How to Qualify for Social Security Benefits?

Understanding the Social Security Administration’s disability claims processes can be just as challenging as qualifying for the actual social security benefits. Fortunately, there is an online medical condition reference manual, commonly referred to as the Blue Book, which explains the policies and mental and physical impairments that may qualify an individual for Supplemental Security Income (SSI) or Social Security disability benefits (SSDI).

The Blue Book

The SSA’s Disability Evaluation Under Social Security web page includes general information, evidentiary requirements, impairment overviews, how-to videos and adult and childhood listings. The online version is continually updated and hard copy versions were last printed in 2008. The Blue Book contains important details about the SSI and SSDI programs. It is designed to help applicants better understand the medical conditions, policy restrictions, documentation requirements and process guidelines for supporting and proving disability claims. It succinctly explains the official processes for making, appealing and communicating disability determination decisions. The entire process involves complex requirements and technical medical jargon that is best understood by health care providers and Social Security disability professionals.

The Condition Categories

The impairment categories include musculoskeletal conditions, such as back pain, and neurological disorders, such as cerebral palsy and multiple sclerosis. Respiratory diseases include asthma, immune system disorders include rheumatoid arthritis and cardiovascular conditions include coronary artery disease.  Even skin disorders, such as dermatitis, and digestive problems, such as inflammatory bowel disease (IBD) may qualify for benefits. Mental health problems, such as anxiety, autism and depression, are covered. Speech and visual disorders include statutory blindness and permanent hearing loss. Endocrine conditions include hormonal imbalances, congenital diseases include anemia and malignant conditions include cancer. Other medical condition categories include hematological, genitourinary and immune system disorders.

The Disability Claims Process

Having an approved condition that meets specific criteria does not guarantee automatic benefit approval. Instead, it establishes the existence of a disabling condition that may qualify for certain benefits. The SSA uses the individuals’ medical documentation to determine the severity, urgency and legitimacy of the application.  Understanding the medical listing and the associated expectations for benefits approval is the key for approval, so many social security benefit applicants rely on the assistance of legal professionals to handle their claim. Otherwise, the SSA claims processor may require additional medical documentation from health care providers who often have more urgent priorities to deal with than filling out SSA paperwork.

What are the Evidentiary Requirements?

The SSA requires objective medical evidence from acceptable medical sources to make their decisions. Medical evidence and documentation are primarily used for determining disabilities. Applicants must submit medical evidence that clearly proves that they have a severe impairment. The SSA is sometimes willing to work with claimant’s to gather medical evidence and request copies of medical documentation from clinics and hospitals. The severity and impairment of the condition may be established through non-medical sources such as caregivers, employers, educational staff and social welfare personnel. The best way to accelerate the claims process is to provide timely, accurate and complete information.

Qualifying Medical Conditions

A Social Security disability benefits applicant doesn’t have to meet the exact listing details and requirements for a particular illness or condition. This means that some applicants are awarded disability benefits if the SSA decides that certain aspects of the individual’s condition is medically equivalent to the listing criteria. The SSA refers to this concept as equaling a disability listing. If the medical condition limits an individuals’ functioning and performance so they cannot work, they may qualify for disability benefits. However, this may require the involvement and communication with the employer’s HR office and the state’s workers’ compensation board.

The SSA’s disability claims policies and processes may be confusing and frustrating at times, so working with a disability attorney will speed things up and improve the odds of success. While it is not guaranteed, legal professionals understand the nuances of the SSA system, so they can work around common roadblocks and unique challenges.

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