsideration: A person at Social Security who wasn’t involved in the first decision looks at your application. This is a written appeal, so you don’t have to go in front of a judge. Give Social Security any new information you have about your case.
  2. Hearing: If the reconsideration is denied, you can ask for a hearing before an Administrative Law Judge. You can bring witnesses to help make your case. Think about having a lawyer or representative help you.
  3. Appeals Council: Social Security’s Appeals Council will review your case if you appeal the Administrative Law Judge’s decision. The Council can accept the judge’s decision, decide the case for itself, or send it back to a different Administrative Law Judge for another hearing.
  4. Federal Court: If the Appeals Council decides against you, you can file a lawsuit in federal court.

For any level beyond the reconsideration, you may want a lawyer. Contact Disability Rights New Jersey (DRNJ) for help with appeals.