How do I find out if I'll automatically eligible for disability? Are there certain illnesses and diseases that are guaranteed to be approved?
The answer to this question is yes and no. Even for medical conditions that automatically qualify for disability (and there are only a few), there are financial or legal requirements that need to be met before someone gets approved for disability.
Compassionate Allowances List. For very severe illnesses or injuries, such as Stage IV breast cancer, Social Security keeps a list of over 200 conditions called the "Compassionate Allowances List." Some of these conditions are are so serious that a simple diagnosis of the condition from a doctor automatically qualifies the applicant for disability benefits.
The conditions on the Compassionate Allowances list that only require proof of diagnosis include:
Social Security will expedite an application that claims one of these conditions so that a decision is possible within a month—the closest to automatic as Social Security gets. (For more information on the conditions included on the list, see our article on Social Security's Compassionate Allowances.)
Listing of Impairments. There are also a few medical conditions listed in the Social Security Administration's Listing of Impairments Manual that can qualify as disabilities just with proof of their occurrence or existence. These include a recent:
But for these "automatic disabilities," the SSA will reassess the patient's condition at the end of one year (three years for a lung transplant) to see if the patient still has disabling impairments.
Most of the listed impairments in the Listing of Impairments, however, lay out certain criteria the applicant needs to meet before the condition will qualify as a disability. For instance, for chronic kidney disease to qualify as a disability, the patient needs to be undergoing chronic hemodialysis or peritoneal dialysis, and for central blindness to qualify as a disability, the applicant needs to have 20/200 vision or worse in the better eye—with contacts or glasses on.
In addition, all mental disabilities in the Listing of Impairments require the applicant to have certain severe symptoms and limitations to qualify as disabilities. (You can read more about the Listing of Impairments in our article on the "listed" disabilities).
Medical Records. If the assigned claims examiner at Disability Determination Services does not receive all of the necessary medical records showing evidence of the diagnosis and any required supporting information (or if the doctor left out important information), the applicant may be denied benefits even though his or her condition is medically eligible for Social Security benefits. (In this case, Social Security's denial letter will include a rationale for why benefits were denied, and the applicant can appeal and submit the missing information.)
Before deciding whether you are medically disabled, the Social Security field office checks to see if you fulfills the non-medical requirements for the SSDI or SSI program. These include a required number of years of work (for SSDI) and low enough income and assets (for SSI), as well as citizenship or legal residency requirements. In addition, you can't be currently doing what Social Security considers a substantial amount of work (the field office will check to see if you are working above the SGA level).
After the claims examiner at DDS finds that there is sufficient medical evidence in your record to qualify for benefits, 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 Social Security 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.