Workplace injuries can have long-lasting consequences, sometimes leaving employees unable to return to work. If your injury prevents you from working for an extended period, you may be eligible for Social Security Disability Insurance (SSDI).
However, the process of applying for SSDI after a workplace injury can be complex. In this guide, we’ll cover everything you need to know about filing for SSDI as a California employee and how to increase your chances of receiving benefits.
What is SSDI?
Social Security Disability Insurance (SSDI) is a federal program that provides financial support to individuals who are unable to work due to a long-term disability. Unlike Workers’ Compensation, which is specifically for work-related injuries, SSDI covers disabilities from any cause, as long as they prevent you from performing substantial gainful activity (SGA). If your workplace injury results in a long-term disability, you may qualify for SSDI benefits in addition to any Workers’ Compensation benefits you receive.
SSDI vs. Workers’ Compensation
While both SSDI and Workers’ Compensation provide benefits to injured employees, they serve different purposes. Workers’ Compensation is for work-related injuries and provides medical benefits and wage replacement. SSDI is a federal program that provides ongoing financial assistance for long-term disabilities, whether work-related or not. Employees may be eligible for both programs if their injury meets the criteria.
Eligibility Requirements for SSDI
Before you file for SSDI, it’s important to understand the eligibility requirements. To qualify for SSDI, you must meet specific criteria set by the Social Security Administration (SSA).
Work History
SSDI is available to workers who have paid into the Social Security system through payroll taxes. The SSA uses a system of “work credits” to determine eligibility. The number of work credits required depends on your age at the time of the disability, but in general, you need to have worked five of the last 10 years.
Long-Term Disability
Your disability must prevent you from engaging in any substantial gainful activity (SGA), meaning that you are unable to work in any meaningful capacity. In addition, the disability must be expected to last at least 12 months or result in death.
Medical Documentation
You’ll need strong medical evidence to prove your disability. The SSA requires documentation from healthcare providers, such as doctors and specialists, that outlines the severity of your injury, its impact on your ability to work, and the expected duration of your condition.
Filing for SSDI After a Workplace Injury
If you believe you qualify for SSDI after a workplace injury, the application process can be daunting. Here are the steps to follow:
1. Gather Medical Records
Before filing your SSDI claim, gather all medical records related to your injury. These records should include doctor’s notes, diagnostic tests, treatment plans, and any other documentation that demonstrates the severity of your condition. The more comprehensive your medical evidence, the stronger your claim will be.
2. Complete the SSDI Application
You can apply for SSDI online, by phone, or at your local Social Security office. The application will require detailed information about your medical condition, work history, and any other benefits you are receiving, such as Workers’ Compensation.
3. Wait for a Decision
Once you submit your application, the SSA will review your medical records and other supporting documents. It can take several months for the SSA to make a decision, and many first-time applicants are denied. If your claim is denied, don’t be discouraged—many people successfully appeal denials with the help of an experienced attorney from PLBH.
How Workers’ Compensation Affects SSDI
If you are receiving Workers’ Compensation benefits, your SSDI payments may be reduced due to the workers’ compensation offset. This rule limits the total amount of benefits you can receive from both programs to 80% of your pre-disability earnings.
Example of the Offset Rule
Let’s say your pre-injury earnings were $4,000 per month. The SSA caps the combined Workers’ Compensation and SSDI benefits at 80%, or $3,200 per month. If you receive $2,000 per month in Workers’ Compensation benefits, your SSDI benefit will be reduced to $1,200 to stay within the cap.
Appealing a Denied SSDI Claim
If your SSDI application is denied, don’t give up. The appeals process allows you to challenge the decision and provide additional evidence to support your claim.
Steps in the Appeals Process
- Reconsideration: The first step in the appeals process is to request reconsideration, where the SSA reviews your application again.
- Hearing: If your claim is denied at reconsideration, you can request a hearing with an administrative law judge (ALJ).
- Appeals Council: If the ALJ denies your claim, you can request a review by the Appeals Council.
Working with an attorney from PLBH can greatly improve your chances of success during the appeals process.
Get Help with Your SSDI Application
Filing for SSDI after a workplace injury can be a complex and lengthy process, but you don’t have to go through it alone. If you’ve been injured on the job and need help applying for SSDI, contact PLBH at (800) 435-7542 for expert legal guidance. Our experienced attorneys will help you navigate the application process and maximize your chances of receiving the benefits you deserve.