Social Security Application
17 May 2016

How To Apply For Congenital Defect Disability Benefits

In the absence of government support, many families of children born with congenital defects would be reduced to poverty, buried under mountains of debt and strapped to fund the medical procedures their children need. But these treatments, and other required living expenses, are absolutely necessary, and the government recognizes that fact.

Social Security Disability benefits aren’t just for injured workers. Some children also qualify for benefits, especially those born with severe congenital defects. Our guide will help you understand which birth defects the Social Security Administration considers “disabilities” and how to apply for the valuable benefits your child requires.

Which Kids Will Disability Cover?

There’s no clear-cut answer to that question. The Social Security Administration (SSA) works on a case-by-case basis. Very broadly, the people who review, approve and deny claims for disability benefits, or Supplemental Security Income (SSI), take two things into account when making their decisions:

  • your child’s medical condition
  • your family’s work history, income and assets

In short, your child will qualify for disability benefits if they meet the Social Security Administration’s definition of “disability,” but you have too few income (or other resources) to provide adequate care.

But of course, congenital defects are varied and unique. Not all children, even all children who were born with birth defects, will qualify as “disabled” under the law.

How Does Social Security Define “Disability” For Children?

Where children are concerned, the Social Security Administration uses a definition of “disability” that, by the agency’s own admission, is “strict.”

To qualify for benefits, the child must have a physical or mental condition that very seriously limits his or her activities, and that condition must have lasted, or be expected to last, at least 1 year. Obviously, that definition leaves a lot of room for interpretation, and much of that interpretation will be done by the State employees who review your application.

Social Security Cards

We aren’t completely in the dark, however. In its official listing of eligible impairments, “Disability Evaluation Under Social Security” (but more commonly referred to as the Social Security “Blue Book”), the agency outlines fifteen categories of disability affecting children:

  1. Low birth weight and failure to thrive
  2. Musculoskeletal system disorders
  3. Special senses and speech (which includes visual and hearing impairments; most children who were born with cleft palate will be covered under this section)
  4. Respiratory system disorders
  5. Cardiovascular system disorders (includes most congenital heart defects)
  6. Digestive system disorders
  7. Genitourinary disorders
  8. Hematological disorders (includes most bone marrow disorders and anemias)
  9. Skin disorders
  10. Endocrine, or hormonal, disorders
  11. Congenital disorders that affect multiple body systems (includes non-mosaic Down syndrome, cri du chat syndrome and Tay-Sachs disease)
  12. Neurological disorders
  13. Mental disorders
  14. Cancers
  15. Immune system disorders

It might not feel like we’ve narrowed down the list much, but it should at least be clear that most medically-recognized major birth defects are covered by one, if not more, of those categories.

For more information on the childhood impairments covered by SSA, click here to find a full listing.

How Do We Apply?

To apply, you’ll need to complete two forms:

  • Application for Supplemental Security Income
  • Child Disability Report

Right now, only the Child Disability Report is available to fill out online. It’s best to gather together all of the documentation you already have regarding your child’s condition, from school-administered behavior tests to medical exams given by a physician.

Don’t know what information you’ll need? On this page, you’ll find two checklists that will walk you through all of the documents and details required for the Child Disability Report. Once you have all the relevant info, the Report itself is simple to fill out.

To complete the Application, you’ll need to call the Social Security Administration at 1-800-772-1213. Their operators will connect you with your local field office for help.

Who Decides That My Child Is Eligible For Benefits?

State agencies decide who is, and who isn’t, entitled to disability benefits. It’s not the federal government’s call.

You’ll be submitting your initial documentation directly to a local field office, who will then send your application on to a state-run Disability Determination Services (DDS) office.

After your application has been entered into the system, employees of the state will reach out to your medical professionals and school for more information. Your child’s doctor will be your closest ally in securing benefits. It’s important that you work with them to present your child’s application in the best light.

Sometimes, a state agency will need more information to decide a claim than documents, prior test results and interviews can provide. In that case, they may choose to schedule additional testing or examinations. While these additional tests will be administered by state officials, they will ultimately be paid for by the federal government.

Is This Health Insurance?

No, but after being approved for SSI benefits, most states will make a child automatically eligible for Medicaid. This is particularly helpful, because Social Security isn’t really designed to subsidize healthcare. As its name implies, Supplemental Security Income is income, not insurance.

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