Conditions That May Qualify for Federal Government Disability Benefits

What Is Considered a Disability?

When dealing with a disability, it can be hard to know when to ask for assistance and who you would even go to. Luckily, qualifying for federal disability in California is more straightforward than you think. Two such resources in terms of federal programs are the Social Security Disability Insurance (SSDI) and the Supplemental Security Income (SSI).   There can be some offsets between both state rate workers' compensation temporary disability benefits and private disability policy payments, so you will want to be sure to understand these potential offsets.  If you are seeking these benefits due to a work injury, you will want to consult your workers' compensation attorney about seeking one or both of these benefits.

What is SSDI?

Social Security Disability Insurance, or SSDI is a program in California for those who are employed and pay payroll taxes. If you want to qualify for this program you have to have a disability that is debilitating enough to where you can't engage in substantial gainful activity (SGA). You also have to have earned enough work credits from your previous employment before you became disabled.

What is SSI?

Similar to SSDI, Supplemental Security Income or SSI is a financial need-based program for those in California seeking federal disability benefits. Unlike SSDI, however, SSI is much more accessible, if you meet the financial requirement to qualify, as it is available regardless of your work credits. If you're in the SSI program in California you are automatically eligible for Medi-Cal (California's Medicaid program).

Why Do Disability Benefits Matter? 

With rising costs in California, it can be hard enough to afford the cost of living if you are employed, let alone if you cannot work due to a health condition. If you haven't been through this process before, you could come out on the other side with less than you deserve. It is always best to consult a California Workers' Compensation Lawyer before making big decisions in your disability case. 

Can I Automatically Qualify?

One of the questions you may ask your lawyer is "Do any conditions automatically qualify for disability?" Unfortunately, the answer is no, there are no specific medical conditions that guarantee automatic approval for SSDI or SSI. Even with extreme cases or conditions, it's still a requirement that you meet California's specific income limits if you want to qualify for SSI. It's also crucial to provide medical documentation that proves you cannot work. 
Ultimately, having the right and accurate evidence is key. You must have comprehensive medical records, test results, and doctors' reports in order to verify your claims. There are situations and techniques to make the process easier if you meet all the criteria. 

What You Need to Qualify for SSDI or SSI in California

Although there's no instantaneous way to qualify for an SSDI or an SSI program, there are some requirements you can meet that will make it more likely for you to qualify. The most important for both programs is that you meet the Social Security Administration, or SSA, definition of disability. Disability is an inability to work for at least 12 months due to medical conditions.

Each program also has its own criteria that must be met to qualify. For the SSDI you must have enough work credits to qualify. This will be based on your work history. For SSI qualification, you must meet California's specific income and asset limits, which are slightly higher than other states due to the high cost of living.

The Five Questions SSA Will Use to Decide If You Qualify

• Are you currently working?
• Are you earning over the Substantial Gainful Activity?
• Is your condition severe? Severe is classified as lasting a year or resulting in death.
• Does your condition match one of the stated conditions listed in the SSA's "Blue Book of Impairments"? For more details on the "Blue Book", see below.
• Can you do your previous job or any other type of work based on your condition, age, education, and work experiences?

What Is the SSA's Blue Book of Impairments?

One of the 5 questions SSA will use to decide if you qualify for disability benefits is if you have a medical condition listed in the "Blue Book of Impairments." This raises the question, what is the Blue Book? Luckily, the answer is straightforward. The Blue Book of Impairments is the SSA's list of all the medical conditions that can qualify you for disability benefits. The list is purposely vague, allowing as many people as possible to classify for disability benefits if they are eligible.

List of Disability Conditions in the Blue Book

The Blue Book of Impairments lists 14 general categories of conditions. Those categories are listed below, along with examples of each. Though nothing automatically qualifies you for disability benefits, if your workplace injury or condition falls under one of these categories, it can considerably help your chances and can make your case easier to process, including possibly skipping certain steps in the evaluation process.

1. Musculoskeletal System
This includes major joint dysfunction, spinal disorders, and amputations.

2. Senses and Speech
This includes vision impairments, hearing loss, and speech impairments.

3. Respiratory Disorders
This includes Chronic Obstructive Pulmonary Disease (COPD) and severe asthma.

4. Cardiovascular System
This includes congestive heart failure, coronary artery disease, and peripheral artery disease.

5. Digestive System
This includes chronic liver disease and gastrointestinal hemorrhage.

6. Genitourinary Disorders
This includes chronic kidney disease, nephrotic syndrome, and end-stage renal disease. End-stage renal disease requires dialysis.

7. Hematological Disorders
This includes chronic anemia and leukemia.

8. Skin Disorders
This includes severe dermatitis, chronic infections of the skin, and extensive/severe burns.

9. Endocrine Disorders
This includes diabetes mellitus with complications and hypothyroidism.

10. Congenital Disorders that Affect Multiple Body Systems
This includes Fragile X syndrome and Congenital Heart Defects.

11. Neurological Disorders
This includes Multiple Sclerosis and Parkinson's disease.

12. Mental Disorders
This includes major depressive disorder and post-traumatic stress disorder.

13. Cancer (Malignant Neoplastic Diseases)
This includes breast cancer, lung cancer, and leukemia.

14. Immune System Disorders
This includes lupus, HIV/AIDS, and rheumatoid arthritis.

Fast Tracking the Approval Process in California

As previously stated, there is no automatic way to qualify for disability benefits. That being said, there are severe conditions that can fast-track the process if the situation calls for it. These include presumptive disabilities, compassionate allowances, and terminal illnesses.

Presumptive Disability

If your condition is inarguably debilitating, such as late-stage cancer, you could qualify for up to six weeks of temporary benefits, even if your SSA application is still processing.

Compassionate Allowances

The SSA also expedites reviews for certain qualifying conditions through their compassionate allowance program. These conditions are typically so serious that they tend to more likely than not always qualify for SSDI or SSI benefits. There is a full list that includes over 250 conditions, and the SSA regularly updates said list. For the most accurate information, it is always best to consult a trained California Workers Comp Lawyer.

Terminal Illnesses

In California, terminal illness cases get priority to ensure you receive benefits as quickly as possible. You can expect your application to be expedited by the SSA.

Why Does It Feel So Hard to Get Approved?

When you are suffering from a disability and trying to get disability benefits, it can feel like an impossible journey. You may wonder why it's so difficult to get approved for disability, but the answer is you're not the only one. Even with severe conditions, applicants in California tend to find themselves waiting extensively for their benefits to be approved. This is due to the state's high number of disability applications and some less than straightforward document requirements, going through this process alone is not advised. It's best to reach out to a trained Workers' Compensation attorney. 

Strengthening Your Application

When it comes to applying for disability benefits in California, the best advice is to document everything and be overly prepared. Be sure to collect and submit comprehensive medical evidence from all doctor's appointments, in order to strengthen your case. Make sure your records are up to date and cover all treatments, diagnoses, and medications related to your condition. Finally, it's extremely important to pay attention to specific rules for California on SSI limits.

The Bottom Line

As we've seen, there are ultimately no conditions that can guarantee automatic approval of disability from the SSDI or the SSI. However, in California, certain severe conditions may fast-track your application.

The key to gaining disability benefits from SSDI or SSI is thorough and careful documentation of your disability, getting a firm understanding of the eligibility requirements, and finding an attorney who can help you get the best benefits.

Our team of attorneys at Gordon, Edelstein, Krepack, Grant, Felton & Goldstein (GEKLAW) helps workers in California understand their position regarding disability benefits and can guide you through the legal process to ensure you are informed of your rights.