How Does the Medical Disability Qualification Process Work?

How Does the Medical Disability Qualification Process Work?

If you have a disability that prevents you from working, you may be relying on Social Security disability benefits to help you cover your costs of living and other expenses. This program provides monthly payments to people who have a disability that meets the criteria of the Social Security Administration, and who have worked into the Social Security system (or are low-income, in the case of Supplemental Security Income, or SSI).

However, before you apply to either program, it’s important to understand the definition of “medically disabled” — as well as the process of qualification — to better predict whether or not you will be considered eligible for Social Security disability benefits.

What factors does the SSA consider?

When deciding whether or not someone is considered “medically disabled,” the SSA has a concrete list of criteria that classify disabilities into different categories — for example, heart disease, paralysis or mental illness. Under each one, there is a specific list of symptoms, and you need to meet enough of them for the SSA to consider you to be medically disabled. If your condition does not fall into the categories listed by the SSA, you may not be eligible for benefits.

The condition also has to be severe enough that you are no longer able to work — or, in the SSA’s words, it must “interfere with basic work related activities.” The SSA also checks whether you are still able to do other types of work (even if you can’t do the job you were doing before), as this may affect whether you will receive disability payments or not.

How is disability determined?

When you send in an application for disability benefits, it will be evaluated by a Social Security Administration field office or your state’s disability agency (known as Disability Determination Services, or DDS). The application, which can be obtained online, over the phone or in person, will ask for a description of your disability, any treatments you’ve received and any other information you can provide.

That application will be sent to the SSA field office to be evaluated for non-medical eligibility — for example, representatives there will verify your age, employment status, marital status or coverage information. Then, it is sent to the DDS to determine your medical disability. The DDS will make its evaluation by getting evidence from the sources you provide, such as doctors, hospitals, treatment centers and other places that you say you’ve stayed at or been treated by.

If that’s not enough evidence to determine whether or not you have a medical disability, the DDS gets additional information through a consultative examination (which is conducted by an independent source). After reviewing that evidence, the disability claims examiner will make a decision on your case. The claim is then sent back to the field office, where the SSA will either calculate the amount you will be paid (if the claim is approved) or keep your case on file in case you decide to appeal (if the claim is denied).

Should I apply?

If you have checked the SSA’s disability impairment listings and feel that you meet the criteria listed there — including severity of the condition and inability to work — then you can apply for Social Security disability benefits to go through the process listed above. If you are unsure, you should talk to an attorney to evaluate your chances of getting benefits and decide whether you should apply or not.