Who Pays The Benefit
Sometimes your employer has an arrangement with the insurance company known as an Administrative Services Only agreement, where the insurance company adjudicates the claim, but your employer is responsible for paying the benefit. The insurance company advises your employer if benefits are approved, should continue to be paid and when they are denied. However, the insurance company is not allowed to release confidential medical information to your employer.
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Social Securitys Compassionate Allowance List
Another way to have your disability claim expedited is by having a medical condition that is on the Compassionate Allowance List . Currently, there are about 240 medical conditions on that list.
|Compassionate Allowances Conditions|
Editors note: If you do not see your medical condition on the list above you can submit a new condition to the Social Security Administration for consideration.
The medical conditions on the Compassionate Allowance List are used to quickly identify applicants who clearly meet the standard for disability benefits. If you have a condition on this list be sure to provide medical documents as proof because this will help your case.
Does A Medical Condition Have To Be In The Blue Book
A Social Security disability claimant doesn’t even have to have an impairment that is listed in the Social Security disability blue book to be awarded disability benefits. For instance, migraine headaches are not included in the blue book, but if a claimant’s migraines are severe enough and are well documented, the SSA may grant disability benefits if the migraines make it impossible for the disability applicant to work a full-time job. The keys here are that the condition be a medically determinable impairment and that it reduces someone’s RFC enough so that they can’t do their prior job or any job. In this case, an applicant could qualify for benefits under a medical-vocational allowance. Other common impairments that aren’t listed in Social Security’s blue book include carpal tunnel syndrome, fibromyalgia,chronic regional pain syndrome,reflex sympathetic dystrophy, celiac disease, and degenerative disc disease.
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Is Arthritis A Disability
Arthritis can be considered disability by the SSA. If you suffer from arthritis that is so severe you are going to be unable to work for at least 12 months and you meet the work requirements as well, the SSA will deem you disabled and you will be able to earn disability benefits.
There are listings in the Blue Book that apply to arthritis, and if your condition meets those criteria, then your claim would be approved.
Any of these forms of arthritis can limit your ability to perform routine daily tasks as well as work and earn a living. The SSA looks at the different kinds of arthritis differently.
There are some ways your disability claim for arthritis can be automatically approved. One of those is if you have joint dysfunction, such as a misalignment, shortening of the joint, or chronic pain or stiffness.
Another way would be if you had proof that you had undergone surgery on a weight-bearing joint, such as a knee or a hip and you will be unable to walk effectively for at least a year.
Another way to have a claim approved is if you have arthritis of the spine and the same is true if you have inflammatory arthritis.
You must have medical evidence to support your claim and to confirm that your arthritis is severe enough to keep you from working.
S To Take In Order To Qualify
To determine whether a person qualifies for Social Security Disability because of arthritis, the SSA uses the following steps:
The SSA first determines whether you are currently working. If you are gainfully employed , you will be disqualified for Social Security Disability based on your demonstrated ability to perform substantial gainful activity.
To qualify for Social Security Disability Insurance , you will need to have enough work credits. These are earned by working and paying Social Security taxes. Typically, if you have worked five of the last ten years, you will have enough work credits. Depending on your age, there are a specific number of credits you must have to qualify for SSDI.
If you do not have enough work credits, but your income and assets are limited, you may be eligible for Supplement Security Income . SSI is meant for those of extreme financial need, so you must have less than $2,000 in assets . SSI is based on household income, so your spouses income will be considered when the SSA is determining if you are financially eligible.
Medical Requirements For Disability Benefits With Arthritis
The SSA determines whether your arthritis is severe enough to hinder you from performing physical activities commonly required for working. These activities may include such things as:
- sitting or standing
- kneeling or walking
- lifting and use of fine motor skills
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Who Is Eligible For Ssi
Now that you know some of the financial criteria, you may still be wondering, How to qualify for SSI? If you meet the financial and residency requirements and are at least 65 years of age, you may qualify for benefits. Younger individuals may qualify provided they are blind or disabled.
The SSA defines disabled as a physical or mental impairment that prevents the person from engaging in substantial gainful activity. The impairment must either be expected to cause the person to die, or it has lasted or is expected to last for at least 12 consecutive months.
Blindness is defined as visual acuity of 20/200 or less for the persons better eye when using corrective lenses. A person with a visual field that subtends at its widest diameter to no more than 20 degrees may also meet the test for blindness.
Is Your Condition Found In The List Of Disabling Conditions
For each of the major body systems, we maintain a list of medical conditions that we consider severe enough that it prevents a person from doing substantial gainful activity. If your condition is not on the list, we have to decide if it is as severe as a medical condition that is on the list. If it is, we will find that you are disabled. If it is not, we then go to Step 4.
We have two initiatives designed to expedite our processing of new disability claims:
- Compassionate Allowances: Certain cases that usually qualify for disability can be allowed as soon as the diagnosis is confirmed. Examples include acute leukemia, Lou Gehrigs disease , and pancreatic cancer.
- Quick Disability Determinations: We use sophisticated computer screening to identify cases with a high probability of allowance.
For more information about our disability claims process, visit our Benefits For People With Disabilities website.
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How To Qualify For Ssi And Ssdi
How To Qualify For SSI and SSDI
The federal government estimates that 61 million people in this country have some type of physical or mental impairment that causes them to be disabled. If you are disabled and unable to work, two programs available through the Social Security Administration offer financial assistance provided you qualify for benefits.
Social Security Disability Insurance or SSDI pays monthly benefits, but you must be disabled as defined by Social Security regulations and have worked a sufficient number of quarters at a job or through self-employment that was subject to Social Security payroll taxes. The other program, Supplemental Security Income or SSI, is similar in that you must be disabled to qualify for benefits. However, you do not need a work history to qualify for SSI as you do for SSDI, but you are subject to very strict limits on your income and the value of assets that you own.
Complicated regulations and procedures make it difficult to qualify for SSI and SSDI. In fact, according to data released by Social Security, only about a third of initial applications for benefits are approved. The following information along with the trusted advice and skilled representation of an SSDI and SSI lawyer from MJ Ellis Disability Law may improve your chances of success.
Social Security’s Alternative Listing For Depression
Social Security provides another way to meet the listing for depression for those who can’t show they currently have the functional limitations above because they’ve been living in a highly structured or protected situation or undergoing intense therapy.
If you are in this situation, you may be able to meet a second set of functional criteria. You can do this if your disorder has been medically documented as serious and persistent over a period of at least two years and you have either been living in a highly structured setting or you’ve been receiving ongoing medical treatment, mental health therapy, or psychosocial support that diminishes the symptoms of your mental disorder. You must also show that you have little ability to adapt to demands that are not already part of your daily life or to changes in your environment.
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The Benefits Of A Concurrent Claim
The benefit to collecting SSI when you are collecting a low monthly SSDI benefit is that the SSI payment will raise your benefit up to $794 per month.
The benefit to being able to collect SSDI when you are eligible for SSI is that you may be eligible to get on Medicare as an SSDI recipient, although you must wait two years from when your SSDI eligibility begins. For more information, see our article on getting Medicare or Medicaid while on disability.
Canada Pension Plan Disability Benefits
The Canada Pension Plan provides monthly payments to people who contribute to the plan during their working years.
You may be eligible for CPP disability benefits if:
- you contributed to the CPP for a certain number of years
- youre under 65 years old
- you have a severe and prolonged mental or physical disability
- your disability prevents you from working on a regular basis
The benefits include payments to children of a person with a disability.
Apply as early as possible if you think youre eligible for CPP disability benefits. Quebec residents may be eligible for a similar program called the Quebec Pension Plan . It may take several months to process your application.
If you applied for CPP or QPP disability benefits and were told that youre not eligible, you can ask to have your application reviewed or considered again.
Once you reach age 65, your CPP disability benefit will automatically change to regular CPP payments. Your regular CPP payments may be less than the CPP disability payments you got before.
If so, consider:
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Qualifying For Ssi: Maximum Monthly Income Amount And Resource Limits
Since SSI helps disabled people with little to no income, the SSA uses resource limits to decide whos eligible. In order to qualify for monthly benefits, eligible SSI applicants must:
- Have less than $2,000 in resources available to you individually . Your home, vehicle, wedding rings, clothing, appliances and furniture dont count towards your resource limits in order to qualify for SSI. However, the SSA does count cash, savings bonds, land, life insurance and anything else you can sell towards this limit.
- Receive less than $1,310 in monthly income. This is what the SSA calls substantial gainful income, and it covers more than just work wages. It also includes your non-wage earnings, like alimony, child support, dividends and earned interest as well as free housing or meals from family members.
What Are The Medical Conditions That Qualify For Quick Determination Of Disability
If you are an SSI applicant with one of about 15 severe physical or intellectual impairments among them amputation, Down syndrome, total blindness or deafness, and HIV/AIDS Social Security may find you have a presumptive disability . This qualifies you for up to six months of benefits while your claim wends its
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You Must Receive Routine Doctor
One way the SSA determines your eligibility for monthly disability benefits hinges on your credibility as an applicant. If you havent sought treatment for your condition or discussed symptoms with your doctor, it looks bad to the SSA. If you arent treated, the SSA automatically assumes your condition isnt limiting you as much as you say it is. The more documented evidence from your doctor showing regular treatment appointments and progress notes, the higher your chances for approval. Among all disability secrets, this ones likely to result in your technical denial if you cant or wont follow through. In other words, no physician actively treating your disability = no claim approval for benefits. If you cannot afford to see a doctor, make an in-person appointment at the SSA office for a referral.
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Musculoskeletal System And Connective Tissue
The SSA reports that the largest category of diagnoses among disabled workers receiving disability benefits was diseases of the musculoskeletal system and connective tissue. These disabilities, which represented 32.3 percent of the diagnoses, involve damage to ones nerves, muscles, tendons or ligaments. Examples of this type of disorder include:
- ArthritisAn individual with rheumatoid arthritis, a disorder of the immune system, must experience significant limits on his or her ability to work to qualify for benefits under this medical diagnosis. Rheumatoid arthritis is sometimes referred to as a connective tissue disorder.
- Back pain Abnormal curvature of the spine may affect an individuals ability to walk as well as the function of other body systems. The intensity of back pain and the limitations on an individuals ability to function are considered in a disability diagnosis related to back pain.
- FibromyalgiaFibromyalgia is a complex syndrome in which a person has widespread pain in the joints, tendons, muscles and soft tissues that lasts for more than three months. Claims reviewers will try to assess whether there is adequate evidence to show that the condition limits a persons ability to perform any type of gainful work.
- Reflex Sympathetic Dystrophy RSD describes a range of symptoms that may occur from injury, diseases or surgery. RSD is characterized by intense burning or aching pain typically caused by trauma to a single extremity.
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Some Publications That Will Give You More Information On Disability Benefits
The Disability Starter Kit will help you get ready for your disability interview or online application. Kits are available for adults and for children under age 18.
The starter kits provide information about the specific documents and the information that we will request from you.
The kits also provide general information about the disability programs and our decision-making process.
Here are some additional resources with information on disability benefits:
- Disability Evaluation Under Social Security – Medical criteria for evaluating Social Security disability claims
Survivors Benefits For Children
Unmarried children can be eligible to receive Survivors Benefits generally 75 percent of the workers benefit amount as long as they are:
- Under 18 years old
- 19 or under and attending an elementary or secondary school full time or
- Disabled before age 22 and remain disabled.
Stepchildren, grandchildren, step grandchildren or adopted children may also receive benefits under certain circumstances.
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What If My Ptsd Does Not Meet The Functional Criteria
If you do not satisfy the criteria mentioned above, you will need to demonstrate that your condition is serious and persistent. To show that your PTSD is serious and has been persistent, the SSA will need:
- Medical history of the existence of the disorder over a period of at least 2 years.
- Evidence of any ongoing medical treatment.
- Demonstrate that you have minimal capacity to adapt to new changes or demands.
The SSA will use both medical and non-medical evidence that you provide to evaluate the limitations in your activities to determine if you are eligible for benefits. You can also provide evidence from family, friends, neighbors, or any mental health programs relevant to your PTSD.
How The Ssa Determines Disability With Arthritis
In the case of arthritis, you must receive medical treatment for at least three months before the SSA will make a determination regarding the extent and severity of your condition and whether or not it qualifies you for Social Security Disability benefits.
No matter where you develop arthritis, whether in your hands, feet, knees or back, if you have medical evidence to support your claim, you may be eligible for disability benefits. You will also need to meet financial requirements to qualify for disability benefits.
Follow the steps below to find out if you qualify for Social Security disability benefits due to your arthritis.