The five-year rule for SSDI recipients is explained in Social Security USA.

The United States Social Security Administration governs the Social Security Disability Insurance program that offers benefits to disabled individuals who cannot engage in a productive occupation. Alongside disbursing to disabled claimants, SSDI also generates benefits to the dependents of the disabled individual. Suitable applicants must meet the very stringent conditions to be eligible to the SSDI. One of the most important requirements that is often overlooked, however, is the 5-Year Rule.

Understanding this law and knowing what to do when your application for the claim is refused can make a difference in the full value of your claim.

5-Year Rule

For filers over 31 for SSDI benefits, there’s a 5-year rule. An applicant must demonstrate, under SSA requirements, that he has worked five out of the ten years preceding the development of his disability for him to be eligible to get SSDI benefits. It is so because SSDI is quite insurance-like; you need to pay in before you draw on your benefits.

At the time, you also had to have earned at least 20 work credits to qualify. Under current law, you can generally earn four credits each year based on how much income you bring in each year. Even with a severe disability, likely your SSDI application will be denied if you haven’t earned enough work credits.

Importance of Work Credits

Your work history can serve as a basis for which you may receive SSDI. The more work credits you build, the greater your chances of qualifying. These work credits that you’ve earned will determine with the SSA whether or not you have sufficient contributions to the program to grant you disability payments.

The 5-Year Rule would mean that any individual applying for SSDI has a recent work history when the impairment sets in. If you do not meet this requirement for work history, you might consider other programs as well, such as SSI, which have different requirements.

Steps After an SSDI Denial

Actually, even if SSDI denial is most common, it does not necessarily mean this is the end. As a matter of fact, after a claim has been denied, the SSA gives you many choices to appeal.

Request a Reconsideration

Reconsideration requests are the first step in the process for your appeal when a denial occurs. Another person who was not part of the determination that denied your claim will look at your case again on review by the SSA. During this review, you have an opportunity to better make your case with further medical or job-related information.

If your file meets the standards for disability, the SSA will reopen your entire file. Be sure to acknowledge all reasons in your first notice for denial and include new supportive evidence.

Administrative Law Judge

If your denial is affirmed, you have the right to a hearing in front of an ALJ. He or she will review all the evidence brought forth and consider any new papers or testimony that may be presented.

On the day of the hearing itself, you may bring in witnesses during the hearing who can include medical professionals or vocational specialists who testify on your impairment and work limitations. The judge will hear your assertions and make their decision based on the given evidence.

Additional Medical Evidence

Medical documentation is probably the most important part of an SSDI appeal. The more detailed your medical records are, the better your case will be.

This might be made easier by getting your doctor to give you a Residual Functional Capacity RFC form documenting all of your mental and physical limitations. A letter written and stamped by your doctor stating the authenticity of your claim can make a big difference. To make your case stronger you may wish to undergo further medical tests or get reports from other experts.

Disability Lawyer

It might be quite difficult to handle the SSDI appeals process. Having an attorney who is experienced in this field increases your chances of success by far. Attorneys know how to gather all of the proper medical records, prepare you for the hearing, and help formulate a strong case.

A disability lawyer is also more knowledgeable of the nuances of SSA laws, such as the 5-Year Rule, thus assisting you to navigate through the legal minefield of what is required. Not that you need it, but an attorney will further increase your chances of receiving all benefits you’re entitled to legally and of a denial reversal.

If someone suffers from a serious medical condition that makes him or her unable to work for an extended period of time in the United States, he or she will need SSDI benefits. To qualify for SSDI benefits, one has to have the 5-Year Rule met. This is one of those rules of thumb that can make or break your claim, so be sure not to forget to include this in the denial. Don’t let this denial be the last word: there are a few things you may do contest the determination and to get your benefits. You may be able to improve the likelihood of receiving SSDI payments if you collect more documentation, file a reconsideration, and possibly hire a disability attorney.

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