Can Certain Medical Conditions Get You Approved for Disability Automatically?

There are conditions for which disability is automatically approved if you fulfill the listed requirements.

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Question

How do I find out if I'll automatically eligible for disability? Are there certain illnesses and diseases that are guaranteed to be approved?

Answer

The answer to this question is yes and no. Certain impairments are singled out in the Social Security Administration's Impairment Listing Manual (you can find these impairments in our article on the "listed" disabilities). Disability claimants who fulfill the severity criteria for one of these listed conditions can be approved for benefits somewhat easily. However, the disability evaluation process, even for "listing-level" impairments, is never automatic, and with Social Security, nothing is ever guaranteed.

The Social Security field office first must check to see if the disability claimant fulfills the non-medical requirements for the SSDI or SSI program. Next, the claims examiner at Disability Determination Services has to request and review the claimant's medical records. If the criteria required to qualify for the listed condition are not evident in the medical records (that is, the doctor left out important information), the claimant will be denied benefits even though his or her condition is medically eligible for Social Security benefits. (In this case, the denial will include a rationale for why benefits were denied, and the claimant can submit the missing information in a reconsideration review, by appealing.) Similarly, if, by the time the claimant's disability file lands on an examiner's desk, if the medical records the claimant submitted are no longer current (within 60 to 90 days), the examiner will have to request more recent records or send you to a Social Security medical exam.

If the claims examiner at DDS does find that there is sufficient medical evidence in your record to qualify for benefits under an impairment listing, your file will be sent back to the field office to make sure that you still are eligible for SSDI or SSI and that you still aren't working above the SGA level. If this final check goes well, your file will be sent to a payment center and you'll be sent an award notice with an estimated date of when your payments will start (for SSDI, this will be after the five-month waiting period). Finally, you will receive your first disability check and any disability backpayments owed.

In 2008, Social Security did implement a program to expedite the handling of serious cancers and rare diseases. Medical conditions on the "Compassionate Allowance List" are now expedited through the Social Security disability determination process, so that a decision is possible within a month--the closest to automatic as Social Security gets. The conditions on the list are so serious that a diagnosis of the condition would clearly qualify for disability benefits. The list started with 50 conditions, but has now been expanded to include 165 conditions, and more are added every year. For more information, see our article on Social Security's Compassionate Allowances. Social Security also has an expedited terminal illness program and a quick disability determination program for disability claims that a computer flags as clear-cut disability approvals. 

Updated by: , J.D.

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