If you’re unable to work due to a disability, you may be considering filing for Social Security Disability Insurance (SSDI) or a private disability insurance claim. Both options can provide crucial financial support, but the application processes and eligibility requirements are different—and often complicated. This is where a skilled disability lawyer for SSDI and private insurance can make all the difference.

In this post, we’ll break down the differences between SSDI vs. private disability claims, explain why working with a disability attorney is essential, and offer practical advice for improving your chances of a successful claim.

SSDI vs. Private Disability Claims: Key Differences

When you’re unable to work due to a medical condition, two primary options can provide financial relief: SSDI, a government program administered by the Social Security Administration (SSA), and private disability insurance offered through employers or purchased individually. While both provide income replacement, they differ in several key ways.

Eligibility requirement:

SSDI

To qualify for SSDI, you must have a medical condition that prevents you from performing substantial gainful activity (SGA) and is expected to last at least 12 months or result in death. Additionally, you must have worked and paid into the Social Security system long enough to earn the required number of work credits.

Private Disability Insurance

Eligibility for private disability benefits depends on the specific terms of your policy. Private insurers typically require medical evidence proving that you cannot perform the duties of your occupation or, in some cases, any occupation. Unlike SSDI, there’s no requirement to prove your disability will last a specific duration.

Benefit Amounts:

SSDI

Monthly benefits are based on your lifetime average earnings covered by Social Security. As of 2024, the average SSDI benefit is approximately $1,537 per month, although the exact amount varies by individual.

Private Disability Insurance

Benefits are typically a percentage of your pre-disability income, often ranging from 50% to 70% of your salary. The exact amount and duration of benefits depend on your policy terms.

Application Process and Approval Rates

The SSDI application process is notoriously challenging. According to the SSA, approximately 67% of initial SSDI applications are denied, often due to insufficient medical evidence or application errors.

Private insurance claims are processed by individual companies, which can have more flexible eligibility criteria. However, insurers may still deny claims due to insufficient medical documentation or failure to meet policy definitions of disability.

Medical Evidence Requirements

• SSDI: The SSA requires comprehensive medical records proving your disability and how it limits your ability to work. The process often involves consultative exams and reviews of your daily living activities.
• Private Disability Insurance: Private insurers also require detailed medical evidence, but the focus is typically on whether you can perform your specific job duties. Some policies may include regular medical reviews to ensure your condition still qualifies for benefits.

Duration of Benefits

SSDI benefits continue as long as you remain disabled and meet SSA criteria. Periodic reviews are conducted to assess your ongoing eligibility.

Benefit duration depends on your policy. Short-term policies may provide benefits for several months, while long-term policies can cover you until retirement age, provided you continue to meet the disability criteria.

Why You Need a Disability Lawyer for SSDI and Private Insurance Claims

Navigating the complexities of SSDI and private disability claims can be overwhelming—especially when dealing with medical challenges.

A knowledgeable disability attorney can significantly improve your chances of approval by:

Ensuring Accurate and Complete Applications

An attorney will help you gather the necessary medical evidence, complete paperwork accurately, and meet all deadlines, reducing the risk of delays or denials.

Communicating with the SSA and Insurance Companies

Your lawyer will handle all correspondence, ensuring that requests for additional information are answered promptly and correctly.

Representing You in Appeals

If your initial application is denied, a disability attorney can guide you through the appeals process, including representing you at hearings before an administrative law judge (ALJ) for SSDI cases or negotiating with private insurers.

Advocating for Your Rights

Insurance companies may prioritize their bottom line over your needs. An attorney ensures that your rights are protected and that the insurer adheres to the terms of your policy.

Maximizing Your Benefits

By presenting a well-documented case, an attorney can help you secure the maximum benefits available under both SSDI and private insurance.

Coordinating SSDI and Private Insurance Claims

If you qualify for both SSDI and private disability benefits, it’s essential to understand how these benefits interact. Many private insurance policies include a provision that reduces your monthly benefit by the amount you receive from SSDI. This is known as an “offset” and can impact your total income.

A knowledgeable disability attorney can help you:

• Maximize your total benefits by ensuring that offsets are calculated correctly.
• Coordinate the timing of your claims to avoid unnecessary delays or reductions.
• Navigate the process of applying for SSDI while receiving private disability benefits, ensuring compliance with both programs’ requirements.

Common Challenges in Disability Claims

Both SSDI and private insurance claims can be denied for various reasons, including:

• Insufficient Medical Evidence: Failing to provide detailed medical records that support your disability.
• Missed Deadlines: Missing filing deadlines or failing to respond to requests for additional information.
• Incomplete Applications: Omitting required information or making errors on your application.
• Disputes Over Disability Definitions: Differences between SSA and private insurer definitions of disability.

Having a disability lawyer for SSDI and private insurance on your side can help you overcome these challenges and improve your chances of a successful outcome.

Protect Your Financial Future with the Right Disability Attorney

Navigating the complexities of SSDI vs. private disability claims can be overwhelming, but you don’t have to do it alone. Whether you’re applying for SSDI, filing a private insurance claim, or coordinating both, a skilled disability attorney can guide you through the process, ensuring your rights are protected and maximizing your chances of receiving the benefits you deserve.

Ready to take the next step? Schedule a consultation with Disability Attorney Services today and let us help you secure the financial support you need.