In the world of private long-term disability (LTD) insurance, a pre-existing condition will almost always result in a denial of benefits if your current medical impairment relates in any way to the original condition. The most common pre-existing conditions in the U.S. include high blood pressure, high cholesterol, mental health disorders (such as depression and anxiety), asthma, chronic lung disease, diabetes, and cancer. Many disabled Americans who have such impairments do not apply for Social Security disability benefits, because they believe their pre-existing conditions will disqualify them.
But this is not the case. Social Security uses a different set of qualifications than private LTD insurers. The Social Security Administration (SSA) will not automatically disqualify you if you had a previous medical condition. For claims for benefits from Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), SSA is not really concerned about the origin of your medical condition. The agency is focused on whether your condition prevents you from working and earning a certain level of income.
Specifically, the Social Security Administration defines “disability” as the inability to do any substantial gainful activity (SGA). The reason must be medically determinable physical or mental impairments which have lasted or can be expected to last at least 12 months or can be expected to lead to death. What this means is that to prove you have a disability under Social Security’s rules, you at a minimum must prove you are incapable due to your health problems of earning more than $1,690 in gross monthly earnings if you are not blind and $2,830 per month if you are blind. (These are the SGA levels for 2026. They are adjusted annually to reflect changes in the cost of living.) This standard is different, higher, and much more specific than an inability to work full-time, an inability to perform work in your field, or an inability to earn enough to support a certain standard of living.
(We are often asked how Social Security could deny a case if a person’s own doctor states that they are “unable to work” or “disabled.” The reason is that the SSA has no idea what the doctor means when they say this. The word “disabled” can mean different things to different people and even to different parts of the government.)
If your condition was present before but has significantly worsened or has led to another disabling impairment, you may be eligible for benefits. You will have to prove that your medical condition (or combination of conditions) prevents you from earning more than the SGA amount. The SSA relies on accurate and complete medical evidence from doctors, clinics, and hospitals to determine how severe a physical or mental condition is. Medical evidence takes many forms, including bloodwork panels; imaging studies like MRIs, CAT scans, and X-rays; physician examination and treatment notes; and mental health records. The importance of medical records in Social Security Disability cases cannot be overstated. You will need up-to-date medical records to show the current state of your condition, and how the condition has progressed.
To prove that your disorder prevents you from maintaining employment, you must start with a diagnosis through a doctor’s exam. But a diagnosis alone is usually not enough to qualify you for benefits. Your doctor should also explain how the symptoms of your medical conditions limit your ability to work. This is usually done using a form called the “Residual Functional Capacity” (RFC) form. The RFC form is separate from your medical records and helps your doctor explain your limitations. Simply stated, an RFC is an evaluation of what you can still do despite your impairment(s).
Additionally, Social Security has non-medical requirements. You can learn more about them by reading our blog post “Non-Medical Requirements You Must Meet to Qualify for Social Security Disability.”
The road to winning Social Security disability benefits is complicated and difficult to navigate, but your chances of winning the benefits you have earned are better if you have a qualified and experienced advocate by your side. According to a Government Accounting Office study you are 3 times more likely to be awarded disability benefits if you have a representative such as a disability attorney who will fight for your rights than if you have no representation at all. Contact us at Cuddigan Law for a free evaluation of your disability claim.
