If you’re disabled and unable to work for one year or more, you may qualify for Social Security disability benefits. However, approval is based on certain Social Security guidelines and the type of disability that you have, so it’s important to understand how to get approved for disability before you submit a claim for benefits.
What Conditions Are Considered a Disability?
According to the Social Security Administration (SSA) guidelines, the definition of disability only allows disability payments to individuals with total disability. Guidelines restrict all disability benefits for partial disability and short-term disability. SSA considers a person eligible for Social Security disability benefits if the following conditions are met:
- The person can not perform work or engage in a substantial gainful activity (SGA) because of his or her medical condition
- The person can no longer perform his or her previous job or adjust to other types of work due to his or her medical condition
- The person’s medical condition has lasted or is expected to last for at least one year, or is expected to result in the person’s death
In addition to the above guidelines, the person must also have a medical condition that meets Social Security’s strict definition of disability. The SSA maintains a list of medical conditions for each major body system, and the person’s medical condition must be considered severe enough to prevent him or her from engaging in substantial gainful activity (SGA). The SSA list of medical conditions (also known as blue book listings) is quite extensive and is broken down into Part A and Part B.
Part A Listings
Impairments listed in Part A apply to adults who are 18 years old or older. These impairments may also be applied to children under the age of 18, if the medical impairment has a similar impact on both adults and children. Medical impairments shown under Part A listings include:
- Cancer (malignant neoplastic diseases)
- Cardiovascular system disorders
- Digestive system disorders
- Immune system disorders
- Neurological disorders
- Respiratory disorders
Part B Listings
Impairments listed in Part B apply only to persons who are 18 years old or younger. Generally, most medical conditions shown in Part B are only found in children. If the medical criteria in Part B do not apply, the medical criteria in Part A will be used. Medical impairments shown under Part B listings include many of the same impairments shown in Part A, as well as others that include:
- Congenital disorders that impact multiple body systems
- Endocrine disorders
- Genitourinary disorders
- Hematological disorders
- Low birth weight and failure to thrive
- Musculoskeletal disorders
If you are disabled and plan to apply for Social Security benefits, you must understand that the SSA list of medical conditions has a major impact on how to get approved for disability benefits. Since SSA guidelines and requirements for eligibility are strict, it is wise to talk to an experienced Social Security disability lawyer who understands what you need to apply, which type of benefits you need, and who can help you file your claim for benefits according to SSA guidelines.
How to Apply for Disability
In Illinois, the Bureau of Disability Determination Services (DDS) is the state department that makes the initial determinations about your eligibility for Social Security disability benefits. When you submit your application, DDS reviews your application and gathers your medical information to validate your claim. Following the review of your claim and medical information, DDS may schedule a consultative examination (CE) for you to reaffirm your medical condition. A CE is a medical examination that is administered by a licensed physician who’s hired by the Social Security Administration, rather than your personal physician.
Once you have submitted your disability application, it will be reviewed by DDS and you will receive a letter by mail with their decision that your application was approved or denied. Generally, it takes 3 to 6 months to receive an initial decision.
In Illinois, if you’re disabled, you are entitled to apply for disability, but you should know how to get approved for disability benefits before you apply. You can file a claim for Social Security disability benefits through two federal agencies: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). The main difference between SSDI and SSI programs is who is eligible to receive benefits based on program requirements.
Applying for SSDI Benefits
SSDI benefits are based on both medical requirements and nonmedical requirements. Benefits are available to workers and their families when the worker has a work history that was long enough to pay Social Security taxes and accumulate a required number of work credits. If SSDI benefits are approved, they are payable to (1) disabled or blind workers under 65 years old, (2) a claimant’s spouse or widower, (3) a claimant’s children, and (4) adults disabled since childhood. The amount of monthly disability benefits is based on the Social Security earnings record of the insured worker. After receiving SSDI benefits for two years, the worker will automatically receive Medicare coverage.
Applying for SSI Benefits
SSI disability benefits are available based on a person’s financial needs instead of his or her prior work history, taxes paid, and accumulated work credits. SSI benefits are available to low-income individuals who either have a prior work history or who have no work history at all. SSI is financed through general tax revenues and does not relate to work history or work credits. In some cases, individuals who don’t have sufficient work credits for SSDI benefits may qualify for SSI benefits, if they have limited income and resources.
Both SSDI and SSI claims can be complicated due to the specific information requested by SSA. Although you can apply for both types of claims online, by mail, or in person at a local Social Security office, you have better odds for claim approval if you work with a Chicago disability lawyer who can guide you through the filing process and help you with required personal information, medical documents, filing timelines, and SSA followup. Unfortunately, both SSDI and SSI claims are often denied because of inaccurate or missing information, so you need a lawyer who knows how to get approved for disability and how to file an appeal in case your claim is denied.
What to Do If You Are Denied Disability
If your disability claim is denied, you have three options: 1- request a reconsideration, 2- request an administrative hearing, or 3- request an Appeals Council review. A disability lawyer can be quite successful with these types of appeals.
A Request for Reconsideration
If the SSA denies your disability claim or reduces the amount of your disability benefits, you will receive an official notice. You will then have 65 days from the date on the notice to make a written “Request for Reconsideration.” During this reconsideration period, you will be asked to submit to further medical evaluation, likely by an SSA-appointed doctor. Your reconsideration will rely on that information.
A Request for an Administrative Hearing
If your claim is denied after your request for reconsideration, you will receive a second notice from the SSA. You will then have 65 days from the date on the notice to make a written request for a hearing before an administrative law judge (ALJ). An ALJ is hired directly by the SSA to conduct legal hearings. During this hearing, the ALJ may arrange for medical experts and/or vocational experts to attend the hearing and testify on pertinent matters like your medical disability and how it impacts your ability to work or perform certain work duties.
A Request for Review by the Appeals Council
If your administrative hearing with an ALJ is not favorable, you or your lawyer can request a review by the Appeals Council. You will have 65 days from the date of the ALJ notice to make a written request for review by the Appeals Council. At this stage, your options for how to get approved for disability are rather limited. The Appeals Council can rule in one of three ways: 1- confirm the ALJ’s decision, 2- send the case back to the ALJ with instructions on how to handle the case, or 3- approve your disability claim.
Unfortunately, about 70% of Social Security disability applications are denied initially, but later approved through the appeals process. The majority of applications are denied due to insufficient medical evidence or medical records, lack of required work credits (for SSDI claims), failure to follow a doctor’s treatment plan, failure to meet income requirements, and failure to respond to SSA requests for additional information.
If your application for disability is denied, filing appeals will require extra time, but your odds of approval improve significantly, as much as 40 to 50%. Remember, if your application for SSDI benefits is denied, you can apply for SSI benefits that do not require a work history, payment of Social Security taxes, and work credits.
