Is Your Disability Found In The List Of Disabling Conditions
The Social Security Administration maintains a list of medical conditions that are so severe they automatically mean that you are disabled . If your condition is not on the list, the Social Security Administration will have to decide if it is of equal severity to a medical condition that is listed. If it is, the Social Security Administration will find that you are disabled.
Many injuries and illnesses are obviously disabling, such as late stage kidney disease, congestive heart failure, and advanced cancers. There are others, however, such as chronic illnesses that become acute with age, or residual conditions that deteriorate over time, that eventually become disabling even though they were not initially too severe. For example, a worker may have had a previous back injury that is aggravated through the years to the point where work is extremely difficult or impossible. That person may become eligible for disability benefits even though the original illness or injury was not disabling.
Because Social Security disability is a government program, its features include a good number of qualifying rules and regulations. To receive Social Security disability benefits, all three of the following must be true:
- You must have a physical or mental impairment.
- The impairment must prevent you from doing any substantial gainful work.
- The disability must be expected to last, or have lasted, at least 12 months, or it must be expected to result in death.
Social Security Disability Benefits
Supplemental Security Income and Social Security Disability Insurance are disability income benefits administered by the Social Security Administration that also provide Medicaid and/or Medicare health insurance to individuals who are eligible. The application process for SSI/SSDI is complicated and difficult to navigate. Nationally, about 37 percent of individuals who apply for these benefits are approved on initial application and appeals take an average of two years to complete.
For people who are homeless or who are returning to the community from institutions , access to these programs can be extremely challenging. Approval on initial application for people who are homeless and who have no one to assist them is about 10-15 percent. For those who have a mental illness, substance use issues, or co-occurring disorders that impair cognition, the application process is even more difficult yet accessing these benefits is often a critical first step in recovery.
Critical components of SOAR include:
- Serving as the applicants representative
- Collecting medical records
- Writing a medical Summary Report
- Conducting quality review
- Please contact a regional coordinator below to find your nearest SOAR Specialist:
What Is Medically Determinable Back Pain
The first thing you need to know about qualifying for disability based on back pain is that the Social Security Administration does not typically grant benefits to those with mild, moderate, or intermittent back pain. Despite the fact that the SSA receives millions of applications for back pain-more applications for any other type of illness or injury, in fact-it only grants benefits to individuals with medically determinable back impairments. This means that, in order to qualify for Social Security disability benefits, youll need to show that you have an impairment that can be detected and affirmed by a medical professional.
The Social Security Administration has a section on Disorders of the Spine in its Listing of Impairments, which is typically used to determine whether back pain is compensable.
In order to be considered a disability, your back pain must involve, among others, one of the following:
- Herniated discs
- Difficulty walking
- Chronic pain associated with compression of the lumbar spine
This list is not exhaustive you may be required to meet additional criteria in order to qualify for disability for your back pain or spinal condition.
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Medications And Side Effects
Serious medications make a serious medical condition more believable. So, you must try all the recommended medications even if you fear the side effects.
If youre not taking antidepressants,, then the insurance company will think your symptoms arent serious enough to qualify for disability benefits. Its common for doctors to have you try multiple medications and different dosages to find the right treatment. So, if you have a bad reaction to one medication, you cant refuse the troubleshooting that follows. You have to try all other medications or changing your dosage.
If you have bad reactions to your medications, your medical records must report that in detail. And, if your doctor recommended against a medication, you need to have it documented that the side effects were worse than the condition. Again, you run the risk of denial if you stray from standard treatments without a good reason.
Provincial Income Support Benefits For Depression
Each province in Canada pays income support benefits to people who cant work because of disability. If you qualify, you can receive fixed payments for life.
You can qualify for provincial benefits even if youve never worked. However, they only apply if your total family income falls below a certain amount. That amount differs from province to province. Family income doesnt affect the approval process for other types of disability benefits.
You apply for provincial disability benefits by applying through your provincial agency or program. As usual, your doctor will need to provide a report or certificate that confirms you cant work because of your condition.
If you get denied, you can appeal internally within the agency or program. In some provinces, you can also appeal to an outside tribunal for a final decision. Check with your province for the proper procedures.
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How Is Long Term Disability Calculated
Long term disability is meant to replace your monthly income if you are unable to work due to your disability. The exact amount will be dependent on your income and the terms of your long term disability policy along with other sources of income, such as Employment Insurance benefits.
How Difficult is it to Keep Long Term Disability Benefits?
Certain disabilities require that the policyholder provide evidence that they continue to suffer from the disability and that they are unable to work. Called the change of definition, most policies require after two years that policyholders demonstrate that their disability makes them unable to participate in any type of work, rather than the occupation they had before their disability.
For some mental health conditions that result in hallucinations, paranoid behavior, or other behaviors, establishing an inability to work in any occupation can be straightforward. Other claims, such as a long term disability depression claim, ongoing documentation of the mental health condition will be required.
Fill Out the Form to Get Help with Your LTD Insurance Claim
If your long-term disability insurance claim was denied, legal help is available. Obtaining the assistance of a lawyer will increase the chances of success. See if you qualify by filling out the form on this page or clicking the link below.
Medical Conditions That Qualify For Disability Benefits
You may be wondering what are the medical conditions that qualify for disability? And is my diagnosis on that list? We give a list of medical conditions below, but as you will learn, any medical condition can potentially qualify for disability benefits. The focus is always on the extent of the disability caused by your medical condition. And whether the extent of your disability meets the requirements for various disability benefits plans and programs. This article lists common disabling conditions. I then review the eligibility criteria for the most common disability benefits. So, you can know if your medical condition can qualify for benefits.
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Get Help In Order To Automatically Qualify For Disability
You may want to seek the help of a disability attorney if you are looking to file a claim for Social Security disability. A disability attorney can help you navigate the process of applying for disability benefits through a compassionate allowance in order to help you get your benefits as soon as possible.
Your disability attorney will be able to know what paperwork, tests and other medical evidence you will need in order to prove to the SSA that you will automatically qualify for Social Security disability benefits.
Schizophrenic Paranoid And Other Psychotic Disorders
Section 12.03 defines this group of disorders as being characterized by the onset of psychotic features with deterioration from a previous level of functioning. But while the SSA recognizes the medical validity of these disorders, they must meet additional requirements in order to be considered disabling enough to merit benefits.
For example, the SSA requires medically documented persistence of one or more of the following, and goes on to cite hallucinations, catatonia, and emotional withdrawal among potential symptoms. Furthermore, these symptoms must lead to marked difficulties in various areas, including daily living and social functioning.
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What Medical Conditions Qualify For Disability Benefits
Any medical condition can qualify for disability benefits. Generally speaking, most disability benefits programs in Canada do not give benefits based on a medical diagnosis. Rather, they provide benefits based on the level of disability caused by the medical condition. So the focus will always be on the level of disability caused by your medical condition, rather than only the name of your medical condition or diagnosis. To qualify for benefits, you must show that the level of disability from your medical condition meets the eligibility criteria of the disability benefits plan in question.
Following is a list of common medical conditions that qualify for disability benefits. For each of these conditions we discuss the unique challenges you will face.
Objective Evidence To Support A Long Term Disability Claim
The burden to prove that a condition has impacted the claimant in such a way that they are unable to work falls on the claimant. You are expected to provide medical evidence to support your claim during the claims process. It is not unusual for an insurance company to require proof of objective evidence before it will pay long-term disability benefits. Objective evidence is the evidence in your medical records that insurance companies cannot deny exists. It may be difficult to qualify for benefits if there is no objective evidence to support your claim.
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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
- you’re 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 you’re 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 you’re 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:
Does Your Injury Qualify As An Automatic Disability
As discussed above, some injuries are considered so severe that the SSA always considers them a qualifying impairment for SSD benefits. Below are just a few of the categories and conditions included in the List of Impairments :
- Autoimmune disorders Lupus, multiple sclerosis or rheumatoid arthritis
- Musculoskeletal impairments Degenerative disc disease, spinal injuries, herniated disc, ruptured disc, carpal tunnel syndrome and arthritis
- Neurological disorders Traumatic brain injury, stroke or seizure disorder
- Respiratory disorders Chronic Obstructive Pulmonary Disease , asthma or emphysema
- Sensory impairments Hearing loss or vision loss
- Mental disorders Anxiety, depression, post-traumatic stress disorder or autism
- Endocrine disorders Obesity, diabetes or neuropathy
- Cardiovascular disorders Heart failure, high blood pressure or coronary artery disease
- Digestive disorders Crohns disease, liver disease or irritable bowel disorder
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Unitedhealthcare Connected Benefit Disclaimer
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
You can get this document for free in other formats, such as large print, braille, or audio. Call , TTY 711, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.
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Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al , TTY 711, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.
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Medical Conditions And Disability Claims: Do You Qualify
Created by FindLaw’s team of legal writers and editors
The Social Security Administration maintains a “Listing of Medical Impairments” that automatically qualify you for Social Security Disability Insurance or Supplemental Security Income , provided certain conditions are met. If your medical condition, or its equivalent, is on SSA’s Listing of Impairments, then you’re generally considered disabled and therefore eligible to receive SSA disability benefits. If your medical condition is not on the list, you may still be eligible under other SSA guidelines.
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Eligibility For Medicare Disability Benefits
If You Are Under Age 65 Social Security Disability Insurance
If you are age 18 to 64, your eligibility for Medicare is tied to your eligibility for Social Security Disability Income benefits. One exception is for people with end-stage renal disease , who are automatically eligible for Medicare solely on the basis of having ESRD.
You must qualify for and receive SSDI monthly income benefits to be eligible for Medicare. SSDI benefits are based on work credits earned through Social Security, Railroad Retirement or Medicare-covered government employment. Note: If you dont have work credits and dont qualify for SSDI, you may qualify for other income benefit programs such as Supplemental Security Income . For more information, see If You Dont Qualify for SSDI.
To qualify for SSDI, you must be unable to work for a least one year because of a qualifying physical or mental impairment, a combination of impairments or a terminal condition resulting from an impairment. You can apply for SSDI at your local Social Security Administration office. Once you are approved for SSDI, you must wait 5 months for your income benefits to begin, and an additional 24 months before Medicare benefits begin.
However, there are 2 exceptions:
Amyotrophic Lateral Sclerosis
If you have Amyotrophic Lateral Sclerosis , you can get Medicare the first month you get SSDI monthly income benefits.
Ongoing Eligibility for Medicare and SSDI
If You Dont Qualify for SSDI
Which Medical Conditions Are Likely To Qualify For Disability
While any of the above medical conditions are SSDI and SSI qualifying disabilities, some medical conditions are more likely to lead to an approval of benefits than others. We recently surveyed our readers about their experiences in applying for disability benefits and compared their answers to government statistics. The conditions most likely to get approved were multiple sclerosis and some types of cancers. Respiratory disorders and joint disease were also high on the list. For the details, see our article on survey statistics on getting Social Security disability for common medical conditions.
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Trauma And Stress Disorders
These disorders may have similar results to obsessive-compulsive disorders and neurological disorders, but they are often caused by some significantly traumatic event or because of extreme stress. Post-traumatic stress disorder is the most common of these disorders. Often, after witnessing or being involved in a very traumatic event, people suffering from these disorders find themselves facing symptoms that include depression, flashbacks, lack of interest or enjoyment, constant distress, aggression, overreactions, fear, anger, and trouble sleeping.
These disorders can often place a huge toll on a persons day-to-day life, and may make daily tasks and work tasks nearly impossible. Often, people with a history of military service or victims of traumatic accidents or crime face these kinds of disorders. If their case is severe enough, qualifying for SSD may help support them.
Medically Qualifying For Ssd Through An Residual Functional Capacity Analysis
If you are unable to meet or match a listed condition, you can still be approved for disability, though additional review steps are necessary for the SSA to verify your eligibility. These include the completion of functional reports by you, your doctor, and sometimes by other individuals, like friends, family members, or caregivers.
These reports are part of a residual functional capacity or RFC analysis, a process the SSA uses to better understand medical conditions that dont precisely fit a disability listing.
Functional reports may include forms that ask about your physical and mental or emotional limitations. These reports must be thorough and must show that your obesity and related complications severely limit your ability to complete everyday tasks and activities like:
- Getting dressed, grooming, and bathing
- Preparing or shopping for food,
- Taking care of yourself and your home, yard, children, or pets.
Although functional reports ask primarily for information about your personal life rather than your work life, the SSA is able to glean information from them. For example, if you are unable to walk, balance, or stand without assistance, then the SSA knows you cant work in a physically taxing job.
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