medical eligibility for disability

Medical Eligibility for Disability Benefits

Are you medically eligible for disability? Can you qualify, and what are the factors that can affect disability eligibility?


The Social Security Administration (SSA) has two disability benefit programs (either SSDI or SSI). For both, you must prove that you have a medical condition severe enough to limit your ability to work.


First you must determine whether your condition has medical eligibility for disability. The SSA maintains a listing of eligible conditions called the Blue Book. Your disability does not have to be permanent; it can be temporary. If your disability is not listed in the Blue Book, there are other mechanisms for you to apply for benefits. For example, chronic pain sufferers can provide evidence of impairment even though this is not explicitly listed in the Blue Book. Furthermore, you can apply if you have multiple disabilities. The SSA will consider the combined effects of all illnesses and injuries when making their determination regarding medical eligibility for disability.


Then, you file a claim. SSA has no requirement that you have to have had the disability for a certain length of time. Once you file, however, there is a five-month waiting period after you’re approved for you to receive the first payment.


After you file your claim, the state level Disability Determination Services (DDS) will evaluate your claim using a five-step process. The process is fair and objective. Most claims are denied for two reasons: lack of compelling medical evidence, and lack of evidence linking your medical condition to an inability to work. Claims are also denied if you do not follow your doctor’s treatment plan. For example, if a surgery will improve your condition, and you’ve elected not to have surgery, that can affect your claim. All of these are factors that can affect your disability eligibility.


Note that SSA does have a Compassionate Allowances (CAL) program to fast-track claims for terminal diseases and other conditions that have automatic medical eligibility for disability.


When SSA approves your disability benefits, you will typically receive that benefit until retirement age. At that point, social security retirement benefits take over. If your condition improves enough for you to return to work, your disability benefits will cease at that time.


If you’ve looked at the SSA process and you’re frustrated, you’re not alone. Most people are very frustrated by all the paperwork and phone calls that are required to file your claim with your local DDS office. Don’t go it alone. Give us a call and we’ll get started right away to help you with the process.