Do I Automatically Qualify for Disability Benefits?    

Do I Automatically Qualify for SSI or SSDI Disability Benefits?   

Technically speaking, the answer to this question is no.  All persons currently receiving disability payments were required to submit an application, present detailed medical evidence of their physical or mental health conditions and meet certain non-medical requirements before ever receiving these benefits.  However, the process involved in getting there may have been less difficult for some recipients than it was for others, depending on the conditions the Social Security Administration relied on in approving their application.  

For more about the conditions which make the path to receiving disability benefits quicker and more straightforward, continue reading.

Is Your Condition in SSA’s Blue Book of Listed Conditions?

To be medically eligible for disability benefits, a person’s physical or mental health must be deemed severe and in accordance with the applicable disability standard established by the SSA. According to the SSA, an adult’s health condition is sufficiently severe for disability purposes if it prevents his or her capacity to work for one year or longer or is likely to cause death, while a child’s condition must be one that is terminal or that creates significant obstacles for his or her functional abilities.

Without more, these standards offer minimal guidance as to whether a particular individual’s health impairments are serious enough to entitle them to disability.  Social Security’s Blue Book adds substance to these standards and helps simplify disability determinations by providing an up-to-date list of health conditions which the Administration has determined are severe enough that those suffering from them should “automatically qualify” for disability benefits. 

Unfortunately, this doesn’t actually mean you will begin receiving disability payments the moment you are diagnosed with a listed condition. Individuals with such condition(s) are still required to apply for these benefits, and must include with their application their medical records, test results, and/or other reports or evaluations for SSA to review before determining whether there is enough objective and reliable medical evidence to support the diagnosis and to meet each of the criteria required for that condition, as prescribed by the condition’s Blue Book listing.

The conditions listed in the Blue Book are organized by major body system, with several qualifying diseases, disorders, and impairments listed under each.  Each listing provides an overview of the condition, the diagnosis or symptoms associated with the condition, and the types of evidence needed to qualify for disability benefits based on that condition.  Today, the types of conditions listed in the Blue Book are still primarily physical, but the list continues to grow and evolve alongside emerging research, technology, and other medical advancements.

Even if an individual’s physical or mental health impairment does not appear in the Blue Book, however, he or she may still be found disabled and eligible for benefits.  Applicants who can present reliable medical evidence which establishes their health condition or impairment is as severe or more severe than a listed condition, or which otherwise proves that their condition aligns with the above-referenced disability standard applicable to their claim may still be found disabled by the SSA.


Is My Condition Part of the Compassionate Allowance Program?

Often, the conditions listed in the Blue Book are confused with those which qualify for expedited treatment under Social Security’s Compassionate Allowance Program, or CAP.  Applicants who will receive the advantages of the CAP program are those suffering from a terminal illness or other disease or condition that typically lasts for one year or longer.  Under CAP, applications which reference or contain keywords related to a program-eligible condition are sent through an expedited review process, thereby allowing the applicant to begin receiving their benefits much sooner than they would if their application been subject to the normal review and processing timeline.

Non-Medical Eligibility Requirements

Even if an individual suffers from a condition listed in the Blue Book or under the Compassionate Allowance Program and would be considered disabled and medically eligible, he or she will not receive benefits unless they also have enough work credits to be covered by Social Security Disability Insurance, or SSDI, or fall below certain established income and asset limits applicable to the receipt of Supplemental Security Income (SSI).  

For more information on the non-medical eligibility requirements applicable to these programs, please reference our previous blog posts:

Should I Apply For SSI Or SSDI?

Am I Eligible For Disability Benefits?

What’s Next?

Determining your chances at being approved for disability benefits can be challenging, and requires an in-depth analysis of several medical and non-medical factors in most cases.  If you would like to speak with one of our attorneys about whether your health impairments may entitle you to benefits under SSDI or SSI, please contact our firm at (417) 883-7800 to schedule a consultation.