What Conditions Automatically Qualify You for Disability? – NerdWallet
What Conditions Automatically Qualify You for Disability? – NerdWallet

There are no conditions that automatically qualify you for Social Security Disability Insurance (SSDI) benefits. However, the Social Security Administration (SSA) does have a list of conditions that qualify for expedited review and that are much more likely to be approved for benefits.

You still have to apply and go through the process if you have one of the conditions that warrant a faster review, but you may be able to get benefits sooner than people with other disabilities.

Disability approval process

The SSA evaluates claims through a series of steps. Each time an application completes one step, it moves on to the next one until it is either denied because it doesn’t meet all of the criteria or is approved for benefits.

This process is known for being slow. After submitting the application, medical records and evidence of disability, applicants can do little more than wait for someone to review their cases. Applicants who appealed an initial denial waited an average of 27 months from start to finish to get a final decision, according to a 2017 study

But not everyone has that much time. The SSA knows that and makes an exception for individuals who have certain conditions that are very likely to qualify for SSDI benefits. It fast-tracks applications so these people can get benefits sooner.

In some cases, a condition or disease meets all of the criteria with a simple diagnosis. When this happens, the SSA approves the disability claim with less documentation and without evaluating other factors such as the applicant’s age, work experience or functional abilities

Presumptive disability or presumptive blindness

Some conditions have such a high probability of qualifying for SSDI benefits that individuals who are diagnosed with them may receive benefits up to six months before the SSA officially approves their application. These cases of “presumptive disability” or “presumptive blindness” can occur when medical evidence or nonmedical evidence isn’t strong enough to make an SSDI determination immediately

Examples of conditions that are very likely to receive the presumptive disability status include:

Examples of information necessary to evaluate presumptive disability or presumptive blindness qualification include:

  • Medical records regarding the condition or disease.

  • Reports intended for presumptive disability or presumptive blindness purposes.

  • Indications by an interviewer in a field office, such as an observation that an applicant has had a limb amputated.

Did you know…

If the Social Security Administration has already denied your SSDI claim, you can still ask to be considered for presumptive disability or presumptive blindness. You’ll need to submit a new application and either provide evidence that the condition has worsened since your initial application or offer documentation of a new impairment that wasn’t in your initial application.

When someone has a life-threatening diagnosis that undeniably meets the SSA’s definition of a disability, the SSA can grant a compassionate allowance. This speeds up the processing time so the SSA can make a decision more quickly and begin providing financial assistance as soon as possible.

The SSA has a list of more than 250 pre-determined diagnoses that qualify for compassionate allowance. People with these conditions still need to fill out an SSDI application and provide documentation to show their diagnoses — but it is likely that the medical records confirming your diagnosis will be enough to qualify

🤓Nerdy Tip

If you think a condition should qualify you for compassionate allowance, but that condition isn’t on the SSA’s list, you can submit information about your diagnosis so the SSA can consider covering it under compassionate allowance.

People with terminal illnesses qualify for an expedited review of their SSDI claims

The SSA does not have an exhaustive list of qualifying terminal illnesses like it does for compassionate allowances. If a doctor has given you a terminal prognosis, it’s a good idea to ask for terminal illness consideration, regardless of the diagnosis.

Someone is likely to qualify for an expedited review if they are:

If you qualify for an expedited review because of a terminal illness, you’re unlikely to see the phrase “terminal illness” on your SSDI paperwork. The SSA flags terminal illness cases internally, so it doesn’t mean your claim doesn’t qualify as one if you don’t see the term listed in your file.

4 tips for qualifying for disability

  1. Know the SSA’s definition of a disability. To qualify for SSDI, you must show that one of the following is true for your impairment: It has lasted or will last for 12 months without interruption, or you are expected to die because of the condition

    SSA.gov. Red Book. Accessed Sep 8, 2023.

    . If neither of these is true, you will have a much more difficult time proving you are disabled per the SSA’s criteria.

  2. Understand the income limitations. SSDI applicants who earn more than $2,460 per month (if blind) and $1,470 per month (if not blind) may not qualify for benefits

  3. Research what criteria the SSA uses to evaluate certain conditions, diseases and disorders. The SSA provides a list of impairments for which it has established criteria to determine if someone with a specific diagnosis qualifies as disabled. The impairments are categorized by body area and then by specific diagnosis within each area

  4. Be prepared to submit as much documentation as you can. You must prove that you meet the criteria for being disabled according to the SSDI program

What to do if your disability claim is denied

If your SSDI claim is denied, you will receive a notice from the SSA that explains why it was denied. If you disagree with the denial, you can appeal the decision to request another look at your case. You only have 60 days to request an appeal in writing

Frequently asked questions

Whitney Vandiver

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