Understand SSDI Eligibility for Disabilities from Birth

The Social Security Administration (SSA) provides SSDI benefits to individuals with disabilities, including those that occurred at birth. To qualify for SSDI, you must meet the following general requirements:

• Work History: Typically, SSDI is available to individuals who have worked and paid Social Security taxes for a sufficient number of years. However, if you were born with a disability and have not worked, you may still qualify based on the work history of a parent. If your parent is receiving Social Security benefits, or has passed away, you may be eligible for benefits through their record under Social Security Disability Benefits for Children.
• Disability: Your disability must be severe enough to prevent you from engaging in substantial gainful activity (SGA). If you have a disability from birth, the SSA will look at how this condition affects your ability to work.
• Age: If you are over the age of 18 and have a disability that started before you turned 22, you may be eligible for Adult Child Benefits through your parent’s work record, even if you have never worked yourself.

Gathering Necessary Documents

When applying for SSDI due to a disability from birth, the SSA will require documentation of your condition and how it affects your ability to work. Key documents you will need include:

• Medical Records: Detailed medical documentation of your birth condition, treatment history, and any medical evidence that shows the severity of your disability. This could include doctor’s notes, hospital records, test results, and treatment plans.
• Work History (if applicable): If you’ve worked at any point in the past, you’ll need to provide a record of your employment. However, if you are applying as an adult child, this step might not apply.
• Parental Work History (if applicable): If you are applying based on your parent’s work record (because you were disabled at birth), you will need to provide proof of your parent’s Social Security work history, such as their Social Security number, dates of birth, or death certificate if applicable.

Apply for SSDI Online, By Phone, or In-Person

There are three main ways to apply for SSDI benefits:

• Online: The fastest way to apply is through the SSA’s online application at www.ssa.gov. You can create an account and submit your application directly on the website.
• By Phone: You can call the SSA at 1-800-772-1213 to apply for SSDI benefits. A representative will walk you through the application process.
• In-Person: You can also apply in person at your local Social Security office. It’s recommended to make an appointment before visiting to avoid long waits.

SSA’s Evaluation Process for Birth Disabilities

The SSA will assess your application by evaluating whether your disability from birth meets its eligibility criteria. If your condition is severe enough to limit your ability to engage in substantial gainful activity, they will review your medical records and determine if your condition is covered under the Listing of Impairments.

The SSA follows a five-step evaluation process to determine whether you are eligible for benefits:

• Step 1: Substantial Gainful Activity (SGA) – If you are earning over the monthly threshold for SGA, you may not be eligible for benefits. For 2023, the threshold for non-blind individuals is $1,470 per month.
• Step 2: Severe Condition – Your condition must be severe enough to prevent you from working and significantly limit your ability to perform basic tasks.
• Step 3: Meet a Listing – If your disability is listed in the SSA’s Listing of Impairments, you may automatically qualify. For example, if you were born with a serious physical or mental condition, it may be listed, and you would qualify without further evaluation.
• Step 4: Past Work – The SSA will evaluate whether you can still perform your previous job, considering your disability.
• Step 5: Other Work – If you can’t do your past job, the SSA will assess if you can perform any other type of work, considering your age, education, and other factors.

Wait for a Decision and Follow Up

Once you submit your application, the SSA will take time to process it. It can take 3 to 5 months or longer to receive a decision. During this time, the SSA may ask for additional documents or medical records, so it’s important to stay organized and respond promptly to any requests.

What to Do If Your SSDI Claim Is Denied

It’s common for SSDI claims to be denied, even when the applicant has a disability from birth. If your claim is denied, you can appeal the decision. The appeals process includes:

• Reconsideration: If your initial application is denied, the first step is to ask for reconsideration. This is a review of your case by someone who was not involved in the initial decision.
• Hearing Before an Administrative Law Judge (ALJ): If your reconsideration is denied, you can request a hearing before an ALJ. During the hearing, you can present additional evidence and explain your case in person.
• Appeals Council: If the ALJ denies your claim, you can ask the SSA’s Appeals Council to review the decision.
• Federal Court: If all appeals fail, you can file a lawsuit in federal court to contest the decision.