The disability determination process often seems to take forever. Many people don't receive an approval until after their disability hearing, which can be two years after they first submitted their application. But for applicants with certain debilitating conditions, Social Security has methods of fast-tracking their disability claims, allowing them to get approved "automatically."
Even if you have one of these medical conditions, before you can qualify automatically for disability, you'll still need to meet certain non-medical requirements (for example, you can't currently be working full-time). The non-medical requirements vary, depending on whether you're applying for SSDI or SSI.
The Social Security Administration (SSA) maintains lists of medical conditions that they consider to be especially severe: the Compassionate Allowances List and the Listing of Impairments. Examples of medical conditions on one of the lists that the SSA will consider for expedited processing include advanced cancers, rare genetic disorders, and organ transplants.
If you have one of these diagnosed conditions and your medical record has the right documentation, the SSA will approve you for disability benefits without needing to decide whether you can work. Successfully showing that you can't do any work is a lengthy process, so if your impairment is on one of the lists, you can significantly cut down on the time it takes to get approved for benefits.
When you first apply for disability benefits, a disability determination services (DDS) examiner receives and reviews your application. The examiner will look at what you've told Social Security about your disabling medical conditions. If you've mentioned a condition that appears on the Compassionate Allowances list, for example, and the examiner doesn't need any more medical information, they can approve your claim in as quickly as a few weeks—the closest to automatic as Social Security gets.
Using a method called Quick Disability Determination (QDD), DDS examiners get help from a predictive computer program (algorithm) suggesting that you're likely to be awarded benefits. For example, the algorithm could pick up on keywords or phrases in your record that have frequently resulted in a condition that meets one of the SSA's listed impairments. The program will then flag your application for faster processing and send it to a special group of DDS examiners for human review.
For very severe illnesses or injuries, Social Security keeps a list of over 200 conditions called the "Compassionate Allowances List." Some of these conditions are so serious that just having a doctor's diagnosis of the condition automatically qualifies the applicant for disability benefits.
Examples of conditions on the Compassionate Allowances list that only require proof of diagnosis include:
From the SSA's perspective, these conditions are "open and shut" cases, which lets the agency award benefits quickly.
Claims with other conditions on the Compassionate Allowances list will also be expedited, but they may require more medical evidence than just a diagnosis. For instance, for many late-stage cancers, Social Security will want to see pathology reports, operative notes, or summaries of hospitalization and medical reports showing that the cancer could not be completely removed or isn't a candidate for surgery. For more information on the other conditions included on the list, see our article on Social Security's Compassionate Allowances.
Some common medical conditions aren't quite as serious as the ones in the Compassionate Allowances list, but are still considered disabling by the SSA. Officially, these conditions are in a manual referred to as the Listing of Impairments, but you may have heard it called the Blue Book (as a nod to the historical color of the impairments manual).
Even within the Listing of Impairments, some conditions are "more disabling" than others. Organ transplants, for example, are considered to be automatically disabling for at least one year (liver, kidney, and heart) or three years (lung). Cochlear implants to treat hearing loss are also automatically disabling for one year.
If you're found automatically disabled for a time period due to the above transplant or implant listings, the SSA will review your condition after the end of the period to determine if you're still disabled.
In addition, under the listings, several aggressive forms of cancer are considered automatically disabling, including small-cell (oat cell) carcinoma of the:
For most of the other listed impairments, your medical record will need to show evidence of certain specific criteria before Social Security will find that you're disabled. For example, if you have chronic kidney disease but haven't received a kidney transplant and you aren't on dialysis, your medical record will have to document a specific amount of creatinine protein in your blood before the SSA can find that you meet a listing. Other examples include needing to show corrected vision of worse than 20/200 to meet the listing for loss of central visual acuity, or having marked limitations in your functioning for the mental disorders.
The SSA prioritizes processing of disability claims for medical conditions that are untreatable and expected to result in death (TERI claims). TERI applicants don't need to state on their disability application that the diagnosis is terminal (although they, along with their friends or family, can).
DDS examiners are trained to be alert to potential TERI cases while reviewing a medical record, and can fast-track decisions at any point in the disability determination process. Medical evidence that DDS examiners use to identify TERI claims includes receiving inpatient hospice care, being comatose for longer than a month, or requiring continuous home oxygen.
Many terminal illness cases are automatically approved for disability, but not all. If the terminal condition is a compassionate allowance or has a listing that requires only a diagnosis, it will get automatically approved. If not, the DDS examiner will look for evidence of the specific criteria required by the compassionate allowance entry or the listing.
Just because some conditions are automatically approved doesn't mean that you don't need to submit comprehensive medical records laying out your diagnosis and treatments.
If the DDS examiner assigned to your claim doesn't receive all of the necessary medical records showing evidence of your diagnosis and any required supporting information (or if your doctor left out important information), Social Security could deny your claim even if your condition is medically eligible for Social Security benefits.
If you've already been denied benefits and you think your condition might qualify for a compassionate allowance or meet a listed impairment, read your denial letter carefully. Social Security is required to tell you the reason you were denied, and you can submit any missing information along with your appeal.
For more information, see our article on what conditions qualify for disability.
|Take our disability quiz to help you determine whether you qualify for benefits.|
Need a lawyer? Start here.