Are you or a loved one facing challenges due to a severe medical or mental impairment? The process of applying for disability benefits in North Carolina can be daunting, but understanding each step in detail can help alleviate some of the uncertainty. Let’s dive deeper into how to apply for disability in North Carolina. While we hope this guide provides you the knowledge and confidence to navigate this important journey, each disability claim is unique and claimants working with attorneys have higher approval rates than those who file alone. We encourage all potential claimants to contact our firm directly for a free consultation with one of our North Carolina disability attorneys.
Which Body Determines Disability in North Carolina?
In North Carolina, the Disability Determination Services (DDS) determines whether claimants meet the guidelines for SSDI or SSI disability benefits.
The Disability Determination Services (DDS)
DDS is a crucial entity tasked with evaluating disability claims within North Carolina. DDS comprises medical and vocational professionals whose role is to meticulously review each case, examining medical records, conducting assessments, and considering the claimant’s ability to perform substantial gainful activity (SGA). SGA is a monthly limit for earnings set by the Social Security Administration (SSA) annually. Claimants earning above SGA do not meet the technical requirements for SSDI disability programs. This evaluation process involves a comprehensive analysis to determine if the claimant meets the SSA’s definition of disability, which requires the inability to engage in SGA due to a severe impairment expected to last at least 12 months or result in death.
DDS is a state agency charged with administering the Federal SSDI and SSI disability programs. Each state has a DDS office that manages and reviews claims from their state.
What is Social Security Disability Insurance (SSDI)?
Social Security Disability Insurance (SSDI) is a federal program designed to provide financial assistance to individuals who are unable to work due to a disability.
Overview of SSDI
SSDI is funded by payroll taxes from individuals which is often why it is referred to as a work-based program. To qualify for SSDI, applicants must have worked and paid Social Security taxes, accumulating sufficient work credits based on their earnings history. Individuals with no work history or work credits do not meet the technical requirements for the program. SSDI offers disability monthly benefits in the form of payments to eligible workers and their dependents, offering financial support during times when they are unable to work for at least 12 months or longer due to severe mental or physical impairments.
What’s the Distinction Between SSDI and SSI?
SSDI and Supplemental Security Income (SSI) are both federal disability programs administered by the SSA, but they differ in eligibility criteria and funding sources. Individuals may qualify for either SSDI or SSI or both, depending on their individual circumstance. We encourage potential claimants to contact our firm for further questions about eligibility.
SSDI
The SSDI program is based on work credits and prior earnings, providing benefits to individuals who have sufficient work credits from their work history. These workers have paid into the Social Security system which is how the program is funded.
SSI
SSI is a needs-based program for those with limited income and resources, offering financial assistance to disabled individuals with low income and limited assets.
Eligibility Criteria for SSDI and SSI
Who Can Qualify for SSDI?
Eligibility for SSDI and SSI is determined based on specific criteria outlined by the SSA. There are both technical (non-medical) program requirements and medical requirements. All claimants, no matter which program they apply for, must meet the Social Security Administration’s definition of disability. The SSA defines a qualifying disability for SSDI and SSI as “the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”
In addition to meeting the medical requirements for the program, to qualify for SSDI, applicants must have sufficient work credits and earnings. SSI claimants must have limited assets and incomes and fall under the program’s resource threshold to qualify.
Common Disabilities that Qualify for Social Security Disability Benefits
The SSA outlines various medical conditions and impairments that may qualify for benefits in the SSA’s Blue Book. However, each disability claim is unique and is evaluated on the basis of its severity and how it impacts a person’s ability to work. If a medical condition is listed in SSA’s Blue Book, that is not a guarantee that an individual with that diagnosis will receive disability benefits. But, the Blue Book does provide decision criteria and guidance for those applying for SSDI or SSI and for the individuals charged with administering the programs.
How Do I Prepare to Apply for Social Security Disability in NC?
Preparing to apply for Social Security Disability in North Carolina requires gathering detailed information about your work and medical history.
Work History
To confirm work history for SSDI, you will need to collect and provide SSA or your disability lawyer with dates and documentation of past employment, including dates of employment, job duties, and earnings records.
Medical History
In addition to your work history, claimants will need to collect comprehensive medical evidence. This evidence is essential to support your disability claim and includes medical records, diagnostic test results, treatment history, and statements from healthcare providers regarding your condition’s severity and its impact on your ability to work. Without documented medical history which demonstrates that your condition is severe and persistent, your claim is unlikely to be successful. If working with a disability lawyer, their team can help you collect and organize your medical and work history for SSDI benefits.
The Application Process
How Do I Apply for SSDI?
The application process for SSDI in North Carolina can be initiated through various methods, including online, by phone, or in-person at a local Social Security field office. If you’re working with a disability lawyer, they will assist you with the completion and submission of all paperwork for your claim.
Getting Approved for Disability Benefits in North Carolina
Once your application is submitted, it undergoes a thorough review process by the SSA and DDS. This involves the evaluation of medical evidence, work history, and other supporting documentation to determine eligibility for benefits. This process involves several stages from initial application to reconsideration and ultimately to hearing. Read this blog post for recent updates on NC wait times. To avoid lengthy waits, it’s very important to meet all SSA deadlines and ensure your paperwork is completely accurate.
Who Makes the Decision on Your Disability Claim?
The decision-making process is based on the severity of your impairment, its impact on your ability to work, and whether it meets the SSA’s criteria for disability. Decisions can be made at any stage of the process, from the initial application to much later on at the hearing stage. If resolved before hearing, DDS makes the decision on your claim. If your claim progresses to a hearing, the Administrative Law Judge (ALJ) assigned to oversee your hearing will make the determination.
How Long Does It Take to Get a Decision on My SSDI Application?
The timeframe for receiving a decision on your SSDI application can vary greatly depending on various factors, including the complexity of your case, the volume of applications being processed, and your compliance with SSA deadlines and paperwork.
Decision Timeframe
Most disability claims are denied at earlier stages in the process, which is why appeals and disability hearings are common. But, most claimants can expect to receive a decision at each stage a few months after submitting their application assuming their paperwork is accurate and they follow all SSA deadlines. However wait times at each stage are increasing which adds to the total time to receive a favorable decision on a claim.
As of 2024, claimants in NC whose claims progress to the hearing level should expect total average wait times of 24 to 28 months. However, Social Security wait times differ by local field offices and by stage. For example, recent data indicates that reported wait times for the Reconsideration stage of the Social Security Disability application process were averaging 182.7 days or roughly 6 months. And, that in 2023, the national average wait time for hearings was 9.7 months from the hearing request date.
Next Steps Following Application for SSD/SSI Benefits in North Carolina
After submitting your application for SSDI or SSI benefits in North Carolina, the next steps involve a series of reviews and evaluations by the SSA and DDS which include the initial application review, the reconsideration stage if the initial application is denied at the first stage, and a disability hearing if the claim is denied at reconsideration.
Application Review
At the first stage, DDS conducts an initial review of your application to ensure all necessary information has been provided, and that your claim meets the technical requirements of the SSDI and SSI programs. When applications are received, the local SSA field offices perform a preliminary screening and quality check. They confirm the application meets the technical requirements for the SSI and/or SSDI programs. If the application does not meet the requirements, it is denied. This is called a technical denial. This decision can be appealed with the local field office within 60 days. If this decision is overturned and technical requirements are met, the application is then forwarded to the Disability Determination Services (DDS) office located in Raleigh, NC where they review the claimant’s medical evidence.
Medical Disability Determination
If the claim meets the program’s technical guidelines, the application advances directly to the Disability Determination Services (DDS) office located in Raleigh, NC for the required medical evaluation. DDS then issues a decision – an approval or denial on the claim based on the medical evidence. If a claimant receives a medical denial, which is common at this point in the process, they can appeal the decision at the next stage in the process which is the Reconsideration stage
Medical Evidence Collection
When someone completes paperwork for their disability claim, they provide a list of medical providers and facilities they have visited to receive treatment for their medical condition. At initial stages, the SSA pulls your medical evidence and reviews information from this list of providers when making their decision. At later stages, you can supplement their records with additional (and more recent) information. Or, if you’re working with a disability lawyer, they will assist you with this process to ensure your medical evidence supports a strong claim.
Decision Making
DDS makes decisions on claims at the initial application and reconsideration stages of the claim. Assuming you meet the technical requirements for the SSDI and SSI programs, they will review your medical evidence and determine whether you are disabled based on the information they have. If denied at initial or reconsideration stages, claimants have 60 days to file appeals. Once a claim progresses to the hearing stage and beyond, to the appeals stage, Administrative Law Judges review the claim. Approval rates for disability claims are highest at the hearing level.
Notification of Decisions
SSA sends most of its communication via mail. However, you can also check claim status online, via a My Social Security account or contact your local field office for an update on your claim.
Appeals Process (if Necessary)
Claimants applying for SSDI or SSI benefits who do not qualify for the Compassionate Allowance list should expect to receive a denial on their application at the initial and reconsideration levels. This is very common and the SSA allows claimants 60 days to file an appeal and continue the claim forward in the process.
What Happens if the SSA Denies Your Application?
If your application for SSDI or SSI benefits is denied, you have the right to appeal the decision through a series of reviews.
Reconsideration and Appeals
Reconsideration is the first opportunity to appeal and occurs when a claimant appeals an unfavorable decision at the initial application stage. In this stage, the decision made by DDS is reviewed by another DDS examiner. Most denied claims are not reversed at this stage so it is common for claims to progress to the hearing level. At hearing, an Administrative Law Judge will hear the evidence as well as any procedural reasons for denial and render a decision. This decision can also be appealed within a set timeframe. Appeals can continue all the way to the Federal court system.
Each level of appeal provides an opportunity to present additional evidence and arguments in support of your claim, with the goal of obtaining a favorable decision on your disability benefits.
What is the Average Monthly Payment for Social Security Disability in North Carolina?
The average monthly payment for Social Security Disability benefits in North Carolina varies depending on individual circumstances, including work history and income level.
Payment Calculation
SSDI benefits are calculated based on a formula that takes into account your average lifetime earnings, with adjustments for cost of livings annually. SSDI claimants can receive up to a maximum of $3,822 per month, up from $3,627 in 202 and and SSI claimants can receive up to a maximum of $943 per month for SSI for individuals and $1,415 per month for couples. Additionally, certain factors such as dependent benefits may impact the total amount of benefits received.
Can You Work While on Social Security Disability?
Individuals receiving Social Security Disability benefits may be able to work and earn income while still maintaining eligibility for benefits, depending on their circumstances.
Income Deductions
There are limitations and restrictions on the amount of income you can earn without impacting your benefits. And, you will not qualify for disability benefits if your monthly earnings exceed SGA or if your resources exceed the SSI limit. It’s important to understand income deductions, reporting requirements, and income caps to ensure compliance with SSA regulations and avoid penalties for non-compliance.
Mandatory Reporting
SSA will review your prior earnings when applying for SSDI or SSI benefits. If you receive benefits through the federal Supplemental Security Income (SSI) program, the SSA can check your bank account. They do this to verify that you still meet the program requirements. SSI is resource-specific and reserved for disabled people with limited means. That means you qualify for the program because you have limited resources. On the other hand, if you receive disability benefits through the Social Security Disability Insurance (SSDI) program, the SSA won’t check your bank account. Individuals qualify for SSDI based on their work history.
Consequences of Non-Compliance
If your resources exceed the program’s SSDI or SSI limits, you will no longer qualify to receive disability benefits. Claimants who receive SSDI or SSI benefits are subject to ongoing eligibility reviews.
Income Cap
As mentioned above, when applying for SSDI benefits, your earnings cannot exceed the SGA limits for that year. In 2024, the Substantial Gainful Activity (SGA) limit for people who are blind is $2,590 per month, and $1,550 per month for people who are not blind. SGA is the maximum income level that a disabled person can earn while still receiving disability benefits. SGA for the blind does not apply to Supplemental SSI benefits, but SGA for the non-blind disabled does apply to both SSDI and SSI benefits. Additionally, the SSI program has resource limits which the SSDI program does not have.
Collins Price Can Help You with Your Disability Claim with Personalized Legal Support
Navigating the disability application process can be challenging, but you don’t have to do it alone. Collins Price is here to provide expert legal support and guidance every step of the way.
Legal Assistance
There are many benefits of working with an experienced disability lawyer and there is never any fee for our services unless we win your claim. Claimants who work with lawyers have higher approval rates than those who file alone. Our disability lawyers can also help you understand which disability programs you may qualify for and whether you have a strong claim for benefits. Additionally, our team helps organize your claim by ensuring SSA has the latest and most complete medical evidence. And, our North Carolina disability lawyers are local and experienced in representing claimants at the hearing stage where our knowledge helps us make strong procedural and medical arguments to overturn denials.With over 10 years of experience working to represent disability claimants in North Carolina, our managing partners handle each claim, ensuring personalized attention and dedicated advocacy for our clients. From initial application through hearings and appeals, we’re committed to providing the highest quality legal counsel to help you obtain the benefits you deserve.
By understanding the intricacies of the disability application process and knowing your rights, you can navigate it with confidence. Remember, Collins Price is here to support you throughout your journey to securing the disability benefits you need. Contact us today for a free consultation.
