There are many factors that play a role in SSA’s evaluation of a claim for disability. Simply put, if you are no longer able to work full time and earn “substantial gainful activity” amounts each month ($1,690 gross for 2026), then you might be deemed disabled. Both mental and physical health conditions can be the basis of a claim for disability. You need to have medical care with testing to confirm diagnoses and treatment notes that help verify your limitations. Your age plays a role, and the rules become less demanding once you are over age 50. It is much more difficult to prove disability for younger individuals, but not impossible.

Anybody can file on their own, either online through SSA’s website, or by calling and speaking with SSA directly. You do not need to have a representative in order to start a disability application.

Typically, we schedule a 20-30 minute phone call for an intake conversation. We will talk through all of the basic information that we need in order to assess your claim and determine what step needs to be taken next. We will gather all of your personal information like your name, date of birth, address, etc… We will also ask for the status of your disability application to know if we need to help you file, or if an appeal is necessary already. We will talk through your medical conditions and gain a basic understanding of how you’ve been doing and why work hasn’t been possible for you. Having your list of current medications is helpful, as well, along with a list of your doctors and other medical providers.

Both types of applications have the same standard for disability in terms of whether or not a person is capable of full-time work. The differences have to do with other eligibility questions and how the benefits are paid. A person can get Disability Insurance Benefits if they have been working and paying taxes into the SS system. The monthly benefit amount depends on how much you earned and what taxes you paid. SSI is a monthly payment just to help people survive. SSI can be paid for children with disabilities, refugees, or other people who haven’t ever worked and paid taxes, or who have a DIB monthly amount that is lower than the SSI maximum. For 2026, SSI will pay a maximum of  $994. That amount is reduced each month based on any other source of income or support that a person receives.

An initial claim is filed and reviewed by the Social Security Administration before being sent to the state’s Disability Determination Services office for a medical decision concerning disability. If the claim is denied, a request for reconsideration needs to be filed. The claim is sent back to the state agency for a second determination. If they deny the claim again, the next appeal asks for a hearing with an Administrative Law Judge. If you still do not succeed with the judge, there is one final possible appeal with the SSA asking for a review of the judge’s decision through the Appeals Council. If the claim remains denied, then the next possible step would be a civil law suit in federal district court, asking for legal review of the SSA’s decision that was made by their Administrative Law Judge.

For the last year or so, Idaho’s Disability Determination Services office has been catching up with their backlog and resolving claims much more quickly. We usually expect 3-5 months for an initial claim and 2-4 months for a reconsideration request. Once we request a hearing, we have been waiting 8-9 months for the ALJ hearings to take place. The Appeals Council has been taking 9-10 months to make their decisions.

Hearings with an Administrative Law Judge are surprisingly informal. Ultimately, they are just a conversation with the judge to explain what has been happening in your life to prevent you from keeping a full time job. The hearings are recorded and you will be asked to swear to tell the truth so that technically, everything you share is sworn testimony. Beyond that, though, the hearing is very conversational and intentionally relaxed. Most judges want the claimants to be as comfortable as possible during their hearings. They want to be able to speak openly about medical conditions and work history and each of the factors that are relevant to the disability claim. In all adult disability cases, a vocational expert will also participate. They help with two things. They can help explain to the judge what work a person has performed in the last five years so the judge knows how to evaluate that. Then, they answer hypothetical questions for the judge and for your representative. We talk through various sets of limitations and ask the VE whether or not a person with those limitations could still work full time. This helps the judge to determine what they need to believe about you and your conditions in order to agree that disability benefits are appropriate.

There are pros and cons to any of the options. Ultimately, it will depend on your situation and which type of a hearing makes the most sense for you. Timing for the hearing often differs between the options. Sometimes hearings can be scheduled faster if they are held by video because files can be transferred anywhere in the nation when some offices get further ahead and have less work to accomplish. Other times, in person hearings have been scheduled faster. For some people, traveling to the nearest hearing office can be fairly difficult, and the ability to stay at home for the hearing is incredibly helpful. When the time comes, we would talk through your specific situation and the most recent trends before deciding what kind of a hearing you ought to ask for.

We help with initial applications, filing for Disability Insurance Benefits or Supplemental Security Income. If a claim has been denied, we can assist with the request for reconsideration. With either initial claims, or reconsideration requests, we help manage the paperwork that the state agency sends out in each case to gather relevant information about a person’s functioning and limitations. We can help with all communications with the adjudicator at the state’s disability determination services. If the claim is denied again, we help file the request for a hearing with an Administrative Law Judge and then make sure each file is fully prepared for that hearing when it happens. We will be there with you for the hearing to make sure your claim is properly presented to the judge. If further appeals are needed beyond the ALJ hearing, we can help with the Appeals Council and will assist with a referral to a federal district court appellate firm, if an appeal to the district court is also needed.

All attorney’s fees are tightly regulated by the SSA. We only get paid when we are able to succeed with a claim. Fees are calculated as 25% of past due benefits only, with a maximum fee cap that is determined from year to year by SSA. Currently, the max fee is $9,200, regardless of how much you are awarded in retroactive pay. There is no fee if we cannot succeed, or if the claim doesn’t result in any past due benefits.

You are allowed to change representatives, if you choose to. You need to inform the prior representative in writing that you no longer need their services and ask them to withdraw officially. Be aware, though, that they have the right to withdraw, but maintain their right to be paid for work that they have already performed. If they do not waive their entitlement to eventual fees, it will mean that a fee agreement cannot be approved for any representative. Every attorney will be forced to file a fee petition, asking to be paid for their work. Before we can have a full conversation with you, we will need to know that any prior representative has already withdrawn.

Absolutely. If you fail to complete their questionnaires, they are able to simply deny the claim for failure to cooperate. They require details from you in order to understand your work history and so that they can assess your ability to function from day to day. The Adult Function Report is your opportunity to tell your story. It is worth it to take the time to provide lots of information with good, clear examples as you answer the questions on that form.

If you don’t attend an appointment that SSA schedules for you, they can simply deny the claim and say that you refused to provide information that was necessary in order to make a decision in the claim. When you see a consultative examiner, remember that they are watching for people who are faking symptoms or exaggerating their conditions. Just be completely honest and do your best to help them understand your situation. Participate fully and give your best efforts. Ultimately, your own doctor’s information should be the most important evidence in your claim, but Social Security’s doctors can also give helpful information in their reports, as well.

Once a claim is awarded, SS usually works fairly quickly to get benefits started. Usually within the following two weeks, the local office reaches out to ask several follow up questions concerning SSI eligibility to make sure they are paying the correct amount of SSI each month. They can then release portions of the past due benefits immediately. They only pay 3 months’ worth of SSI at a time, though, with a six month wait before the next installment of past due payments will be released. You can ask for more of your money to be released immediately, if you can verify for Social Security where the money will be spent quickly so that you don’t go over the asset limits and become ineligible.

DIB payments are calculated out of several payment centers. They typically have details calculated about 30-45 days after a favorable decision has been made. In some cases we need to call and check status when benefits are not released by 60 days.

SSI payments begin the next full month after the date of application. For DIB payments, they can pay up to 12 months of retroactive benefits before the date of application. They do not pay any benefits at all, though, for the first 5 months of a person’s disability. In some cases, that means that benefits won’t start until a few more months in the future and there are no past due benefits. In other cases, the five month waiting period will have already passed before the 12 months prior to the application date, so they are able to pay that full extra year of past due benefits.

Household income and support counts against a monthly SSI payment. If you are able to work at all, the first $65 doesn’t count at all. For every $2 above that, though, they will reduce the SSI payment by $1. That is a monthly process. If a person receives benefits of any kind from other sources, such as veterans disability, workman’s compensation, short or long term disability, or even support from friends or family, then Social Security will reduce the amount in SSI that they pay each month. If an SSI recipient is able to live somewhere without paying rent, their monthly SSI check will be reduced by 1/3 automatically. If you have more than $2,000 in assets as an individual or more than $3,000 as a couple, then you cannot receive SSI payments.

Depending on your own monthly DIB payments, there may be an additional amount that is payable for any dependent children, as well. There are no additional benefits for children through SSI.

Yes, you can. There are a number of different scenarios that could play out depending on your situation and exactly what is happening. Some law offices will tell their clients simply not to work at all because it brings up additional questions. When cases take up to a year or longer to resolve, though, it is difficult to figure out how to survive while waiting. Ultimately, if you were able to find a job that you could still perform despite your limitations, then you wouldn’t need to wait for disability, anyhow.

If a job is part time only and your earnings are always below SGA, then you can still be considered disabled, even with that work activity. If your earnings were over SGA, but the job only lasted for several months before your disabilities interfered with your work, then we would argue that was an unsuccessful work attempt. There are several scenarios that are permissible in terms of ongoing work activity, even though you are arguing for disability benefits.

If you are in school, they will usually want to know how that is working out. When you are a full time student and taking classes on campus and doing well overall, they can argue that it looks a lot like a full time job, and use that as evidence that you should be capable of working still. When a person is taking one or two classes only, or taking online coursework, or working with a school’s disability advocacy office to function with significant accommodations in school, then you can show why your efforts in school shouldn’t be used as evidence of an ability to work full time.