How Does an Individual Qualify for SSDI or SSI Disability Benefits?

Interviewer: What are common disabilities does a person need to be diagnosed with in order to qualify for SSDI?  Are there certain conditions that automatically mean you are qualified for benefits?

Meeting the Social Security Listing and Establishing a Medical Record

Jeanne: I wouldn’t say that there’s any conditions that mean you automatically qualify.  Let’s start with some basics.  First off, the disability payments, the one where you have a disability and you’re going to be getting payments that you paid in, you have to meet what’s called a social security listing, and it’s all based on medical.

Eligibility for Benefits Is Based on Medical Evidence

We have clients who have a lot of conditions that are debilitating, but unless they’ve created a medical record, they can come to us, file all they want for hearings but they’re not going to get approved.  It has to be based on medical evidence.

Issue number one is, people do need to go to the doctor, and they do need to tell the doctor what’s wrong with them and have the doctor run whatever tests and exam them and write it down in a record.  Some of the conditions that we see a lot of are people with musculoskeletal type infirmities.

There Are Very Specific Guidelines that Need to Be Followed When Applying for Benefits

These clients have arthritis or we’ve had people with amputations or people who have lost the use of the function of an arm or a leg because of some traumatic injury.  You can get social security disability for mental disorders, including depression and anxiety.  But there are very specific guidelines on what has to be shown in the medical records.  Someone can’t just go to the doctor and go, “Oh, I’m depressed” and, okay, here’s your check.

Attorney Morales’ Office Works with Clients to Match the Guidelines to the Information Documented in Their Medical Records

One of the things we do as we’re getting ready to go to a hearing is we call up the listings in social security and sit there and try to match up what the requirements are with what’s in the medical records.

Elvira: Social Security looks at the person’s age when deciding about eligibility for benefits.  That makes a big difference. They look at their education to see if this person is educated or has limited education or no education at all.  They look at their past relevant work to see if that person can return to their past relevant work or this person at this age, with this education, can they be trained to do other kinds of work.

Jeanne: And they look to see if the individual has transferrable job skills.

Social Security Looks at Five Criteria When Determining an Individual’s Eligibility for Benefits

Elvira: There are five steps that they look at. First they want to know what your disability and do you actually have a disability.  They have to look at the medical records to see if this person has a condition that’s going to keep them from working for 12 months.

Then they will go onto the second step, which is how old they are, the scope of their education and can they return to their work.  Then they figure it out from that, from their age, their education, their work, and their medical records, if that person is disabled.

Children Meet Different Criteria for Social Security Benefits

Then the children’s cases are different.  Of course, again, they look at the medical records.  You have to have documented medical evidence.  A lot of times, with an adult, if you don’t have medical records, the social security office, the examiners, will go ahead and send you to one of their doctor’s office.

They schedule them for the doctor’s visits because they feel they don’t have enough medical evidence to decide whether this person is disabled or not, so they, at their expense, will send this individual to a doctor’s appointment to get evaluated.

On a child, it’s different.  They look at how they’re functioning in school.  They look to see if this individual is functioning at an age level that he should be functioning, as other children their age is.  They also will get the school reports from the school and see how their grades are or if they’ve been missing school.  That’s on a child’s basis.

Common Conditions among Children Applying for Benefits Include Asthma and ADHD

Some of the conditions we see with children are asthma and ADHD and depression.