Disability benefits are a program through the Social Security Administration that provides financial assistance to those who have become disabled and are unable to work. Disability benefits can cover the costs of medical bills and everyday living expenses.
Disability benefits are for people of all ages. They are available for people who have recently become unable to work, such as a cancer patient. They are also available for people who have never been able to work, such as someone with Down syndrome or cerebral palsy.
To receive benefits, you must first qualify both medically and financially. To medically qualify for disability benefits, your medical condition must prevent you from being able to reasonably perform any type of work. Financially, there are certain income limits that prevent you from being eligible for disability benefits, based on the type of benefits for which you apply.
SSDI and SSI Benefits
There are two main types of disability benefits: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). SSDI benefits are based on your work history and are paid into through social security taxes taken out of your paychecks. To qualify for SSDI benefits, you must:
- Be between the ages of 18 and 66
- Have earned a specific amount of work credits. These credits depend on your work history.
SSI, on the other hand, is based on financial need and has nothing to do with your work history, if any. If you have never held a substantial job, you will most likely apply for SSI benefits. To qualify for SSI benefits, you must:
- Earn a limited amount of income
- Own assets of less than $2,000 if single
- Own assets of less than $3,000 if married
Medical Qualifications
Whether you are eligible for SSDI or SSI benefits, to be approved by the SSA, you must meet certain medical disability requirements. The easiest way to medically qualify for disability benefits is if you are able to meet a listing in the SSA’s Blue Book.
The Blue Book is a comprehensive list of disabilities that the SSA uses to determine your disability benefit eligibility. It is divided into adult and childhood disabilities. If your listing is included in the Blue Book, the SSA will determine if your unique case matches the criteria for that listing based on your medical evidence.
For example, brain cancer is listed in the Blue Book, but to medically qualify for disability benefits with brain cancer, you must have a highly malignant tumor on your brain or spinal cord, or your brain cancer must return or worsen after treatment. If your brain cancer does not meet one of these requirements, you are not eligible for benefits under that condition.
If your disability does not match a condition in the Blue Book exactly, another option is to “equal” a disability listing. Equaling a listing means that the impairments and symptoms caused by your medical condition are equal to another listing in the Blue Book.
For example, you may suffer from seizures that are not related to epilepsy, but they may impair you from holding any type of work comfortably. Therefore, you may argue that the impairments and symptoms caused by your seizure disorder equals the Blue Book listing for epilepsy.
The SSA may request that you see a different doctor independent from your own for a consultative medical exam. This doctor will review your medical records and determine the extent of your disability and how it affects whether or not you are able to work. It is important that you follow through with the SSA’s request for a consultative medical exam. Your own treating physician’s determinations and statements will still be reviewed and held in as high of a regard as those of the independent doctor.
For certain medical conditions that are particularly severe, such as most forms of severe cancer, the SSA allows for quicker approval times than usual through the Compassionate Allowance program. This way, a process that usually takes three to sixth months can be approved in as little as 20 days so that you are able to start receiving the benefits you need.
Residual Functional Capacity
If you cannot match or equal a Blue Book disability listing, you do not medically qualify for disability benefits, but there are still options available to you. You can provide non-medical evidence to prove your eligibility for disability benefits with a medical-vocational allowance. Under a medical-vocational allowance, the SSA determines that you are unable to return to work or work a less demanding job based on a variety of factors.
One of these factors is your Residual Functional Capacity (RFC), or your ability to work with your current disability. The SSA will take a look at your RFC assessment, which is a combination of factors, including your medical records and especially the opinion of the physician or specialist treating your specific disability.
Your treating doctor can prepare a written statement to include with your RFC or even prepare your RFC on your behalf. Details in your RFC should contain information on how your disability affects your ability to:
- Perform physical tasks, such as standing and walking for long periods of time, sitting, lifting weighted objects
- Concentrate, focus, easily wake up and stay awake
- Exhibit social skills and interpersonal abilities
The SSA will also consider your age, education level, and work history. For example, if you are older, have not had a lot of education, and have only held one specific type of job for most of your life, the SSA may be more likely to approve your disability benefits. This is because you wouldn’t reasonably be expected to learn a new skill and try new types of work at your age and experience level.
Tips on Applying for Benefits
If you have decided to apply for disability benefits through the SSA, your first step is to complete and submit the initial application. This includes the application itself, as well as compiling and sending in all relevant medical evidence and documentation. The application can be completed online, over the phone, or at your local Social Security Administration office, of which there is at least one in each state.
You should first talk to your primary care doctor about your decision to apply for benefits, as you will need them to furnish your medical records and potentially write a statement on the extent of your disability and how it affects your ability to perform work. The medical evidence you will need to gather includes, but is not limited to:
- Lab tests and blood work
- Treatment history for your condition
- A list of medications you are taking for your condition
- Records of surgeries and procedures
On your application, remember to provide as many details as possible, as this will help the SSA in making an informed decision about your disability and won’t prolong the process of having them ask you for any missing information. Answer each question thoroughly, honestly, and to the best of your ability. Don’t fill in your application with just “yes or no” answers, or leave any questions blank, as this will result in your application most likely being denied.
Lastly, consider hiring a disability lawyer or advocate to help you with your disability benefits application. A lawyer can help you fill out your application, gather your medical evidence and documentation that will help your case, and answer any questions you may have throughout the process. A lawyer will also ensure that the entire initial application stage goes smoothly and be there to help you in case your application is denied and you would like to appeal the SSA’s decision.
