Initial Determination

When someone applies for Social Security disability insurance (SSDI), he or she must go through an extensive application process in order to get an initial determination as to eligibility. Most applicants are denied SSDI benefits after their initial determination. However, applicants also have 60 days after the initial determination within which to file an appeal, where a fair number of initial decisions are reversed. Many applicants also like to use a benefits calculator to try to estimate their potential SSDI benefits.

Application Process

The initial SSDI application can be made either by phone, through the mail, online or in person. Illinois has over 50 Social Security Administration (SSA) field offices where applications can be made or should be sent. There are two main parts to the SSDI application.

The first portion of the application covers the non-medical eligibility information. This includes information like age, marital status, work history, income, living arrangements, residency and other sources of income. This first stage of the application process also verifies that the applicant has paid into the Social Security program for the required number of years in order to be eligible for SSDI benefits.

The SSA field office makes the determination whether an applicant has met the financial and legal eligibility requirements. If so, it passes the application on to Disability Determination Services (DDS).

The DDS is a state agency that is federally funded. Its mandate is to review SSDI applications for medical eligibility. The DDS will review the information provided in the application. If it feels it needs more information than what’s in the application to make a determination, it will conduct a consultative exam (CE). A CE can include contacting medical personnel, both the applicant’s treatment provider and/or outside consultants. It may also visit the applicant to conduct an interview.

The DDS is trying to answer five critical questions:
1. Is the applicant working?
If an applicant is working and earning a minimum monthly amount, he or she is considered to be engaging in substantial gainful activity (SGA), which makes the applicant ineligible for SSDI benefits.

2. Does the applicant have a severe impairment?
It’s insufficient for the applicant to have a medical condition. The condition must be serious enough that it’s expected to either last at least 12 months or end in death.

3. Is the medical condition included on the SSA’s Listing of Impairments?
The SSA publishes its Listing of Impairments, which lists out all of the conditions that qualify as a medical disability for SSDI benefits. The listing for each condition details the symptoms, signs and medical findings that must be present. In some cases, if the medical condition is sufficiently severe, it needn’t meet all the requirements in the Listing of Impairments.

4. Can the applicant still do work done in the past?
If yes, the applicant is considered to have enough residual functional capability (RFC) despite the medical condition to work and would be considered ineligible for SSDI benefits.

5. Can the applicant do other types of work?
Here the DDS considers the applicant’s RFC, age, skills and education to determine if he or she can perform other types of work besides what’s been done in the past.

At the end of the initial application process, all applicants receive a letter informing them whether the application has been denied or approved. The process can take up to 90 days.